Nuance Communications announced this morning that it will acquire transcription technology vendor eScription of Needham, MA for $363 million. Nuance says it will use eScription’s systems as part of its hosted solutions.
As part of the transcription, private equity firm Warburg Pincus will buy $100 million of Nuance stock and will acquire warrants allowing it to purchase an additional 3.7 million shares within four years at $20 per share.
Many people will remember Rick Skinner from his time as CIO at Providence Health System. One of his Navigant colleagues suggested that I interview him since he’s been in the industry a long time and adding, "I’ve yet to see him get stumped with any healthcare IT question that has come his way." Thanks to Rick for taking the time to chat.
Photo: HIMSS Analytics
Give me some background about yourself and your job with Navigant.
I am a career healthcare IT type. I’ve been in this business for 25 years. I’ve spent most of my career being a CIO at various places. The last one was the Providence Health System out on the West Coast, a large, Catholic-sponsored system from LA up to Alaska. After having been there for quite some time, I decided to see what the other side of the world was like.
I went to work with Steve Heck, a good friend of mine who was, at the time, the president of First Consulting. He convinced me to come work for him and I did that for a couple of years. I ran First’s outsourcing business, which certainly taught me a lot about the bottom line and the balance between scope, costs, and service.
What attracted me to Navigant is that it’s definitely not an IT services firm. It’s an organization that helps healthcare organizations achieve their business goals and value. IT is a tool, or a means, to do that. I was attracted to come to Navigant to be the second employee in a start-up healthcare IT practice, because of just that philosophy.
After my time as a CIO, after my time running an outsourcing business, I wanted to be part of an organization that really was business- and value-oriented, rather than one that was enamored of technology. I think that’s where I am.
Some folks will remember The Hunter Group, which Navigant acquired.
There are very few people left from The Hunter Group, but we do an increasing amount of work in performance improvement. We don’t do it in quite the same way as The Hunter Group used to do it. Our clients aren’t typically in as dire straits as those that engaged The Hunter Group.
I think the parallel is still there, as the healthcare industry, in particular hospitals, are projected to lose ground financially over the next few years. Many of our clients — most, actually — are looking for ways to preserve and/or improve their financial performance. They want to use all the tools available to them from IT to finance, to supply chain, to you name it.
We have, as a client told me last week, a reputation for being direct, to the point, and providing actionable advice. In the last eight months, we’ve been seeing more and more clients interested in that kind of engagement.
What did you like or not like about consultants when you were a CIO making the decision to engage them?
The thing that I disliked the most about engaging consultants or professional services firms — not all went through this, but many did, and most of the larger ones did — is what I call the get-to-know you dance. It seemed to take forever to get from, "I’ve got a problem and I need some help. Can you help me?" to a signed engagement that put the right skills in the right proportions to work in my organization.
I see it today in some firms. It takes forever to do that. It wastes everybody’s time. So what I ended up doing was finding those few folks who I got to know, or who knew me, and we didn’t have to go through that at the front end of every engagement. That’s what I try and do as a consultant — to cut to the chase instead of a 70-page PowerPoint proposal. A simple three- or four-page letter of engagement that says precisely what our understanding is of the client’s needs and what we commit to doing.
How do you fight the battle of needing to generate new business vs. doing what the customer paid you to do and moving on?
Consulting firms are in the business to make money and that requires new engagements. However, you’ve got to specify the business that you’re in. At Navigant, we have very purposefully stayed out of the outsourcing business. And so far, stayed out of the implementation business, because we did not want to be like everybody else, trying to swim upstream from doing a strategic plan, to doing a systems selection, to doing the implementation for the system, and then to try and run the system for the client.
On the other hand, with that kind of business philosophy, it means that we have to work a lot harder to have a lot more clients than we would if we had a $5 million outsourcing deal on the table all the time. So, it’s just what you’re interested in and the kinds of services that we want to deliver.
I know you are a fan of formal project management office and so am I. For folks who don’t know if they have one or not, which I still believe there are those who think they are doing project management but really aren’t, what would be the bullet list of things you would say, "If I find these things, I’ll know a hospital is doing project management correctly?"
It’s interesting you should ask that question because we just finished working with one client and are in the midst of working with a second client who are in exactly that boat. That is, having something called project management, but at least in my evaluation, they really aren’t doing project management; more managing it with a project management office.
What I look for is, one, the whole work intake, front-end process. If that’s going on through multiple decision-makers at multiple levels, rather than eventually coming to a single committee or individual that can prioritize for the enterprise, then I don’t think they have effective — in this case, not project management, but commitment management.
Secondly, if I see an organization where the project managers, whatever they happen to be called, come from many different parts of the organization and they each manage projects in their own way, using their own methodology. I don’t see the sharing of expertise and the economies one can get from having full-time project managers, especially for larger projects, who have had the opportunity to develop the kind of skills necessary to manage projects that are tremendously different than the skills necessarily to run a day-to-day operation.
What are your thoughts about the goods and the bads you’ve seen when CIOs, for whatever reason, decide to start roping in little pockets of IT that were actually doing pretty well for their departments and bring them into the central IT fold?
I think it’s a balancing act. I learned most of my lessons from observing IT in other industries. If you look at what everybody always looks at, financial services, it went through this cycle from trying to corral everything that did IT into a corporate IT department and dictate standards, process, and so forth across a far-flung, diverse organization. That worked OK for a while, but pretty soon it was a constraint on the ability of the organization to innovate, change quickly, respond to market pressures, and so on.
And so, in that particular industry, some of that decision-making, some of those resources were apportioned back out into the business units. I think the same thing is going on in healthcare. Actually, has gone on. I think I could point to at least two different iterations of that cycle in my time in healthcare IT. But what I see going on currently is, for those organizations who haven’t consolidated infrastructure in particular, but those parts of IT that really benefit from economies of scale and from discipline management, I would call it — I see those organizations trying to do that and I think it’s a good thing.
On the other hand, I see — especially in larger organizations or organizations with diverse entities — discovering the need to empower their customers, their customers out in the hospitals, in the physician practice, or whatever, in order to get the kind of responsiveness and buy-in and value out of the technology.
The best organizations I see balance both. They’ve got a pretty centralized control, if you want to call it that, for infrastructure and even mainstream applications function, but then they’ve got IT people out with the customers whose job it is to make sure the customers needs are met, to be the account rep for IT. I see them all working fairly well in organizations.
Do healthcare organizations really want IT innovation and is that within the capability of the average hospital CIO?
I think healthcare organizations want some innovation, but you’ve got to remember that the operation of a hospital is, and probably should be, 99% routine. Nurses should be taking care of patients according to some protocol or process, not each one making it up as they go along. And so hospitals, in particular, are really oriented towards getting as good as they can at doing the same thing over and over again.
I understand variation in patients and so forth, but in order to change with the times, they’re required to — if not as quickly as in other industries — start to adjust. For instance, the whole move to ambulatory provision of services. If you’re not thinking about how you can provide it in a lower cost environment at a more convenient point for the patient, then somebody else is going to come in and do it for you.
So having said all of that, with respect to CIOs and innovation, I can tell you when I was a CIO and found myself answering a question with, "Well, its going to take three years to get this system in and then this other system. And then we have to write the interface." And to have given a 10-minute answer someone who says, "I’ve got a business problem. Can you help me?" the light bulb went on in my head that said, "Sure, most of this is very complicated. It’s very large scale. It takes time," etc, but if you don’t develop the little skunk works R & D lab that can respond pretty quickly — not to everything, but at least to some of your customers’ requests — your customers are going to forget about you by the time you get to the big picture solution.
Why do you think it is that CIOs tend to worry a lot about their jobs?
First of all, it’s a high-risk job. There’s no question about it. Other than the chief operating officer, nobody in any organization has a broader scope of responsibilities. Whether it’s in terms of customers, or number of moving parts, complexity, whatever. So that’s the first point. Its just a tough, high-risk job.
Secondly, it’s a job that’s constantly changing, and in particular in healthcare, it’s gone from, "Just keep the billing system running. Do that plus put in these electronic health records" and now, "Oh, by the way, you’re spending too much even though we agreed to it back when you started the projects." So now you’ve also got to cut your costs.
The environment and the job itself changes fairly significantly over a short period of time. I think that there are a lot of CIOs who didn’t manage properly expectations. In some cases, it wasn’t their fault. Or, had trouble meeting expectations, whether that was because of poor management or expectations were wrong to begin with.
And then third, the expectations themselves change midstream. I see this particularly with respect clinical systems implementations. What the organization thought they wanted when they approved the project or program and what they really want three years down the road are two completely different things.
Lots of money, energy, and resources are being spent on clinical systems and yet I’m not seeing many results or even hope of results. Hospitals are just glad they can call it done, move on, and not really reap any value.
Again, I look at other industries for lessons. I really liken what we’re seeing now with clinical systems to the ERP craze in the nineties in other industries. That everybody in manufacturing or retail thought, "Wow, if we could just get rid of all these systems we’ve got. Get one system that’s going to control everything from resources to manufacturing, to customer service, we could make a real difference in our operation. "
And you know the story of everybody that bought SAP and Oracle and spent a zillion dollars on consulting firms to help them put it in. Most of those organizations had a disappointing outcome. They spent hundreds of millions of dollars, and in many cases, more than they had expected.
But you look now, ten years later, most of those other industries and the organizations within them could not have made the productivity improvements — In some cases the customer service improvements –- without the IT infrastructure, in particular, the ERP systems that they struggled to put in in the nineties.
So I see a parallel there. I see that eventually IT support to the process of delivering healthcare is going to be a requirement. Otherwise, we’ll never be able to meet the cost and quality demands of the market. On the other hand, these projects are going to be more expensive, take longer, and be riskier than most organizations recognize. It’s only those organizations that do recognize it, manage it well along the way, and then insist on demonstrable results that I think are really going to get the benefit.
What percentage of hospitals would you say fall in that category of doing it right?
I don’t think very many. How many people have actually done it? In my opinion, I think there is maybe 10% who have slammed through this maze and emerged out the other end with a set of operational clinical systems that have been around for a while. So that’s a low number to start with. Then if you look at the number of those who can point to demonstrable business benefits, it’s an even lower number. That’s perhaps, not because the benefits aren’t there, but its because nobody bothered to implement a methodology to document them.
I’m not seeing the clinical system "haves" and "have nots" diverge very much, either in patient care or quality.
I don’t either, although, this is the perennial long-term/short-term kind of question. If you’re an organization that thinks that clinical systems will eventually be required and that you’re not going to be competitive without them; and you know that it’s a five- or ten-year cycle to get them all installed, figure out how to use them, change the way you work in order to take advantage of them, and so on; then can you afford not to start down that path, knowing that if you don’t, you can’t catch up because of the long lead time?
Or do you see the market as what you said — that there’s no real benefit to doing this, that nobody’s shown yet and so why should we go chasing off after this and why don’t we save our money and let it shake out? And then, if there does appear to be benefits — people are realizing it — we’ll be able to quickly get to where we need to be.
I see the first philosophy of, "Gee, everybody else is doing it. If we don’t get started, we’re going be left behind, even though we don’t have a clue what it’s going to do for us in the short term."
So even though the benefits may not be what you expected, taking the leap of faith gets you in the game?
It does, but again, I think there’s some middle ground. And that’s my or our philosophy — that you should plan for benefits. You should measure those benefits and, to the extent you can, you should demand them.
My recommendation — although not many people back me up on, it to be honest — is that you ought to just set the benefits in business metrics. If you think that having electronic documentation is going to make your nurses more productive, then you ought to demand that nursing productivity goes up, as measured by a solution or whoever, over the next three years. Or, if you think that having electronic records in your employed physician practices is going to make patients want to come to your docs, then you ought to set a goal for increasing your market share for physician patients.
But people don’t tend to do that, at least in healthcare. It’s, "Well,if I can’t point to a real cause-and-effect relationship between putting in System A and getting Benefit B, then I’m not going to hold anybody accountable."
You work working with McKesson to establish a usability lab at Providence. Why don’t you think healthcare software vendors have done a better job in designing applications that you don’t have to give a nurse a 100-page manual and pull them off the floor for two days to even get them started?
I think people get overwhelmed by the complexity of healthcare and the variation in practice. I’ve had it happen to me. I’ll tell you a short story.
When I was a CIO at Providence in the early nineties, we we’re going to take a system that was in one hospital on one side of Portland, Oregon and replicate it in a second hospital on the other side of Portland, Oregon. Ten miles apart — separated by a river, granted — but still part of the same organization.
Well, in order to be able to have a "standard system," we put together a team of people who came up with a million dollars’ worth of customizations for that system in order for both hospitals to be able to use the same system. Like a fool, I paid for that million dollars’ worth of customizations and, five years later, I’ll bet you there was not more than ten cents’ worth of those customizations that were still in use.
And I tell that story, and I remember it vividly, because I think that’s the holy grail that we all go chasing down. There doesn’t seem to be any such thing as "good enough" in healthcare. It’s got to be perfect.
It seems like we’re also terrible at standardization. A nurse on the pediatric wing does it differently and a nurse in the ED doesn’t believe that’s vaguely sensible. Even within a department, you can’t get consensus. Is that ever going to end, or is that unique to healthcare?
I think it’s unique to healthcare in that we’ve tolerated it. I think what will make it end is kind of the same thing that made it end in other industries, where making a car went from doing it in your back yard the way you wanted to do it, to doing it in on an assembly line. It’s the pressure of the marketplace.
Granted, I’ve been saying this for 20 years and it hasn’t happened, so you can take it with a grain of salt, but I still believe that at some point, the marketplace is going to demand higher quality and lower cost than healthcare in the United States is currently delivering. When that happens, we won’t have any choice but to re-engineer the way we deliver care to make it more standard and to make it sufficient rather than perfect.
I see a little of that starting. When we get called in to do performance improvement kinds of engagements, it used to be that, "Well, we want to improve our performance, but don’t touch the clinical stuff. Tell us how to cut money in HR or supply chain or whatever, but don’t mess with the clinical stuff." And now, many organizations are saying, "You know what? We have to change the way we work or we’re never going to lower our costs or increase our quality to what the market demands."
Some of the medical tourism hospitals have taken a different approach, with ISO certification and a guest experience emphasis. Are there lessons to be learned from outside our borders?
I think there are. Certainly the insurance companies are learning those lessons. They’re learning that they can please their customers, the member, and still save money by utilizing hospitals that have standardized on process. Granted, now they’re operating on a lower cost area, which helps. But who have also focused on, to use the Starbucks term, "the customer experience."
In particular, hospitals are going to have to get that message, because with technology the way it is today and moving this way for the last 20 years, there’s not many things that you need a hospital for any more.
The HIMSS leadership survey indicated concern by IT leaders about declining reimbursement and resources. What are you seeing?
I think that the concern that the leadership study showed is right on. As I mentioned before, we get involved in performance improvement engagement, not just from an IT perspective. And everything we see, the clients we talk to, all think that we’ve hit the high-water mark in terms of reimbursement and things will get worse from here.
Hospital margins will go down. Certainly you can’t depend upon investment income at the moment. So that’s played out for the IT leader. Most CIOs are somewhere in the midst of the most expensive, most risky, and potentially most disruptive IT projects their organization has ever taken on — clinical systems. And in those engagements — not in all, but in many health systems — they tend to run too long and cost more than anybody thought they would to start with.
And then the piece that we really see people starting to pay attention to is the impact on operating budget. Conventional wisdom is that, whatever your operating budget is today, if you’re not running clinical systems, that’s going to go up and go up dramatically once you implement all these clinical systems. Many people believe, me included, that you can probably add a full percentage point to the size of the IT operating budget as a percentage of overall spending. That percentage point comes right off the hospital’s bottom line. So there’s an inherent conflict there for CIOs.
And if you’re a consultant, is that good or bad news for you?
I think for us at Navigant, it’s good news, because we’re not an IT consulting firm. We’re trying to help our clients mange their business and accomplish objectives.
So if I see, and I’ve had a couple of incidents of this recently, that a health system is saying on the one hand to us, "Look, we’ve really got to get a handle on expenses. Reimbursements are going down. We don’t think we can grow market share. Our only prayer is to reduce our costs so we can maintain a reasonable operating margin" and then, in the next breath they say, "Oh yeah, by the way, we’re going to spend $100 million on electronic health records, but we’re not sure what the benefit is. I guess that will raise our costs, won’t it?"
So there you’ve got a dilemma for the organization. Its not a dilemma for us, because we advise them, if that’s where they are, that they should either document the benefits that they’re going to get and make sure they get them or they shouldn’t be doing it.
Should the boat show atmosphere of the HIMSS conference change?
I’ve been going to HIMSS for a long time. I walk onto the show floor whatever the day is it opens. I walk from one end to the other and it’s like, "I’m done". I’m overwhelmed. I just don’t know where to start. Then I go back to something else.
Having said that, I think it’s that way in any industry. A vendor fair/show is all about visibility for the vendors’ products and I don’t think this is going to change. As vendor margins go down, they’ll put less money into it, if that happens. But I think its serves a purpose, so I don’t get too worried about it one way or another, to tell you the truth.
If you look ahead three to five years out, give me a handful of trends that you think we’ll see in healthcare IT.
First and foremost, simply a continuation of investment in, and trying to optimize to use of, clinical information systems. I know that’s pretty broad.
Secondly, I think we’re going to see a whole lot more emphasis to the outpatient or ambulatory environment. I’m not just talking about physician EMRs, but ambulatory surgery centers, all kinds of out-of-the-hospital provision of care that we’re just staring to see now.
Third, I think we’re going to experience a bunch of horror stories around simple operations. Actually, that’s an understatement. They’re not simple — complex operations. What I mean by that is, all of a sudden, we’re going from having an IT or customer environment that’s not exactly happy, but tolerant of six-hour downtimes, a day and a half outage, slow speed — to one that just can’t afford any of that. I don’t think that we’ve paid enough attention or invested enough in the infrastructure to keep up with it. So I think we’ll see a number of stories about bad things happening when you don’t have the operational efficiency to really run these mission-critical systems.
Last, I don’t know how to quantify this, but I think we’re going to see a whole sea change in leadership within healthcare IT on the vendor side and on the CIO side. We’ve had people like me around for the last 10 or 20 years in some capacity or another. Many of those people won’t be here five years from now. We’ve got a whole new set of leaders that are just now starting to fulfill their promise and that will be very exciting to watch.
You took me right into my next question which was, during that next 3-5 years, who do you think the most influential people will be in healthcare IT?
This isn’t really answering your question, but I think the most influential people in healthcare IT are going to be non-IT people. The business people. Whether it’s the CFO or the CEO — in the next few years, they are going to be engaged in IT things to a far greater extent than they ever were before, just because they have to be.
IT is one of their biggest capital investments; it’s one of their most mission-critical functions. So all of a sudden, like it or not, they’ve got to pay attention to IT. And because they’re paying attention in a way they haven’t in the past, I think we’re going to see their influence a lot more than it has been. I think that’s good because, after all, they’re running the business.
If you look at the vendors and consulting services firms that are out there, what advice would you give them to be prepared for what you think is coming?
I think that the old school of vendors and consultants — the typical large, global, partnership-oriented consulting firm, on the one hand, and the large, complex, multiple-business unit healthcare IT vendor — both of those are at risk. We see it today with the emergence of Epic, Meditech, and, before it was purchased by IBM, Healthlink. Those with a simpler, more direct, more customer-focused business model, I think, are going to make some headway in the market.
Is there anything else that you want to talk about?
I suppose only one other point, and that is for those of us that have made a career out of healthcare IT — I’m struggling with this personally — how to help make this transition from IT being a separate black box, so to speak, disconnected from the organization in a lot of ways, managed in a different form that the rest of the organization, etc. — how to transition IT into the mainstream of healthcare, the same way that IT is in the mainstream of retail or financial services or what have you.
I believe that’s where its going. I believe that’s our philosophy at Navigant. But I also think that those of us who have been in this business for a while have some obligation to try and help it get there in the least bloody manner possible.
From Sleepless: "Re: Hackensack. If the Soarian rumor is valid, it would not be a surprise. I was involved in their Soarian Financials decision in 2002. They have been looking for ‘perfect’ rather than ‘good’ since then. They could have gone live with Financials three years ago, but they kept moving their ‘wants’ list, rather than address their ‘needs’. Lex is somewhat to blame, but his constituents keep moving the bar on him. His FTEs are extremely competent people, but the clinicians across the street constantly move the target. Siemens competed heavily against EPIC and IDX back in 2001/2002 and again for the Clinicals in 2005. No surprise that one of the clinicians has maintained a relationship with EPIC."
From On A Friday: "Re: Cerner marketing slick. An unidentified man seems way too happy to be configuring his computer’s BIOS. Scroll down to page 2, look closely at the text on the computer screen in the picture." Link (warning: PDF). Yep, Stock Photo Man is poking vigorously at a BIOS setup screen, of which the IDE drive’s master/slave settings are clearly visible.
From Wendell: "Re: GE Healthcare. 150 people cut Thursday."
From The PACS Designer: "Re: SAP. TPD has worked with SAP and noticed their expanding healthcare presence. Their software is quite complex and not easy for users to comprehend, so it could be a difficult sell if IT is unfamiliar with their applications. One option could be to hire a consulting firm to do custom development and provide training. When the SAP application is turned over to the client for daily use, the quantity of the data collected can grow quickly, thus providing real value to the client while reducing the number of data silos."
From Carl Hubbell: "Re: Unibased Systems Architecture. Health IT Strategist ran a blurb on the company’s CEO, with the last sentence being ‘Unibased declined to provide Covington’s age.’ Isn’t that odd, both that they wouldn’t say and that the journalist printed that fact? Maybe it’s like a back-handed compliment in discussing John McCain’s 50 years of service."
A well-placed source suggests that Misys will be losing some top-level salespeople (like VPs and directors) when the company’s fiscal year ends in May.
One reader guessed one hospital from the set of pictures I ran last time – UPMC Presbyterian. Nobody recognized MD Anderson (or said they did, anyway). Here’s another, sent in by Ray. Hint: the Swan-Ganz catheter was invented there (that gives it away, right?)
I see new HIStalk sponsor Innovative Consulting Group redesigned its web site.
Newt Gingrich is a self-worshipping blowhard at times, but he gets off a good line at Princeton: "“In the average doctor’s office, when a UPS person walks in, they double the amount of technology in that office." He also mentioned that some South Florida pizza restaurants registered as HIV clinics to rip off the federal government, apparently a widespread practice there.
TEPR unleashes another example of the marketing savvy that has made it a trivia question compared to HIMSS. The name of its latest award: "EMRs Best Meeting Medicolegal Requirements." I know they do serious work there, but theirs is the least-fun conference I’ve ever attended (once, long ago), about as dry as that name. Still, 5,000 attendees is pretty darned good and I guess that’s what you get when you dump the boat show and emphasize education. And while we’re all freezing in Chicago in April, TEPR attendees will be enjoying Fort Lauderdale in May, a far wiser decision.
Daph sent over some HIMSS pictures. Feel free to reminisce:
The first is a trio of lovely lasses (two of them Professional Fake Ingas) at the HIStalk reception. I should bring them to a TEPR shindig to spice things up.
The beer encouraged more food and vice versa and Healthia arranged a first-rate spread. If I had Neal Patterson’s money, I’d have a guy like this in my kitchen around the clock just in case I wanted a sandwich while toiling away on HIStalk, as opposed to the current arrangement whereby I drop broad hints and Mrs. HIStalk tells me to get my own peanut butter.
This is Red Hat’s Mr. HIStalk Shoeshine. It’s strange to see your stage name on beauty queens and shoeshine stands. I rather like it, actually.
Here’s another patent extortion company making money from healthcare. Kaiser Permanente "buys a license" for running a call center, the patent for which is claimed by a company that’s allegedly extracted over $1 billion through aggressive lawsuits that end up being settled for the purchase of a license. The company’s patents are notoriously vague and short – here’s an example.
The folks at Raymond James sent over their quarterly KLAS review, which is handier than digging through KLAS myself (although keep in mind they’re in the stock biz, so there’s some vested interest inherent). Some nuggets, which mostly involve my interpretation (disclaiming so the KLAS folks don’t complain that I’m not presenting the entire statistical story):
OSU Credit Union donates its used telephone system, valued at $100,000, to Samaritan North Lincoln Hospital (OR).
A three-stented heart patient scheduled for a monitor implant in the UK is scared out of her mind when her appointment is cancelled. The hospital told her it was because of equipment and staffing levels, but a spokesperson contacted by the newspaper said the patient scheduling system messed up.
The Wall Street Journal rips non-profit hospitals that roll in the cash, citing 25 that earn more than $250 million a year and calling attention to Ascension Health’s $7.4 billion war chest. They mention Gary Mecklenburg’s $16.4 million parting gift when he left Northwestern Memorial in 2006 (he’s now a venture capitalist), nearly as much the paltry $20.8 million it spent on charity care (less than 2% of revenues, a ton less than the tax breaks it gets for doing so). UPMC, defending its $3.35 billion in cash and investments, says it will spend $1 billion (!!) to create electronic medical records, although the reporter mentions its $10 million in advertising and $3.3 million CEO salary. A billion-dollar EMR built on top of Cerner? How much better or cheaper would care have to be delivered to pay back a billion dollars? In the mean time, Pittsburgh is rotting away because there aren’t many taxpaying businesses left in it.
An enterprising doctor in Australia admits he used a PC to blast out boilerplate treatment plans to receive reimbursement, of which "every single one of them was considered inappropriate."
Inga’s Update
Will Congress be hot to focus on patient privacy issues now that one of their own might have had his privacy breached? Apparently Rep. Joe Barton was one of 3,000 patients whose records were on a stolen NIH laptop. Barton was already a strong privacy advocate, having founded the Congressional Privacy Caucus.
No surprises here. Men are more likely to lose money on Internet scams than women, losing $1.67 for every $1 the fairer sex loses. Send a man a sexy photo and an e-mail and you never know what you’ll get back. So I hear.
Will the palm be more popular than the finger? BioGuard announces the launch of PalmGuard for biometric authentication. The product will look at unique pattern of veins in the palm for authentication.
Here is a link to participate in the Medical Records Institute/Philips Speech Recognition survey on EMR trends and usage. Results to be released in July.
From Stu Mascarpone: "Re: Siemens. Even after flying in its entire top brass to NJ, Siemens in now only a clicking clock away from losing one of its key flagship Soarian clients, HIMSS President’s Award-winner Hackensack Univ Med Ctr. After basically turning nothing on since 2004, HUMC is now in negotiations with Epic. The kicker: Epic is telling HUMC, which has an IT department of over 100 FTEs, that it is understaffed. So, before the Epic project can start, the hospital has to hire in excess of 50 FTEs and then send them to Madison to become Epic certified. Total cost is already estimated at well over $100M." Unverified. Makes sense on the staffing though. I can’t imagine installing Epic or any other big system with just a handful of reassigned staff and 100 total in the shop sounds light. Scrimping on help after spending millions on the system doesn’t make sense since the project will never get done. But, that’s an argument for considering all costs carefully upfront instead of just taking a hiring leap of faith after you’ve signed the deal.
From Gatorray: "Re: your article on CIOs. There are other factors involved in the success or failure of a project. One that drives me nuts — having the IT department off-site. I know space is at a premium in the hospital, but sticking all of us IT types in another building away from the main campus removes us from the care-giving environment. It helps foster an us vs. them attitude." I’m with you there. It’s cool being off in the geek building where you can wear flip-flops and leave campus for lunch easier, but you’re just another vendor at that point. It’s much easier for users to hate people they never see face to face.
From Tina Recruiter: "Re: McKesson. They reorganize every year, change sales leadership every year, change sales strategy every year. Why would this year be any different? The resumes are flowing on the streets, so something must be happening. BTW does anyone know what is happening with the McKesson ED product?" I had another company tell me they’re getting snowed under with Misys resumes (other than the recruiter I mentioned a couple of days ago), so it’s not just McKesson, I’m thinking.
From Carl Kibble: "Re: Cerner picture. If Neal Patterson reads HIStalk, he must be beside himself (again) because your picture of the Cerner headquarters shows the parking lot (scroll to the left or right) as 98% empty. It must have been about 5:05 PM. No pizza deliveries to be seen either." I meant to comment on that, but I figured those parking spaces must be for visitors since most companies make the help park out back. I doubt he reads, although if I were a shareholder or employee, I’d want him to.
Listening: Wolfmother. Aussie Zep/Sabbath clones.
Welcome and thanks to new HIStalk Gold Sponsor Renaissance Resource Associates. They’re in University Place, WA and provide consultants for projects involving Epic, Centricity, Picis, Sunrise Clinical Manager, and other hospital systems. They’ve got some positions available too, I noticed.
Take your last fond look at Merge Healthcare as it slips into likely oblivion. Shares are at $0.52, the company adds to its thick Nasdaq folder a delisting notice because of share price, and just-announced Q4 revenue was a paltry $15.6 million with EPS was -$0.28 vs. -$0.93. Improving, but they’re bleeding cash and not exactly inspiring confidence in prospects (if there are any). Stick a fork in ’em, I’ll predict.
Medicity just sent out its latest electronic newsletter, which I always enjoy. The company did 10 million clinical transactions in the last quarter, has 97,000 physician users, announced Hospital Sisters Health System as a customer, and hired Gifford Boyce-Smith as CMO. They also mentioned my positive comments about their booth, which I thought was very cool, and included a picture that I’m stealing since the HIMSS Police made me holster my camera before I could take one. Looks like you’re headed up the stairs of a spaceship.
If you’re a hospital CIO or IT manager, please take my medical device survey for our little white paper project. Thanks.
More HIPAA problems at UCLA Medical Center: the hospital fires an employee for selling information from Farah Fawcett’s chart to a tabloid. The rag got the ultimate scoop — reporting her cancer relapse even before she’d had the chance to tell her family and friends. It’s like drugs, though: you will never win trying to curtail supply instead of reducing demand – all that does is raise the price. Most of the country seems to be preoccupied with reality TV and gossip sites, too busy to worry about war, the economy, or their own financial future.
Doctors order inappropriate lab tests because of computers, including ordering prostate screening levels like PSA on teenagers who don’t need them.
Teddy Kennedy and the usual suspects urge passage of what must be the hundredth health IT bill, of which the previous 99 have gone down in flames. It would codify ONCHIT, give the office $5 million a year, and provide IT grants. Among the rosy verbiage was nothing about the bill’s cost: $692 million (when it was originally proposed in 2005, anyway).
GE Healthcare will shut down its Tampa office, with 72 jobs moving to Milwaukee and to Finland.
Royal Bolton Hospital (UK) goes live with the Ascribe web pharmacy system in 12 weeks.
Philips signs a research partnership with 5,000-bed West China Hospital, one of the largest in the world, to develop medical imaging procedures and cardiovascular monitoring.
OK, here’s a couple of hospital pictures from Google Street View to guess. I’ve been to both campuses and I recognize them – how about you?
Inga’s Update
Mobile computing supplier Socket Mobile announces the results of an “informal” survey conducted during HIMSS. The top concern of HIT professionals is apparently improving patient care, with 1/3 mentioning bedside POC as their top IT initiative. Lack of employee computer proficiency and cost factors were the chief impediments to implementations. The survey also noted that most institutions were considering laptops and COWs, not handheld devices like Socket Mobile sells.
Saint Clare’s Health System says it has saved thousands of dollars a year on paper costs using DB Technology RAS and RASi for enterprise-wide data and report management system. I am sure that saving “thousands” is a good thing, but for an organization the size of St. Clare’s (four hospitals), I sure hope the “thousands” are more like $90,000 than $3,000.
“What Nurses Want” — a completely electronic health record, which they believe will give them more time for patient care and improve patient safety and quality of care.
For those of you who tried but were unable to read Ed Marx’s CIO Unplugged blog. Ed, as well as his editor, dropped me a note saying there were some technical difficulties and the link is now working. I suspect the outage was related to a flood of his HIStalk fans visiting his site, but Ed was too modest to admit that was the issue.
And if you were trying to check out the Soarian user group I mentioned earlier this week, here is the correct link: www.soarianusers.com.
Perot Systems names John Hummel its new CTO for global healthcare. Hummel was most recently CIO of the California Prison Healthcare Receivership and Sutter Health CIO prior to that.
Lehigh Valley Hospital-Cedar Crest is using Patient Care Technology’s Amelior ORTracker in its perioperative department. The automatic tracking software uses an ultrasound indoor positioning system from Patient Care’s business partner Sonitor Technologies.
Six facilities have signed a total of $3.2 million in contracts with RIS/PACs vendor DR Systems. The contracts range from $195,000 to $1.1 million.
Only five VC-backed staged IPOs came out in Q1, the lowest number in about five years. Of the five, four were medical device or biotech companies and one was a computer security technology company.
I suppose looking at IPO numbers is as good a way as any for gauging the state of the economy. My next door neighbor surveyed our regular UPS and Fedex drivers, who both said their companies are laying off drivers and consolidating routes to cut costs. Personally, I have found that getting in for a pedicure is easier than ever, so I am blaming (thanking?) the economy, too.
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in June 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
It’s hardly news that clinical system implementations in hospitals fail with astonishing regularity. Sometimes they explode in a huge fireball of organizational upheaval. Other times, they simply fail to deliver the benefits everyone expected. By failing, I’m referring to not just the IT part of the project, but the overall change management required to be successful.
It seems we as an industry don’t learn well from our past mistakes. We keep making the same ones over and over again. Many of those I’ve seen involve the role of the hospital CIO in the project.
CIOs rarely have a clinical background, most often having risen through the ranks of programming, managing, or consulting. I’m therefore postulating that they should not be given control over major clinical system implementations.
CIOs don’t always have the respect of physicians, nurses, and those other key clinical personnel actually carrying out the organization’s mission. They may be recognized as holding authority over needed hardware and software tools, but to most clinicians, the CIO is the besuited mid-level functionary whose job it is to say “no” to IT requesters who did not pay adequate homage when defining for themselves which technology tools would improve patient care. Since IT controls the budget, innovation is allowed only if committee-approved.
Some CIOs I’ve known made it their personal mission to set clinicians straight, convinced that without their wise paternal oversight, the wacky clinicians can’t be trusted with money or system selection power. Clinicians armed with reams of objective and factual system data are overridden with logic such as “It just doesn’t feel right” or “I know that company from another job or my peers,” which seems reasonable other than it fails to prevent the train wreck most of the time.
CIOs like to make executive decisions even when they’re ill equipped to do so. Since IT executives have little influence when they’re not making big decisions, they tend to relish the chance to buck convention or override carefully designed committees. Their veto power is absolute.
IT executives fear for their jobs, much more than they fear for the well-being of patients. They’ll override nurse informatics people nearly all of the time and MDs 50% of the time when it comes to delaying an implementation when faced with dangerous shortcomings. The most common reasons: (1) we’ve spent the money, so we have to go live; (2) it’s bad and not likely to get better, so we might as well go live, or (3) I promised my peers this system would work and I won’t tell them differently.
Should CIOs be involved in clinical systems projects? I honestly don’t know. Programmer-trained logic doesn’t add much value. Neither does having been involved with a similar project somewhere else or sporting an MBA. Golfing and free lunch vendor relationships seem to hurt more than they help.
Some of our big-name CIOs were directly involved in some of our big-name clinical systems failures, although the ensuing spin often hid that fact from everyone except the hospital employees and medical staff. Whether they made wise decisions or worried mostly about the Dilbert-esque world of timesheets and timelines I can’t say. But they’ve failed enough times that it’s worth trying something new.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.
Who Are Your People?
By Ed Marx
As I sat down to blog, I had every intention of going back to a non-Ironman-related post. My attempts to post on matters more closely associated with health care IT failed to excite me. If I can’t be passionate about one of my own posts, my readers will pick up on that, and I will have failed to connect in a meaningful way. Not to mention that many of you have e-mailed me asking about the Ironman Arizona. So indulge me one final time and glean from the lessons that can apply to both leadership and life.
APRIL 10, THURSDAY– I pulled in a few days early to acclimate to Tempe and to finalize preparations. Though it was a long haul from Dallas, I chose to travel via car so I could bring everything I wanted, plus keep control of my bike. You can better guarantee success by having the right tools and by making sure they stay in optimal working condition.
FRIDAY/SATURDAY– No grand feat, whether it’s a major race or going live with CPOE, is performed well if attempted alone. Surround yourself with people who lift you up. One of my employees, Don, stopped in my office a few weeks prior to inform me that he had started running for the sole purpose of praying for me. He timed his April 13 run to coincide with the start of Ironman. Another employee, Aaron, flew out after the race to help me drive back to Dallas. I welcomed both their embraces.
My son, also an experienced triathlete, flew in from college on Friday to assist me with the final prep and provide counsel. As a film major, he shot all aspects of the race — a potentially interesting YouTube feature this summer. We attended the Iron Prayer event to connect with other like-minded athletes. My wife and daughter, whose support I consider invaluable, arrived the day before the race.
RACE DAY– Athlete #1345. I awoke at 3:00 a.m. to begin the nutrition phase. I consumed a few hundred calories then slept again. Waking at 4:30 a.m., I mixed my drinks and headed down to the transition area. My son was filming and helping carry the specialized bags of equipment. By 5:30 a.m., my body was marked and my bike tires were pumped one last time. I found a spot under a tree and lay down to rest for the next 45 minutes. Appropriate preparation and planning can allow time to rejuvenate while others around you are scrambling to meet the deadline.
T-MINUS 30 MINUTES– Under the scrutiny of the camera, I changed into my wetsuit. After final interview, I jumped into the lake with the other 2,299 Ironman wannabes. I remained unusually calm, partially because I did not shortchange my preparation. When the cannon fired, I was physically, mentally and emotionally ready to race. Proper preparation preludes proficient performance. (Say that 10 times…)
SAM– Climbing out of the water, I picked up my bike bag and ran into the transition tent. My first transition was dedicated to Sam, the young son of one of my employees who got hit with cancer last autumn. I pulled out the handwritten card with his name on it and placed it on the ground before me. I prayed for him as I put on my bike gear. His fight to the finish line would far surpass mine.
112 MILES in 6+ HOURS– The strong head winds and the 95 degree weather were killing my expected biking pace like a defunct router on network uptime stats. Complaining wasn’t going to change it. I had to make the best of it. Persevere. Keep focused on the bigger picture. I loaded up on fluids and consumed 400 calories per hour, a total intake of 3,000 calories, partly to prepare for the marathon ahead. Combating an urge to keep rolling, I made myself stop and reapply lotions to keep from chaffing. It would pay off later. At mile 80 — my last time up the wicked hill — one leg started to cramp, and I realized I had yet to urinate. I forced down more drinks and salt tabs and the cramps subsided. At last, the final 15 miles were downhill and flat. Relief engulfed me.
* During the last lap, the cameraman passed me backwards on his motorcycle, which meant the Ironman leader was right behind me. I sped up a little so when the scene unfolded on TV, it would look like I was in second place! That lasted about 3 frames as the leader made me look like I was standing still.
PAM– The transition from bike to run was dedicated to Pam, who had breast cancer, the wife of one of my employees. I placed her name card in front of me and voiced prayers as I changed. Only a marathon to go, and I would be an Ironman. But how many marathons of treatments did Pam have left? My suffering paled in comparison. Thanks for your strength, Pam and Sam.
DEDICATED PLAYERS– Ironman staff had trained an abundance of volunteers to assist at every stage. At the first transition, volunteers stripped me out of my wetsuit while others applied sun lotion before the bike. As I ran down the middle of the bike compound, someone was at the end waiting with my bike. When I returned to the transition area, one volunteer took my bike while another handed me my run bag. I was again rubbed down with sunscreen before the run. Planted along the run route were hundreds of signs created by race families in support of their athlete. My family had made 3 to help focus me on my purpose in doing the Ironman. Surround yourself with people dedicated to your success, positive people who will encourage you despite the circumstance. They will get you through the loneliness and pain of challenging times.
STRENGTH vs WEAKNESS– In training, I deliberately chose to concentrate on my strengths: bike and run. I had invested a combined total of 353 hours on these two events. Had I invested extra time on the swim, I might have gained 5 percent in overall time. By concentrating on my strengths, I gained an estimated 20 percent. Twenty years ago, I almost made the mistake of returning to school for a technical degree. Realizing my strength was in leadership, I opted to develop those skills instead, and it paid off. What I might have learned in technology would have already been lost — and outdated. Don’t misallocate precious resources by strengthening weaknesses.
FIRST, BREAK…THE RULE– I violated a cardinal race rule, which warns to never ingest something during a race that you have not used in practice; it could make you sick. Following a fellow Ironman’s suggestion — that he declared had saved him on the run — I indulged in a flat Coke. The sugar-caffeine high juiced my battery. Picking up the tempo, I cruised along with renewed vigor. Sometimes you’ve got to shake things up a bit and not do the same things over and over, especially if they are not working.
THE END– I remember spotting the 26-mile mark on the marathon, but the last few hundred yards were a blur. Roaring crowds lined the grandstands. Officials held out the Ironman finish ribbon, and I raised my hands in triumph and received my medal. It was over. I had held nothing back. There is no rush like that of a mission fully completed.
Yet my eyes were searching for my family. My wife and I cried as we hugged. While my son continued filming, I embraced my daughter. This had been a long journey of very early mornings and regular sacrifices. A journey that took over our bathroom and kitchen with a plethora of Ironman gear and foods.
WHAT’S YOUR BIGGER PICTURE?– At the end of the greeting pen was Ellen, the person for whom I had run this race. I had given her all my medals from the events leading up to Ironman with high hopes that in some small way they would be an encouragement to her and to her family. Throughout training, I had focused prayers against the cruel disease that had invaded her body. I desired that, through the providence of God, those prayers would improve Ellen’s quality of life. I presented her with the Ironman finisher’s medal, and we both put up brave fronts for the camera though tears were streaming down our faces. Ellen does an Ironman daily, especially on chemo days.
As a leader, do you have a significant purpose? Or is it solely about the money and the new house? Put people first. Seek to serve. In health care, the Sams, Pams and Ellens are the ultimate endurance athletes running a race that nobody should ever have to run. We are there for them.
FYI- the last 20 weeks training log:
• Swim 111 hours (lost count)
• Bike 235 hours 4230 miles
• Run 118 hours 944 miles
• Lift/Stretch 76 hours n/a
I did get the Ironman tattoo which was nearly as painful as the Ironman itself.
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.”
From Jackie Chiles: "Re: McKesson. It’s probably not really a rumor anymore, but McKesson is acquiring Rosebud Solutions, a maker of tracking software for tissue, instruments, scopes, etc. Press release will likely hit today. The Rosebud booth at AORN conference has the McK logo hanging above it.Another more juicy nugget that I have heard from several independent sources is that McKesson is making some major changes in its salesforce, with some significant restructuring likely. One well-placed source told me McKesson’s cost of sales is about double its competitors due to current sales force structure." Here’s a link to the press release on Rosebud.
From Sophie Winslett: "Re: RHIOs in Europe. They’re not that monolithic in the UK and Canada. Primary care providers are in their own clinics in the UK. Even though it is a single payer system, they all buy their own IT systems. The UK is trying to get them to standardize on a few systems to provide competition and flexibility while limiting the number of interfaces, but each doc decides on their own. In Canada, hospitals the hospitals I’m familiar with are the equivalent of non-profit groups (such as you would see in a metropolitan Catholic consortium in the US). They are not directly owned by the government and they all made their own informatics decisions."
From EasyRHIO: "Re: RHIOs in Europe. There is already a country with a nationwide RHIO for all eight million citizens. All clinics in the country are connected and most hospitals are connected with the remainder rapidly deploying. Welcome to Kaiser country, my friend."
From Amanda Rada-Range: "Re: Brev+IT. I quite enjoy this – thanks for publishing it. You might have heard that AWP stands for ain’t what’s paid." Amanda was commenting on the latest issue’s lead story.
From Lester Bangs: "Re: Axolotl. Axolotl has won the Queens NYC HIE contract, which adds to their dominance in NY state — they also have Buffalo and Rochester, which are also live. Check the details of the press release for what they are doing — EMRLite, e-Rx. It’s not just results reporting."
From Chang Kai Shek: "Re: Epic campus. Looked pretty basic, but cool drive-through. Do you have other vendors’ campuses?" Well I mapped Cerner’s campus and found a drive-through just for you. Here’s a shot (if that design feature stays that way for more than four hours, I’d suggest going to the company infirmary). Thanks to the power of the Internet, I also found Judy Faulkner’s house with drive-by pictures and its appraised value (surprisingly modest), but that’s nobody’s business, of course, including mine. I’m thinking I’ll do a series featuring hospital pictures – what do you think? You could try to guess the hospital from its exterior.
Greenway Medical announces expanded support for PQRI/P4P programs.
If you want a copy of the 101 Healthcare IT Marketing Ideas booklet I mentioned, e-mail Steve Bennett (he said it was OK to give his e-mail, although he may regret that once he starts licking a mountain of envelopes and stamps).
Heard: Hayes Management Consulting is working with a Fortune 100 company to develop an employee health clinic — consumer-centric, paperless, and with an EMR linked directly to medical devices.
CIOs or other hospital IT execs: help me out by completing a questionnaire on medical devices and IT. We’ve got a crackerjack group working on a white paper and we need some input. Thanks.
Jobs: Clinical Applications Analyst Lab (WA), Business Analyst (CO), Centricity Senior Healthcare Consultant (CA), Client Manager (TN).
I thought Dennis Quaid was just being a self-centered movie star in his ripping of the medical system after his twins were overdosed with heparin at Cedars-Sinai. He’s changing my mind: he implies he won’t sue the hospital if it does the right thing — implement bedside barcoding of medications (from his foundation page). He also seems to have a handle on the "system problems, non-punitive culture" concept: "Individually, the doctor, nurse, pharmacist, or other staff members, who commit these unintended medical errors, are not bad people. Indeed choosing a career devoted to curing the sick and easing the suffering of others is one of life’s highest callings. But these health care professionals are working in, and are sometimes victims themselves, of a broken health care system that has become more and more obsessed with the threat of exposure to liability and protecting it’s bottom line rather than being vigilant about correcting the flaws in that system that are the root cause of that very exposure." Damn well said, although this quote surely means he hasn’t seen the barcoding products currently available: "They have a bar code system in every checkout stand of every supermarket in the country. How could it be so complicated, and so expensive?"
A UK health minister admits that work on Cerner Millennium in the South has stopped because of contract disputes with Fujitsu and Cerner.
Problems in Australia, where devices set their clocks back for fall (seasons are backwards from us down there, remember) even though daylight savings time had been extended by a week in New South Wales.
It was hard to tell with all their goofy April Fool’s announcements, but Google is apparently serious that its Google Docs word processor can now be used offline, courtesy of the Google Gears project.
Here’s a pretty interesting look at telehealth in India. Interesting comment: "Technology has never been, and never will be, a stumbling block to progress in telemedicine." Another: "We should, however, remember that a fool with a tool is still a fool, and ultimately therefore it is the individual, not the technology, that can make or break the system." Sounds like they’ve got some great ideas over there. How long before someone starts offering telemedicine consultations from there at low rates?
Fun: a Wales hospital has had its own radio station for entertaining patients for 40 years.
A VA patient who nearly had unnecessary surgery because a nurse mistakenly read an old lab result proposes a software solution that the VA is considering: modify VistA to show only current lab results unless users explicitly request older ones.
Inga’s Update
McKesson announces its acquisition of Rosebud Solutions, which provides software to track and manage surgical instruments and implant materials.
StatCom hires former Siemens and Lawson sales executive Michael Holland to head up sales and marketing.
David Brailer’s Health Evolution Partners launches a $200 million investment fund aimed at early stage and venture companies. The fund’s advisors include a former US Surgeon General, a past Kaiser CEO/President, a Leapfrog Group founder, and a founder/CEO of The Health Technology Center. Former Partech International/First Consulting/Accenture executive Roy Ziegler will lead the group. I guess when you have been a healthcare IT czar, you’re able to get all sorts of folks to come to your party.
Elmhurst and Queens Hospital Centers plan to make a go of a RHIO using Axolotl’s Elysium technology. The project is expected to take three years.
I am not sure how significant this news is, but I smiled a bit at the press release. gMed announces the launch of a new EMR product called gCardio, which the company claims is a solution that “thinks like a cardiologist.” Hmmm.
Cardiac Science announces that its HeartCentrix ECG software is certified with NextGen and the two have already deployed their first installation. Meanwhile, Cardiac Science also just signed a letter of intent to start working on a similar connectivity model with the Misys MyWay product.
Nuance announces the release of Dictaphone healthcare division’s Veriphy-Ready HL7 Integration Server to automate the closed-loop communication process.
Picis announces version 8.1 of its total perioperative automation and critical care applications.
Soarian clients have a new users’ forum available at www.soarian.com. Formed with the help of Stoltenberg Consulting, the group will initially focus on question posting/answering and discussion.
Health Management Associates and Novant Health announce a partnership in which Novant will purchase a 27% stake in HMA. The two organizations will co-manage 16 hospitals.
Sachi Rath asked if there were other CIOs besides Halamka writing blogs. Check out Ed Marx’s CIO Unplugged. I like Ed because he’s a regular HIStalk reader.
A Dell issue or sign of the times? Dell announces actions to restore its competitive advantage and drive $3 billion in cost savings. Included in the plans is the closing of its Austin desktop manufacturing facility, eliminating 900 jobs.
From Up to You: "Re: Scott Wallace. From a magazine: Wallace said he will continue to work in the area of healthcare IT at, ‘something really exciting, but I’m not quite ready to announce it yet. I’ve got another six weeks of really intensive work before I can announce it.’" NAHIT seems to want to reinvent itself following (and may related to) his departure. So, where’s he going?
From Tree Adams: "Re: RHIOs in Europe. Points worth mentioning: (1) Taxpayer money and government are the only available sources of funding and administration in a cradle-to-grave welfare state; (2) Might it be easier to introduce a single, electronic solution within an existing nationalized bureaucracy when compared to our disparate, private organizations?; (3) Is it theoretically easier to finance and implement technology when the populations in question are so small (less than 10 million)? But go ahead and keep comparing them to our model."
From The PACS Designer: "Re: Philips acquisitions. TPD is impressed by the recent acquisitions of Emergin, Visicu, Respironics, and Tomcat With the addition of these four, it appears a move by Philips toward the center of the IT process in the enterprise. The mini-EMR mentioned in my HIStalk interview may have to be revised to a main player in the EMR competition!"
Listening: new B52s, the first album with all four members in 16 years. If you liked Cosmic Thing, this is for you – the always-cute, beehived Kate and Cindy still sound young when they soar on the harmonies. Bet they’d play a mean HIStalk party next HIMSS.
A reader pointed out that the Rumor Report button wasn’t working all of a sudden, so I made a new one and moved the form to a new page. It now loads instantly and takes you back to the "new" HIStalk page. So, send me a rumor.
Why Epic is so expensive: take a virtual drive through its new campus Google Street View (the car-mounted 3D camera thing). Nice buildings surrounded by endless muddy fields, but it probably looks better now (or will by summer).
Cool booklet: Steve Bennett, VP of Snelling Executive Search and Chuck Christian, CIO of Good Samaritan Hospital have published 101 Healthcare IT Marketing Ideas and sent me a copy (I had mentioned their quest for reader ideas, although I don’t know if they received any). Item #38: "Station the Help Desk in the cafeteria for a day." Fun. Some of my smarter IT management ideas have involved internal marketing, so I can vouch for these 101 as useful for ensuring IT department visibility and CIO job security. I don’t know how you can get your copy, but I expect the Snelling folks can hook you up.
Execs may like the Allscripts-Misys merger idea, but the sales natives are apparently restless. Resumes from both companies are hitting the street in great numbers, a recruiter tells me.
Your federal tax dollars at waste: a for-profit hospital in New Jersey gets $500K for PACS upgrades. The hospital won’t peg a completion date until it can take another lap around the trough for more federal money. A real estate development company bought the bankrupt hospital in October. Maybe New Jersey has hospitals that aren’t bankrupt, under investigation, or both, but those aren’t making the papers.
A bunch of New York RHIOs gets $105 million in grants.
I mentioned that AT&T’s booth at HIMSS was busy, with a lot of potential partners sidling up as well. If you wonder what the company’s healthcare strategy is, check out my HIStech Report interview (just posted).
A demonstration project says its "best practices" processes reduced medication administration errors by 56%, but of course leaves off the most important stat: how many of those would have caused patient harm? Most people miss the point that a "medication error" is usually something as benign as not being given your daily 8 a.m. laxative until 8:30. Fixing that doesn’t do … well, you know.
More jobs: Account Executive (NC), Revenue Cycle and Operations (MA), Healthcare IT Project Manager (FL), RVP Sales (Western US), Information Security Manager (CA), MUMPS/Cache’ Software engineer (VA), Epic/Bridges Senior Integration Analyst (MA).
Deborah Moore, a former RN and CEO of Accustat EMR of of Myrtle Beach, SC, is named as state Small Business Person of the Year (I assume it’s the business that’s small and not her).
LSU wants a $250 per semester tuition increase on top of $43 million extra it’s getting from the state. They plan to spend $20 million for a new hospital EMR system.
I was looking for a lesser-known EMR vendor and found them on the list of 321 covered by EHR Scope. I didn’t realize there were so many.
Strange hospital lawsuit: Dongwoo Chang, a UC Davis neurosurgeon, accuses his supervisor Jan Paul Muizelaar of incompetence and practicing illegally. UCD suspends Chang citing his high complication rate and being a general pain in the ass. Chang is suing UCD’s top physician officers, saying he was fired in retaliation and that his own death rate and number of malpractice suits is zero, compared to Muizelaar’s high numbers of each. Makes you feel real good about needing trauma work done there.
HHS launches a hospital comparison site that includes process of care measures and patient survey results (when available). I doubt most patients would understand the clinical measures (although they can review bathroom cleanliness and noise), but providers might find competitive bragging rights therein. Unmotivated newspaper reporters are already crafting stories around how the local hospitals did, I’ve noticed.
Sad: a man whose mother died at Doctors Hospital (GA) in 2004 after what he believed was substandard care returns to the ICU armed to the teeth, killing a nurse, a secretary, and a bystander. I’m scared to say it out loud, but I’m surprised that it doesn’t happen more often with all the wackos that pass through hospital doors.
The charitable foundation started by IDX co-founder Bob Hoehl donates $1 million to a Vermont literacy organization.
Vermont Information Technology Leaders changes its mind – it now backs a surcharge on medical claims to pay for physician EMRs. Getting doctors to use them wasn’t mentioned.
Oracle’s Larry Ellison is bonkers, but smart: he successfully challenges the tax valuation of his $200 million Japanese-themed estate, arguing that Larryland is so bizarre that it’s worth a lot less than he paid. Result: he’ll pay taxes on only $65 million, earning him a $3 million refund.
ZDNet says Janet Dillione, CEO of Siemens Medical Solutions,was the smartest person at HIMSS, apparently because the reporter thought she looked a little like Hillary Clinton and because of her daringly insightful predictions such as "PHRs will be popular" and "Healthcare IT needs to change." ZDNet fawns over Soarian, apparently unaware that nobody’s buying it.
Thoughts from the HIStalk 2008 Reader Survey
Thanks to those to responded. Inga and I pored over your survey submissions endlessly, so your time was well spent.
Not surprising: about 4% of readers are CEOs and 4% are CIOs, not much different than last year. As to the degree that HIStalk influences your perception of products and companies, 8.7% said none, 68.6% said some, 22.7% said a lot. The most popular HIStalk elements (in order) are news, rumors, and humor.
Surprising: to the true/false question of whether reading about a company in HIStalk raises interest or appreciation for those companies, 80.3% said yes (that’s a lot). Best of all, to the question of whether reading HIStalk helped you do your job better in the past year, 75.4% said yes (a 10% jump from last year). I don’t know of any organizations or publications that can claim that strong of an endorsement, so that’s pretty darned cool.
The comments were nearly universally complimentary (thanks for that). Some specific themes I teased out: you would like to see more interviews with non-CEO/CIO types, such as clinicians and non-hospital IT leaders (we’ll work on that). You’d like to see more activity in HIStalk Discussion (so would I.) You suggested a raffle or other incentive for readers who recommend new HIStalk readers (good idea). You suggested changing the sponsor ads (smaller, simpler, different layout) which we will review with the sponsors since they’re the ones keeping the virtual presses running. You asked me to highlight small, innovative vendors who might not make your radar otherwise, another good idea (if you know one or are one, check in).
You also gave us a couple of great ideas for major, separate offerings that we may do if I can figure out how create extra hours in the day. Since I work full time, I’m close to maxing out at maybe 90 hours a week, so maybe it’s time to hire more helpers or something. The ideas were good and have been suggested before, so I’m confident they would be successful.
Inga’s Update
Cerner is participating in a community outreach program that will bring in 45 Kansas City area high school students for half their school day. The curriculum will focus on teaching students the skills necessary to succeed in the workforce, particularly team work and problem solving. Good stuff.
The chairman, CEO, and CFO of Misys show enough confidence in the company’s direction to pull out their checkbooks and make substantial purchases of additional shares.
The chief of neurosurgery at Brigham and Women’s Hospital is accused of sexual discrimination in a lawsuit filed by a female surgeon who believes she was denied promotions in favor of male colleagues with less experience. Whether true or not, the chief definitely has odd taste in office decor and at a minimum has been accused of having a pretty annoying sense of humor. (I will leave my “men are pigs” comments to myself.)
MD Anderson is implementing MedAptus’s Facility Charge Capture and Infusion Services modules. Eight infusion centers will initially use the programs for reconciling the charge review, approval, and transmission processes.
From Cherry Rojas: “Re: PHR fiasco. The State of Washington issued a $2 million dollar RFP for a demonstration project to link the EMS system in four counties to PHRs last fall. An out of state vendor won it December 12 using smart cards to verify patient ID and to hold their critical patient information, readable by portable reader. Two in-state consultants who wanted to sell the state proprietary software and (and who sat on the Health Information Infrastructure Advisory Board) got their legislators to cancel the RFP before the contract could be signed in February. SMART Association, the apparently successful vendor, had no idea it was an inside game. All references to the RFP have been pulled down from the DIS web site (but we have copies). How will we ever change healthcare if it’s just another inside game? Some DIS staffers were so upset that they were ready to quit.”
From Bruce: “Ars Technica, a popular tech news web site, has posted an interesting article on EHRs and PHR. Very high level, but it’s interesting to see this hit the mainstream tech community.” Link.
From Up to You: “Re: Scott Wallace stepping down as NAHIT CEO. This was WAY overdue.”
From Dutch Treat: “Re: PHR/EHR. EMC and InterSystems are testing the PHR/EHR waters in Northern Europe. IBM runs Denmark. Who’s next? Case in point: unlike RHIOs in in the USA, governance and funds make a difference in Euroland.” Link 1, Link 2.
From Art Vandelay: “Re: dumb EMRs. Many specialists using Epic find the EMR dumb until more configuration is done. This is always a tough position for hospitals or medical groups rolling out Epic. In the typical Epic EMR implementation, the first step is to focus on primary care in the ambulatory setting and hospitalists in the hospital setting. To make it more usable by the specialty physicians, a second round of tailoring then occurs. It is much easier for the implementation team to initially go with SmartText macros for notes and a few order sets for specialists. The team comes back again later with more focused templates for specialists. This causes many headaches in organizations without strong leadership, a large team, and good content management capabilities. By now, a couple of years have gone by and it is time for an upgrade, so progress may stall while the upgrade is tested. Still later comes the health maintenance reminders with the specialists saying, ‘WOW, you mean I get to use some of the discrete data I entered?’ Next, comes the focus on making sense of the order set and template proliferation. Few places take content management seriously and later have clean-up to do. It may or may not be time for another upgrade or the roll out of more specialty models. At last, many places then get to publishing queries in Clarity (data warehouse) for more advanced users to use in delivering care where some reminders may not exist. As with larger clinical systems, it is a toolkit. If the organization doesn’t have the right size team to match the hospital or clinic’s desire to implement and strong sponsorship to focus attention on the goals of the implementation, it is a rough uphill climb. It takes time, money, super-users, technology resources and a strong infrastructure to deliver the product. A place implementing an EMR can learn from Allina and Kaiser. Allina seems to have had great super user involvement. Kaiser has a content management discipline and content teams to quickly go area-by-area.”
I got an e-mail from Bryan Walser, MD, JD, CEO of Perlegen Sciences, Inc. about the company’s activities with the unnamed EMR vendor. Actually, it was the same “letter to the editor” sent to other publications, so I don’t see much point in running it here. I asked him for an interview and he declined. I’m mostly interested in the EMR vendor, of course, and I’m still trying to find out who it is.Design Clinicals has a new web site, I noticed.
Philips will buy Irish cardiology software vendor TOMCAT Systems. Lots of informatics activity in Ireland, it seems (field trip!)
Information Week digs around the Gnutella file-sharing network using LimeWire peer-to-peer software to see if business documents might actually be found there. Downloaded: banking passwords, credit card numbers, credit reports, tax returns, cell phone numbers of senators, meeting notes, and medical documents listing patient names with HIV status. The default setup of those P2P clients is often confusing about which PC folders you’ll be sharing with the world, so it’s likely that employees were so anxious to start downloading that they were sloppy in its setup.
Jobs: EMR Developer, Clinical Improvement Analyst, Meditech Clinical Consultants, Physician Liaison. There’s a ton of new jobs listed, I see, so take a look and sign up to get Gwen’s weekly job listing.
A few folks missed the HISsies cartoon, so I’m listing the winners below.
HIStalk readership will break another record this month. It’s nearly there already with four days left in March. Sitemeter projects 66,796 visits and 101,700 page views. Thanks to those who read, sponsor, e-mail me stuff, and spread the word among colleagues. It means a lot. I’ll have an update on the broad themes from the reader survey in a couple of days. One of them: everybody loves Inga (and rightly so).
New text ad to your right: InteGREAT Healthcare, which offers consulting services in the areas of application integration and interoperability.
California will delay for two years its plan to track prescription drugs to prevent counterfeiting, moving it back to January 1, 2011. Everybody in the drug supply chain said they wouldn’t be ready and would have to stop selling drugs in California (riiiiight). How about that nimble pharma industry, of which Pfizer says it will need 5-7 years just to put serial numbers on its products, even though it’s already doing that for some of its high-profit drugs like Viagra?
Allscripts files a new 8-K that describes the mechanics of its proposed merger with Misys Healthcare. It says the per-share value to MDRX shareholders is $14.30 to $16.20, an 85% premium to the share price the day before the announcement. Shares closed today at $9.06 if you want in.
Cerner shares hit a 52-week low today. Share in athenahealth are dropping, too, and PSS sold some of its pre-IPO stake Wednesday. Nothing’s going to do consistently well in this market, of course.
Former Harvard Vanguard CIO Tom Congoran will fill in as CFO of Massachusetts practice group Atrius Health, which has cleaned house on its executive team after parting ways with former CEO Debra Geihsler.
Harvey Picker, founder of the Picker Institute that promotes measurement of the way patients experience healthcare, has died at 92.
Cambridge Consultants says its Vena single-chip platform can allow medical devices to transmit data wirelessly for less than $10.
RemedyMD will integrate the disease models and biospecimen management system of GulfStream Bioinformatics Corp. into its Investigate research software.
The all-lower-case api software (annoying, yes?) acquires EPEPCS, a tool that estimates required nursing hours and skill mix.
Inga’s Update
Dr. Deborah Peel’s Patient Privacy Rights organization has posted a summary outlining each remaining presidential candidate’s stand on patient privacy. It’s worth a read if the topic concerns you.
Mediware announces that its blood management software systems are ready to accommodate ISBT 128 labeling.
Oshsner Health System is implementing new DocuSys technology for pre and post surgical care. The solutions will be used across Oschner’s 28 operating room and 15 other anesthetizing locations.
Some not-so-good news for McKesson. A US District court certifies a $7 billion nationwide class-action lawsuit against McKesson on behalf of consumers and third-party payers. It has the potential to be the third largest class action suit in the US. It charges McKesson engaged in a scheme to fraudulently inflate the price of more than 400 prescription drugs.
While it’s unlikely to cover the extra $7 billion, McKesson is partnering with Clorox to develop and promote disinfection protocols for mobile equipment and handheld devices.
Nebraska’s Great Plains Regional Medical Center selects Eclipsys Sunrise Clinical Essential for EMR and medication management. They’ll add additional Sunrise products after Essentials is deployed.
Thank you Wheaties Gal for sending me this link for an inspiring new bingo game. “This does not have to do with big mergers or company layoffs- has to do more with passing time in those boring IT meetings where they think nothing of rattling off acronyms and trying to put together sentences around the latest business buzzwords. Here is a site that you can print out ‘B-S Bingo’ cards. I think you would have to be careful not to yell out (like the girl in the TV commercial). Some meetings I have been in lately, I could get a cover-all in 30 minutes- or less.” I am on the same page as you on this, Wheaties Gal. Going forward, for all mission critical enterprises Mr. H and I will simply set our goals, leverage our resources, and just get it done.
Speaking of getting it done, I was making up some pretty charts for Mr. H showing the growth in readers over the last 18 months. The number of monthly visits has doubled during that time period, which is pretty darned impressive. So keep telling your friends because it sure seems to make Mr. H happy!
Smartest vendor strategic move
athenahealth, for its initial public offering (IPO)
Stupidest vendor strategic move
Medseek, for laying off employees right before Christmas
Most impressive vendor sales deal
Epic, Cedars-Sinai
Best healthcare IT vendor
athenahealth
Worst healthcare IT vendor
Cerner
Best provider healthcare IT organization
MD Anderson
Vendor most likely to be acquired in 2008
Allscripts
HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
athenahealth
Most promising technology development
Software as a Service/Service Oriented Architecture
Most overrated technology
RHIOs
Biggest HIS-related news story of the year
athenahealth’s IPO
Best speaker you heard at a conference in 2007
Jonathan Bush
Most impressive vendor at the HIMSS Annual Conference in 2007
athenahealth
Most overused buzzword
Interoperability
Most effective CIO in a healthcare provider organization
Judy Middleton, William Osler Health Centre
HIS industry figure with whom you’d most like to have a few beers
Jonathan Bush, athenahealth
HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner
HIStalk Healthcare IT Industry Figure of the Year
Jonathan Bush, athenahealth
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in September 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Stanford Hospital last week joined the growing number of academic medical centers that prohibit their physicians from accepting gifts from drug company salespeople. The reps aren’t even allowed on campus, except by appointment to conduct product inservices.
Bravo to Stanford. Physicians think they’re too savvy to be influenced by free lunches, rounds of golf, or drug samples, but drug companies know better – subtle bribery works. If it didn’t, they’d stop. A $100 staff lunch influences even a $500K a year doctor whose prescriptions for one medical condition might generate thousands of dollars a week of business for the drug company.
I’ve taken my share of IT vendor goodies: junkets, executive dinners, trips on private jets, and one memorable evening spent in an internationally known billionaire’s back yard. Having thereby flouted the rules of propriety myself, I’m qualified to issue my first-ever standards of conduct for CIOs and other provider-side executives.
The most important fact is this: it doesn’t matter whether your acceptance of vendor swag is improper; it matters only that it might appear improper to an outsider, like the attorney of a bid-losing vendor who’s suing you for tortuous interference or the 60 Minutes camera crew accosting you on your way to drop the kids off at school.
It’s obvious, but if your organization is sending out RFIs or RFPs or is otherwise involved in system selection, accepting anything is unwise. Even speaking to vendor reps is not smart. Don’t let vendors provide free lunches or giveaways for employees attending demos. Vendors shouldn’t pay for your site visits – if you can afford their product, you can spend your organization’s own money on flights and hotels. Besides, spurned vendors aren’t nearly as chummy afterwards, I’ve found.
Otherwise, lunches are always OK, whether one-on-one or group. Stuff for the IT department is OK, like shirts, food brought in, or sports tickets. This is the IT version of the unrestricted grants that drug companies offer, where you accept small items without reciprocating and the chance of undue influence is minimal. Corporate ethics people are usually OK with this, as long as the gifts aren’t for the specific benefit of an individual.
On the other hand, it’s never OK to solicit stuff from a vendor: free software from the Microsoft rep, donations for a pet cause, money for a department party, or entry fees for a fundraiser. Vendor strong-arming is tacky.
I also don’t like the idea that vendors buy access by sponsoring conferences and giveaways for HIMSS and CHIME, but that’s apparently a hopeless cause. It looks like Halloween, except the trick-or-treaters are wearing suits or conscientiously casual golf apparel.
Spouse trips are out. So are ridiculously transparent junkets, phony advisory board conferences, honoraria, or a visit to the German countryside to see your future PACS system being assembled. It’s tempting when all your cross-town colleagues are lining up at the feed trough, but it’s still wrong, don’t you think?
Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels: with flattery, rapt listening, and a shower of baubles. You know what they really want. Surely your integrity is worth enough that you won’t sell it that cheaply, especially knowing that they won’t respect you in the morning.
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Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
From Mitch Router: “Re: PatientsLikeMe. This really isn’t my bailiwick, but I thought your readers might be interested. It’s easy to see why doctors and researchers (in particular) would not like PatientsLikeMe.com. As a social network, great. But without scientific scrutiny collated anecdotal data may well be “interesting-in –> mathematical model + statistics –> garbage-out.” Link. An interesting New York Times article on PatientsLikeMe, where patients with a handful of specific conditions are posting detailed information about their treatments, right down to drug dosages correlated to their symptoms. It’s advertising-free, but hoping to sell information to drug companies (of course). The article has some interesting thoughts on the privacy implications of such a service and physician questions about having patients take actions based on what other patients report.
From The PACS Designer: “Re: creating your PHR. TPD has been a member of the ASTM International Healthcare Informatics E31 Committee for some time and worked with others to create the Continuity of Care Record or CCR. Now, anyone can create their own PHR using the CCR format by using the Consumer Empowerment National Demonstration website called CEND PHR, sponsored by the American Academy of Family Physicians Center for Health Information Technology. After you creating an ID and password, you will find the following categories available for inputting your health information: Personal, Emergency contact, Insurance, Primary physician, Problems, Medications, Allergies, Family history, and Social history. After completing entries into the PHR, you can save the file and then access your PHR Portable Document File (PDF) for local printing and also save an XML file to a storage location.” Link.
From Mrs. Brown’s Lovely Daughter: “Re: McKesson Paragon. It’s cleaning Meditech’s clock in a number of regions. Key replacement announcement pending”
From Bearly Stern: “Re: Allscripts-Misys. The amazing thing about the Allscripts-Misys merger is that it could have happened years ago. John McConnell repeatedly pitched the idea to Goldberg and Skelton, but they were so focused on becoming a mini-Cerner or Epic that they squandered $500M and a huge lead in the ambulatory space. Was there any real growth or value added to Misys from year 2000 onward? Leadership’s main ideas were cutting cost as a growth strategy and making it prohibitive for existing practice management clients to buy a non-Misys (read: workable) EMR. This while touting ‘interoperability’ in a failed strategy to connect the products of three business units.”
From Esther: “Re: data mining. I CANNOT confirm the vendor, but I can tell you, as an ex-[company] employee, that [company] is very interested in data mining of patient information. Prior to the opening of the [company] employee clinic, we were told at a town hall meeting that any lab work done in our clinic could and would be used for a DNA project [company] was working on. Trust me – you could hear a pin drop during that announcement. There was a lot of uneasiness expressed after the meeting, but as far as I know, no one ever took them to task on it. Those of us who were truly concerned made sure that we didn’t get any blood work done on the premises!” I expunged the company name since it’s a bit of a hot topic right now and I don’t want to cast any unearned aspersions, but you can probably figure out who she’s talking about. Unconfirmed and still waiting on the smoking gun. Possible clue: four million patients? That’s a big footprint. Maybe it’s a clearinghouse owned by an EMR vendor – the Perlegen press release didn’t say it was EMR data, only an EMR vendor, and it refers to an “information warehouse” that would imply either hosted systems or a transaction database. Hmm.
From Dutch Treat: “Re: data mining. What about this company helping the pharma sector?” Link. IntrinsiQQ LLC, the company behind web-based chemotherapy dosing system IntelliDose, didn’t rack up enough paid monthly subscribers, so it started selling de-identified information about drug usage to drug companies. At least the drug companies don’t have plans to re-identify data or contact patients. Still, patients not only have to trust a company with which they have no legal relationship, they probably don’t even know their data is being bought and sold. Somebody could start a nice little company testing and certifying de-identification processes.
From Larry Lonesome: “Re: development. I would be interested in the perspective of users/purchasers of clinical applications, as well as developers of these applications, regarding AJAX application development versus smart client versus any other relevant methodology. Do hospitals have a preferred technology platform? Is AJAX development robust enough to handle the heavy lifting of clinical applications? Does a .NET smart client really solve deployment issues as neatly as a web application?”
Recommended: if you’re a Firefox user like me, upgrade now to the Beta 4 version. I don’t generally use beta releases, but this one’s a screamer (many times faster in Google Docs and other AJAX-type apps). Most plug-ins aren’t available yet for the Beta version, but all I really use is the Google toolbar and it already has a Google search box. Zero problems here.
Girish Kumar of eClinicalWorks passed along a short comment on the Mass BCBS conclusion that EMRs aren’t worth their cost to doctors. He says that eCW has a 95% adoption rate and that most of the physicians using their system would say they’re better off with it than before.
Reminder: if you’re not getting e-mail updates, put your e-mail address in the “Subscribe to Updates” box to your right, even if you’ve already subscribed from the old site (which is no longer being updated, thus not sending out e-mails). If you’re not sure, sign up anyway – it will tell you if your address is already on the list and you won’t get double e-mails.
Intercepted e-mail: Kaiser’s medical group will start a pilot this summer of a thumb drive-based Personal Electronic Medical Record for emergency use. Files are encrypted and read-only, printable to PDF. Contains a concise record of hospitalizations, allergies, doctors, visits, labs, problems, and demographics. Sounds pretty cool.
Tennessee Medicaid will pilot e-prescribing using Cerner software.
Donna Krause is named CIO at Truman Memorial Veterans’ Hospital, having worked her way up from pharmacy aide over a 25-year career there. Congratulations – darned impressive.
Financial Times says investors are skeptical of the proposed Allscripts-Misys merger, with investors passing on the new shares issued to fund it, leaving ValuAct Capital to eat them themselves. From the piece: “… suggesting US shareholders either don’t believe Misys Healthcare is worth this much, don’t believe the deal will go through, don’t understand it, or don’t trust a management that has presided over 64 per cent share price decline over the course of the year.” They missed one: that continued Misys involvement might actually be negative to the business Allscripts was already doing.
The CEO of MedAssets is team director of the US Olympic wrestling squad. Something else to wrestle with: its Q4 numbers, Revenue up 45.7%, EPS -$0.20 vs. -$0.16. Shares are down a third since the December IPO, with a market cap of $706 million.
Stolen, unencrypted, PHI-containing laptop #650 or so: NIH.
An Australian hospital is accused of hiring a nurse to manipulate the “time seen” ED triage data to make the hospital look better.
Robert Wiebe, formerly of the VA, is named SVP/CMO of Catholic Healthcare West.
Inga’s Update
Lynn County Hospital District (TX) selects Opus Healthcare Solution’s OpusClinicalSuite for its patient information system. The three rural hospitals within the district will use OpusClinicalSuite ASP.
Design Clinicals adds a new client in Iowa. Myrtue Medical Center (IA) is implementing its MedsTracker medication management program.
Medinotes partners with Hawaii’s Akamai Practice Management to provide EMR to small, independent practices. Akamai is a practice management and reimbursement service provider.
digiChart’s OB-GYN Version 7.0 is the latest EMR ambulatory package to receive CCHIT certification.
I suppose because it is such an important use of our tax dollars, HHS just opened a second public comment period to define the following terms: EMR, EHR, PRH, HIE, and RHIO. Actually HIE has already been defined as “the process of electronic health information exchange, not a governing function or entity” so HHS now needs names for a sixth term that will describe “the function or entity that governs health information exchange beyond the confines of a specific regionally based community.” Personally I think Mr. H and I should have opened the blog up and gotten readers to define the terms and then pocketed the millions HHS is spending on this project.
Transcription system provider Healthcare Technologies is partnering with GSA vendor Network Federal. The agreement will facilitate the delivery of HTI’s medical transcription programs to federal, state and local government healthcare customers.
EMR Dude sent me a link to his blog “The Crabby Daddy,” where he provides some commentary on the Allscripts-Misys deal, noting his ties to both companies (he worked at Medic and A4 and now Allscripts.) His take is that the market was in need of consolidation and sends a reminder to the new management that “people enjoy working for a company where quality of life and a fun factor are present.” Probably a good reminder if Misys is involved. Remember this post from a few months back? “From Dan Panama: Re: Misys. Vern said at the business update yesterday that an overwhelming number employees in the employee survey said they are not having fun anymore. Vern’s response: ‘You have to earn the right to have fun.'”
And while I was on Crabby Daddy’s site, I noticed a post about the Common Ground Clinic going live on EMR. This is one of the New Orleans clinics that received funding from HIMSS (and Allscripts in this case) to fund EMRs in the Katrina aftermath. It’s led me to wonder how many other clinics have successfully gone live as part of the HIMSS Katrina Phoenix project and what applications they are using.
I sat in during part of HIMSS’s first virtual conference last year and found it interesting enough, especially for a person who lacks the discipline to listen to a webcast without checking e-mail and taking the occasional phone call in between things. I am almost positive that the first time around that you had to pay a fee if you wanted to participate in the education sessions for CME credits. However, for this third one coming up April 23-24, I notice the whole event is free. Plus there seems to be a strong list of speakers, including Jonathan Bush, Matthew Holt, and John Halamka. I have to assume the exhibitor packages (which start at $5,000) are selling like hotcakes or else HIMSS wouldn’t be offering the conference at no charge.
I am sad to report that I a clear loser in the basketball pool. I knew my selection of Duke was risky, but who would have guessed they wouldn’t make it past the second round. My sole consolation at this point is that I am ahead of Mr. H, but given North Carolina is his top choice he still has a good chance for a strong finish. I’m cheering for Davidson here on out.
A reader heard that MUSC was implementing the Oacis clinical data repository/EMR along with McKesson’s Horizon clinical systems and asked me to find out more. CIO Frank Clark was quick to offer to let HIStalk’s readers know what’s going on in his organization. Some interesting projects, as it turns out, of which the Oacis implementation is certainly one. Thanks to Frank for letting me call him at home to chat.
Tell me a little bit about your organization and what kind of projects are happening at MUSC.
We are a freestanding academic medical center. Our mission is education, research, and patient care. We have about 800 physicians and another 300 residents and fellows. We operate three hospitals – two adult facilities, a children’s hospital, and a psychiatric hospital, for a total of about 850 beds.
Of course, we have the big outpatient clinics where the College of Medicine faculty hone their clinical skills and stay current. It’s probably a $1.6 billion operation enterprise-wide.
Tell me about your IT department.
IT has 250 FTEs. Most of those are centralized within the Office of the CIO. The combined clinical and academic operating budget is probably $35 million. The capital budget ebbs and flows, depending on the projects. We’re in the throes of a big clinical implementation of advanced point-of-care clinical systems within the hospitals, about two years into that and another year to go.
That’s all McKesson, right?
Pretty much. We’ve been a best-of-breed organization. When I came in about five years ago, we had a lot of stuff in place. We couldn’t rip it out and start things over from ground zero. We’ve got systems like Cerner lab, IDX radiology, and Agfa PACS.
We made a decision for McKesson as a preferred vendor. In fact, on Wednesday, we signed a large revenue cycle contract with McKesson . They have a new product, a new ADT, registration, and patient accounting product. We’re implementing their document imaging technology in the business office and also in medical records.
You have a PhD in mathematics. That’s got to be a difficult academic accomplishment. Do you find that’s a good fit for what you’re doing today?
I think I do. I’ve always been involved in computing, very early on as a user and more recently as a provider of services. I’ve always used computing in my academic career and in teaching. My PhD was in applied mathematics, so it had a nice fit for computational analysis.
I started out in an academic career and sort of drifted over into providing IT services. Then the CIO role become an established C-level position, so I moved into that.
How do you run things with regard to IT governance?
Governance is essential to good IT service and a good IT environment. It was one of the first things I set about to establish when I came in here. With any organization, the first thing I’d put in place is a well-defined IT governance structure.
We have various committees that represent different factions of the organization — the clinical, the education, the research, the infrastructure — and we structure that and have it well-documented and then get buy-in from the leadership. I think the key to that is constituting those committees and councils with the right people, people who have an interest and a passion and have the time and who are going to participate in the settings. That really forces stakeholders to take ownership and responsibility. It doesn’t put all the responsibility on IT.
Often issues will come up and people will automatically say, “That’s an IT issue”. Because it has some computing faction to it, people just want to default to IT. The governance really forces users to look at workflow and process and management issues. More often than not, it’s not a technology issue. It comes down to poor workflow, poor process, poor management. So it really pushes back. It doesn’t let people dump on IT. It really forces people to take ownership. It brings people’s common interest and needs together, and looks at technologies.
I think it avoids duplication and re-duplication of functionality because it forces people to look at the inventory of stuff that you already have. Often, people just automatically say, “We need to go out and get a system for this.” More often than not, that functionality exists, so if it meets 85 or 90% of our needs, then we’re not going to go out and buy another system.
What would you say your most important or most pressing projects are right now?
These clinicals that I mentioned, which are nursing documentation, barcode administration, meds administration, and CPOE. We have a lot of research systems that are going on. We’re trying to really streamline and organize the research process. We do about $200 million in funded research and we want to try to scale that to $300 million over the next four or five years. So we’re working with those provosts of research, reorganizing that whole research support sector. Once they’ve identified their strategic imperatives, goals, and objectives, we will look at how we can use technology to assist them.
Going back to the governance issue, it forces people to not just look for technology solutions, but to identify what their strategic imperatives are and their goals and objectives. Then, from an IT perspective, we try to align our initiatives in support of those goals and objectives so we don’t get the cart before the horse. Often this happens — people tend to throw technology at it. It’s been my experience that if you’ve got a bad process and you automate it, you just it do it bad faster. I think that governance helps people to realize that technology is not the panacea or the magic elixir.
So if you’re with McKesson that means you’ve got Meds Manager, HEO, AdminRX, and HED, probably. Tell me where you are with those and what you’ve learned along the way.
Meds Manager is fully deployed. Expert Documentation, we’ve got half of those beds that I mentioned a moment ago. CPOE, we started the initial roll-out in April. AdminRX is probably, like Expert Documentation, about half rolled out.
I guess the vendor is not always right. They still have problems. You would think that as many implementations that they’ve had with these products that most of the issues have been worked out, but I guess that’s not always the case. The people on the ground, the McKesson people who are here on site, are often not the most knowledgeable or the most skilled.
What I’ve learned is that you try to identify within the organization, say McKesson — and it’s huge — it’s a difficult challenge to find the right person to get the right answer, rather than trying to work through the people who are here. I know McKesson doesn’t like that. They like for you to work through the team and the protocol, but we don’t do that.
We just had a team go to McKesson’s clinical brain trust outside Boulder. We send a team out there twice a year. They talk with the right people. So you establish names and contacts. These are the people that we go to when we have issues. That’s been my experience and it’s proven to be successful. That’s just the way I work. McKesson can like it or lump it.
If they’re not performing, we just don’t pay them. Of course, we’re a big McKesson client, so it doesn’t take long for the AR to build up. When it gets to be a million or two million dollars, they pick up the telephone and they call you. I say, “Well, look, when you start performing, I’ll start paying.” I think that’s one of the advantages of the single vendor. You’re doing so much business with them that you really show up on their radar screen. If you stop that revenue stream, it doesn’t take long to get their attention.
You’re hitting some big change management projects that involve a lot of clinical users. What kind of structure are you putting in place, on the informatics side, to get this done?
Going back to the governance model, big projects like this call for an overall steering committee. They’re at a high level, the 50,000 foot steering committee that makes the very big, broad decisions. For each of those products that you mentioned, there’s an implementation oversight committee or council that has people at the operational level. They look at workflow and change management. How is Expert Documentation going to change the way nurses deliver care?
We spent a lot of time before the implementation in thinking through that and talking with other organizations like Vanderbilt and Duke, organizations in our state — Spartanburg Regional and Anderson. These are community-based McKesson clients. Talking with counterparts — “How has that changed the way you deliver care and the workflow?” We’ve really paid a lot of attention on the front end to those kinds of issues.
What are you looking at in terms of success metrics?
Being an academic medical center, we have access to people who are very helpful, skillful, knowledgeable, and experienced in this area. A lady who is in the College of Health Professionals — we bought part of her time. She has worked with the nurses to identify metrics. She did a baseline on these metrics. Like how long does it take to do assessments and how long does it take to get vital signs into the chart?’ Now she’s gone back, once we got a sample size large enough, and done the post-measures.
We’ll do the same thing on trying to measure the reduction of adverse drug incidents. On CPOE, we’ll look at the reduction in lab orders like Chem7’s and portable x-rays. So, we have some well-established metrics that we are measuring. We will report those out. The same thing is true in the perioperatives, OR and anesthesiology. Measuring throughput. We’ve been able to move more people through the OR. Also, the anesthesia coding and charting. We’ve got a project to measure that as well.
How are you going to implement the Oacis repository?
Oacis has been in here since 1994 or 95 and its predecessor before that. Don Simborg started that company many, many years ago. So they’d been in here a very long time. We have a number of very knowledgeable Oacis users as well as IT people. We know Oacis probably as well as anybody, collecting data and the ODR, the clinical data repository, since ’95. That’s thirteen years of clinical data.
It’s rather elegant. The commitment I made when we signed the McKesson contract was that if the McKesson Physician Portal, which is their physician viewer, was not superior to the existing product, we wouldn’t change it out. So about a year ago, we began to look at installing the portal and we got our physicians to look at it. They said, “No, this won’t work.” It won’t work in an academic setting because most of the work is done by the house staff. A resident might have to cover 80 patients, so its not like a community-based physician who comes into the hospital and has one or two patients. The portal is great for them. I had installed the portal in a community-based setting and it worked well.
I thought it had matured and evolved over time, but when we looked at it a year ago, in my judgment, it hadn’t evolved much. So we came to the conclusion that it would not work. It just so happened that Emergis Oacis had a new release, a Java-based release of the viewer and the repository, so we stuck with it. We’ve rolled it out and it will be our enterprise-wide clinical viewer. We import Expert Documentation information into it. Physicians can launch CPOE out of it. So, it’s kind of a single sign-on type environment.
So you are responsible for doing the back-end integration with the Horizon database back into Oacis?
Yes. We’ve worked with Vanderbilt. Vanderbilt did it. It’s not a strategy that’s strikingly different from what is being done at Vanderbilt and Duke, which are both McKesson clients. In fact, Vanderbilt developed the McKesson CPOE. It was called WizOrders and McKesson licensed it. Vanderbilt has installed most of these products that you alluded to a moment ago — Meds Manager, Expert Documentation, barcode administration. They have a homegrown product that’s similar to Oacis called StarCharts/Star Panel. It’s something they developed there. It’s very similar. So they had cracked that nut as far as importing Horizon stuff into it, so we worked closely with them and emulated what they’ve done.
Do you think this will get people’s attention to look at Oacis as an alternative?
Yes, I think it will. In fact, my counterpart in Greenville, Doran Dunaway of Greenville Hospital System, which is one of the largest hospital systems in the upper state — he’s very keen on it. I don’t know whether he’s signed the contract. He looked at the Vanderbilt StarChart/StarPanel, which is being marketed. He looked at a number of different products. He came to the conclusion that it was as good as anything around.
Who’s commercializing the Vanderbilt product?
It’s called ICA, Informatics Corporation of America.
That’s right, I know those fellows.
They’ve got an install in Bassett Health in Cooperstown and it’s being used over in Memphis and it’s a nice product. We looked at it long and hard, but when our caregivers looked at it they said, “This is good, but what we have is equally good, so why would we change it out? If it was vastly superior then we could do it, but what we have is good.”
You’re right, I think the Oacis product is one of those jewels in the rough. It’s widely used in Canada and Australia. Texas Southwestern Medical Center uses it. A lot of people jettisoned it in the nineties –- Atlantic Health, University of Chicago pushed it out. I guess we were on the threshold of doing it until we looked at the McKesson portal and it wasn’t a good fit for academic medicine in our judgment.
As a matter of fact, we signed the contact with Emergis to put in their data warehouse. That’s a Sybase product. We’re in the process of bringing it up. It will be a true research warehouse. In the past, we’d gone against our transaction systems to extract data, but we’ll pull stuff out of our production systems and put it into this warehouse. The schema is optimized for research.
You’ll be able to take your data that’s historic, since you’ve got all that longitudinal data, and move that over to the warehouse?
Absolutely. We’ll pull out all thirteen years, extract it out, put it into Star schema, and optimize it for research.
That’s interesting. What kind of projects do you think will come out of that?
Any of the principal investigators of clinical trials, research … as I said, we do about $200 million now and we hope that the warehouse is going enable us to grow that in scale. Most of it is NIH-funded research, but we do a lot of clinical trials. I think it will make it easier for the researchers to get access to patient data and financial data. We’ll use it for outcomes, accreditation reporting, and CMS.
It will be the gold standard, the system of record. We hope that we can terminate the existence of a lot of these pop-up databases. We’ve got a myriad of them and hopefully we can consolidate it all into the warehouse so we’ll know that any information that leaves this organization came out of that repository, that warehouse, and hopefully it’s accurate and consistent.
Other than Oacis, are there any other applications or vendors that you’ve run across that you think, “Wow, the average hospital has probably never heard of this product or this company, but it’s really cool and it’s doing a lot of good for us.”
There’s a product called Novo out of Georgia.
Novo Innovations.
Yes, Robert Connely. I think Robert is a smart guy. He used to be with McKesson. I think that product seems to be on a very strong trajectory. They seem to be really winning business.
Any kind of tools or anything you’ve found made a big difference or fixed a major problem?
No. I think it’s difficult for these niche players to break in because of the really big players like McKesson, Cerner, Eclipsys, Epic, and GE-IDX. I think more and more organizations are going to move towards preferred vendors because most of these big players now have a fairly robust suite of products, both clinical and financial.
It’s going be difficult for these small players to continue to exist in the major product areas. In the small niche areas, they’ll continue, but for basic HIS kind of stuff, I think its going to be difficult and for standalone labs systems or standalone PACS. We see the integration of radiology and PACS. All these big players have that product now, so I think it’s going to be difficult for some of the small players to continue.
The HIMSS leadership survey seemed to indicate pessimism about funding, capital, and IT resources. Are you seeing any effects?
The housing market is in a rut, but people will continue to get sick and continue to need care. All the predictions show that by 2017 we’re going be spending $4.3 trillion. I don’t see that dissipating.
We seem to be doing OK. Our margins are very respectable. As I said, we just opened the new adult hospital. So I don’t see that healthcare sector being impacted by this so-called bad economy or recession. I think the demand for healthcare will continue to grow. People will continue to get sick and need the service. I don’t see the pessimism, unless it’s a spill-over from the general mood of the country.
Do any vendors stand out as either very well positioned or struggling?
I think Epic is in a good position because of their work with Kaiser. As you know, with the relaxation of Stark, hospital systems are going to do more with community-based physicians. Those organizations that have a suite of products which allow them to do that, I think, are going to be in an attractive position.
All the big players are scrambling to integrate the outpatient and the inpatient. I think that world is going to change. In the community-based setting, it’s always been bifurcated, but the model is going to be more like us. More like the academic medical centers, where you have a closed staff model; and more like what we’re trying to do with Oacis and the viewer is to have an enterprise-wide clinical environment, where a caregiver can access a patient’s information and it’s transparent to them as to where this information was gleaned, whether it was captured in the clinic or whether it was captured in an acute care facility.
With the relaxation of those laws, I think hospitals are going to be able to woo physicians and say, “OK, if you will bond with us, if you will only admit to us through this ASP model, we’ll provide an electronic medical record. We’ll house your data. It will be your data." I think that’s an issue that will have to be resolved — who owns this data. Hospitals will be able to say, “We’ll host this and you won’t have to outlay any cost”. So it think those vendors that are positioned to do that, and I think Epic is because if all that work with Kaiser, I think they’re going to be in an enviable position. I know McKesson is scrambling to try to close that gap. That’s true of Cerner, GE IDX, and others.
Anything else important going on in your world that we can talk about?
We are just trying to finish out this clinical implementation and start the revenue cycle because that’s where the money is. We’re trying to capture more of the money and collect more of the money. It all goes to the bottom line and provide the margins to fund other kinds of things.
One of the big buzzwords was PHR. A lot of the big players are moving into that, players like Microsoft and Google. McKesson has RelayHealth and, I’m sure Cerner and others. Medem, I don’t know if you’re familiar with them …
Yes. Ed Fotsch.
They look very attractive and I think they’re well positioned to do that. My understanding they have partnerships with Google and Microsoft. I think they are going to begin to gain a lot of this market share. That will be a big initiative to us — driven by marketing — trying to have more of what people want and that is online services: read the bill, pay the bill, do some pre-admission/pre-registration scheduling, online consultation with physicians.
We don’t have a lot of referring physicians, but we do have some physicians who have a special case, a transplant or whatever, and they need to move their patient into the center here. How do we push information or pull information back to those referring physicians? Also, as consumers take more control of their healthcare, they will want these health records stored somewhere. So I think that’s going to be a big push over the next few years.
From Fresh Prince: “Re: P4P. There are several patient satisfaction measures in P4P that makes it a horse of a very different color. Medicare will hold back 5% of total Medicare payments, then you have to ‘earn’ it back through quality measures, like patient satisfaction surveys. I think it’s inevitable that it will turn hospitals upside down more so than DRGs in 1983. Think about this: you can give the patient the best medical care on the planet, but if he/she has to wait four weeks for an appointment, gets bumped due to ER cases, or has to sit outside X-ray for an hour, do you think they’ll say they are satisfied? Oh yeah, and what about that hospital food? There isn’t an HIS system out there ready to deal with it.”
From Artie Lange: “Re: eClinicalWorks. eCW may have implemented their systems in MA, but looks like they aren’t working. I wish you would have asked their CEO a question on this.” Link. Reported here earlier – Mass BCBS says EMRs aren’t worth the cost to doctors. But, that has nothing to do with eCW or any other EMR not working. In fact, it says the opposite – that EMRs provide value to everybody except the physician who’s expected to foot the bill. I agree that I should have asked Girish about this – it’s a conundrum that isn’t going away soon and I bet he has an interesting take on it. Maybe he’ll respond.
From LaToya Jackson: “Re: Walnut Creek. I’ve heard that there is a big Epic implementation going on in Walnut Creek, CA. I think this would have to be Kaiser or John Muir. Kaiser is a known Epic site but, I thought that JM was a McKesson shop. Anyone know who is doing the project?”
Intercepted e-mail snips about Misys/Allscripts: “Misys has a huge client base running the old +Medic/Tiger product. In the new environment this old COBOL based system cannot survive for long. Just think of the product mix/mess these guys are in. +Medic/Tiger, Misys Vision PM, Misys EMR, Healthmatics PM, Healthmatics EMR, Touchworks EMR (and all the jumbled pieces that make up Touchworks), Imedica. What the heck will they be selling, and what will they sunset? [A Misys rep who lost a deal] had offered a 60% discount!!! … The two ugliest people in town just got married, and it’s scary to think of what the kids are going to look like.” A bit exuberant, perhaps, but I tend to agree in general. Few will buy until the dust settles, which will take at least a year. Neither company was exactly tearing it up on sales, so now competitors have another weapon to create FUD in the minds of those hospital CIOs and big practice administrators who tend to buy stuff like theirs. Does having Misys involved make Allscripts more attractive to prospects or vice versa? It wouldn’t to me.
To put the Allscripts dilemma into perspective, here’s how the shares of some publicly traded HIT companies did over the past year, sorted from best to worst.
Eclipsys – up 2%
Dow Jones Industrial Average – no change
McKesson – down 3%
Nasdaq Composite – down 8%
Quality Systems (NextGen) – down 18%
Cerner – down 31%
QuadraMed – down 36%
Misys – down 41%
Allscripts – down 66%
The two worst-performing companies will hold a shotgun wedding, with the one that’s burned through 2/3 of its shareholder value in the past few weeks providing all the management talent under the board oversight of former competitor that’s down 41%. I’m not seeing the magic, especially looking at the science fair of products soon to be under one roof. People keep talking about “footprint” and “combined sales”, but what would make you like the two companies combined that you didn’t like about them separately? Or, what synergies will help them boost sales against the same formidable competitors like eClinicalWorks, e-MDs, athenahealth, and NextGen? Sure, the Misys customer base has low EMR penetration, but so does the entire industry – that doesn’t mean they’re going to buy an EMR from Allscripts or anybody else, especially at high prices. Allscripts keeps trying to sell vision instead of results, while Misys just wants to protect its big but steadily eroding maintenance revenue from old sales. And the kicker is that fickle investors who were quick to bail out on Allscripts will now have even higher expectations for the MDRX/newco shares after all the flowery talk about synergies.
So, here are my predictions. Odds that the Misys/Allscripts merger will get shareholder approval (especially with John McConnell as a major MDRX shareholder): 60%. Odds that the proposed management team will survive a year intact: 40%. Odds that the market cap of MDRX will increase in one year after the deal closes: 20%. But, I’ve been wrong before.
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I messed up a couple of Inga’s links in the last issue, so those are fixed now. It wasn’t a devious ploy to get more readers for Scott Shreeve’s blog since that’s where the links mistakenly pointed.
Great idea: the Michael J. Fox Foundation offers up to $1 million in grants for the development of web-based clinical assessment tools for patients with Parkinson’s disease, which will allow clinical research to be performed without the burden of patient travel. Proposals are due May 14 and funding will be available in October. Thanks for that tip from the guys at Healthcare IT Transition Group, who also report that their cartoon announcing the HISsies winners has been viewed more than 2,000 times (the connection being, of course, that they portrayed Jonathan Bush as Marty McFly from Back to the Future in the cartoon because he kind of looks like MJF).
UCLA’s psych hospital, fresh off the Britney Spears debacle and a new incident where patient photos were published on a social networking site, bans cell phones and laptops.
Guess HIMSS gave up on the idea of blogging live from the conference. Its HIMSS Live! site now brings up a “page not found” error, although HIMSS still owns the domain. And speaking of fun domain name facts to know and tell, who knew that Cerner has pre-emptively registered CERNERSUCKS.COM?
Speaking of HIMSS, I checked the hotel site for HIMSS09. The cheapest Chicago hotel is $225 a night. I may Priceline it since that’s worked before.
A couple of folks expressed interest in producing something about medical device connectivity. I’m thinking we could put together an informal white paper for CIOs from multiple viewpoints. If you’re interested in helping, e-mail me. I’m curious to see if we can harness the collective knowledge of HIStalk’s readers to create something useful for the industry.
Inga wants me to brag on how well she and I are doing (for now) in the unnamed vendor’s NCAA basketball pool. We may have peaked Friday night, when a lucky Siena pick over Vandy (time for McKesson to buy the team?) propelled me to #1, with Inga right on my heels at #3. She was quick to conclude, “You and I are clearly geniuses.” Some bad luck since sent us to #2 and #8, respectively, and I’ve got some early losers going deep that will hurt me. I’m thinking of handicapping the pool by choosing schools that aren’t on the Most Wired Hospitals list.
Speaking of Inga, she’s in touch with HIStalk’s sponsors regularly and reminded me of something important. Some sponsors are interested only in page views and ad clicks like with any other advertisement (which is fine), but many/most of them support HIStalk because they believe in what we do. I can’t explain how gratifying that is. Magazines and other online sources would kill to have our loyal sponsors and readers. Just in case I haven’t said it lately, I sure do appreciate it. Thank you.
Deborah Peel renders an opinion on the data mining agreement signed by genetic medicine vendor Perlegen and an unnamed EMR vendor, calling it The New Tuskegee. I want to know who that EMR vendor is. Everybody seems to be beaming about their data deal, so let’s name names. If you know (and especially if you have documentation to prove it), use the confidential Rumor Report to your right to tell me about it. It’s ironic that the EMR vendor is demanding privacy about its deal to sell patient information.
British researchers are working on an enhancement to the Da Vinci robotic surgeon that will allow it to be controlled by the surgeon’s eye movements.
Rural hospitals in Tanzania are using the Internet, scanners, and digital cameras to connect with a referral hospital for telemedicine services, important in a country where transportation to the hospital can cost several months’ of the average wage.
It took a TV station’s intervention, but a Sentara Norfolk ED patient finally gets his medical record corrected to show that he had not, in fact, delivered twins there.
SafeMed, a San Diego decision support engine vendor, will provide Google Health’s drug interaction and treatment recommendation capabilities. Former Amicore CEO and Microsoft manager Richard Noffsinger is CEO. For those who say nobody ever sells anything at the HIMSS conference, Google execs happened to pass SafeMed’s HIMSS06 booth in San Diego and asked for a demo, which was followed by a deal.
Harris Corporation gets an HHS contract to plug federal healthcare agencies into the Nationwide Health Information Network.
I’m sure it will offend someone, but I’m still wishing you a Happy Easter in a non-denominational, rabbits-and-eggs sort of way.
From Gail Kafka: "Re: P4P. Do you or your readers have any data on the Patient Reported Outcomes market and the IT providers in it? I rarely see articles on this topic unless they are from academia or IHI/IOM. If P4P comes to be, which seems inevitable with consumer cost and awareness increasing, then why isn’t there more chatter about measuring performance from the patient’s perspective?"
From Larry Lezure: "Re: Misys/Allscripts. It’s a reshuffle of the deck with two players holding bad cards. All they have in common is overpriced products and getting their asses kicked by eCW, which will benefit even more as they try to retire products. The most interest part of the story is currency arbitrage — a UK company getting a big discount because of the low value of the dollar against the pound." New poll to your right: is the merger a good idea? So far, 76% say no.
From Stan Zloty: "Re: Medcomsoft. I know eCW doesnt like athena’s EMR, but looks like Medcomsoft sure does." Link. The Canadian EMR vendor gives up on direct sales and seeks partners to create an athenahealth-like business model.
From Nicholas Birdcage: "Re: medical devices. With today’s mention of device connectivity as well as Isarona, any thoughts at doing a piece on the players in these market?" I like the idea, but would need some help since I haven’t followed it all that closely.
Intellect Resources will host a webinar on becoming an independent consultant on March 25 at 8:00 Eastern. They’re also starting e-mail newsletters for job seekers and employers, with sample issues coming soon.
I hope everybody made the transition off the old Blog City HIStalk site. Put your e-mail in the "Subscribe to Updates" box to your right if you aren’t getting an e-mail blast when I write something new. You can sign up for the Brev+IT newsletter over to your right, too. And in looking over there, I just realized that HIStalk’s fifth birthday is coming in June.
My editorial this week in Inside Healthcare Computing: "In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System." A CIO e-mailed me to say he liked it, so I’m relieved (I bet the free mags don’t work a Speedo reference into many headlines, at least unless it’s one of those lame puns they love).
The New England chapter of HIMSS will host a killer HIT forum (warning: PDF) in Norwood, MA on April 9. Speakers: Senator Richard Moore, Blackford Middleton, Karen Bell, Francois de Brantes, Girish Kumar, and Jonathan Bush (there are other big names, including CEOs). Frankly, I like the lineup better than HIMSS, plus it’s one big day for $80. I should have had an HIStalk bash there.
Maine Medical’s CEO, Vince Conti, quits for unnamed reasons.
More on Misys/Allscripts. Most of the UK analysts think Misys is paying too much, while most US analysts think Allscripts sold out too cheap. Since the deal has to be approved by shareholders, that could come up in the voting. And, it’s subject to Allscripts getting a better offer, which has happened with similar companies (iSoft, for instance). I doubt John McConnell would make a run of his own on MDRX, but I wouldn’t rule it out. I just have this vague feeling that it isn’t over yet, especially since the response from all camps has been underwhelming.
Stock and HIT expert Sonomaca had some good thoughts on the Allscripts stock message board. He says it will help Allscripts because the company can focus on long-term strategy and not quarterly results. Also, since the market seems unimpressed from the current share price, ValueAct Capital could buy up more of the company. From his calculations, Allscripts shareholders get a Misys Healthcare for four cents per share, based on the one-time dividend (or, looking at the other side of the coin, the market is valuing the combined company at just $4.40 per share, or 10x earnings). Maybe that’s why the Brits were howling.
And in more Allscripts news, former star customer Tennessee Oncology is suing them.
Orion’s Rhapsody integration engine will be used to integrate systems in Saudi Arabia.
A Minnesota hospital admits that a chart error caused surgeons to remove the wrong kidney from a cancer patient, leaving the patient with only its still-cancerous twin.
Art Vandelay on Cerner
As Mr. HIStalk noted, Cerner is diversifying its revenue streams in a coming bear market. Cerner’s medical device and drug-development are long lead-time investments with major barriers to entry. The barriers include human capital, systems, and process & procedure knowledge to navigate regulations. They also have to handle new competitors. I see this strategy being copied by all the major clinical systems vendors.
The approach we will likely see from vendors will evolve to full venture capital investments. There is power in using some of the de-identified data that should be captured with the vendors’ systems to find potential investments. The vendors can then use the data to prove the value of further investment independent of the necessary FDA regulations (ex: 21 CFR 11). This could keep investors interested. To make this real for everyone, only organizations with "Stage 6" EMR deployment can reliably make this happen.
For Medical Devices, expect copycats to mimic Cerner’s CareAware or Cisco’s Cisco Compatible Extensions (CCX) strategies. Vendors will likely certify and partner as opposed to developing medical devices.
Is this a distraction from their core business? You bet it is. The vendors will view it as a necessary strategy to preserve their publicly traded prospects in a bear market.
What does this mean? Three things. First, R&D will be negatively impacted. The enhancements you expect from your vendors will be slower in coming. Expect the vendors to ask you to share the burden of investment for new functionality saying it is beyond standard maintenance arrangements. In other words, "great idea, you want the function, help us develop it (with your human AND financial resources)." Second, the privately-held companies will be even better positioned to weather the storm. Third, companies that are already diversified (ex: McKesson, Cardinal) have a chance to catch-up or pass their competitors if they focus their investments.
Inga’s Update
For the parsimonious (like Mr. H) here is a great list of free or cheap software products, with substitutes for such programs as Word and Adobe Photoshop plus anti-virus tools.
Time Magazine also published a recent article, Is shrink-wrapped software dead? which included a handy side-by-side comparison of the free solution versus the commercial option. The article’s title reminds me of the bright yellow tee shirt Jonathan Bush was seen wearing at HIMSS which said "Software Is Dead" – to the 4th power. Apparently Jonathan tried to convince his PR handlers to let him to wear the shirt for his CNBC interview conducted during the conference, but eventually was persuaded to wear a more Street-pleasing coat and tie.
I guess I didn’t sound pathetic enough when asking for advice on the NCAA basketball brackets. I had to fly solo on my selections and ended up picking Duke to take it all. I actually hope I am wrong because I have a favorite team I’d rather see crowned, but I wasn’t willing to risk my $10 bet on them.
From Nasty Parts: “I was one of the early guys calling the Misys/Allscripts merger. I’ve been talking to guys from both sides of that divide. Here’s the scary part: both of them think they are in charge. Could be a slow motion train wreck. Wait until the long knives come out and folks start fighting for their areas of authority - it won’t be pretty. Plus, we are not even yet talking about product go-forward strategies.” If Nasty is right, maybe John McConnell was the smart one to get out of the way now.
From Poo Flinging Monkeys: “Most Allscripts folks feel like they are getting the short end of the stick, as the big M is generally seen as a dead carp around someone’s neck. There are a LOT of folks who migrated from Misys to Allscripts who groaned out loud at the announcement. The Misys folks are a bit relieved as the last few months and years really have been obviously leading up to SOMETHING, but nobody knew what. All knew Vern was coming in, stripping it down, and selling it off. Most think that Misys EMR should have died a while back. The Allscripts product will be the flagship EMR and there will be an obvious push to get the Tiger folks introduced to it. Big open market there. The Allscripts PM is okay, but generally not as shiny and end user intuitive as Tiger, so there will probably be a push to interface those 2 products while sun-downing the Misys EMR product.” Heard that Misys had a town hall meeting for employees today. I doubt that Vern has answers to all the questions, particularly the one that employees are asking most: how does this affect me?
And if you haven’t heard enough on the topic, check out Scott Shreve’s posting at Crossover Health entitled The Lawrie Dowry: Misys Acquires Allscripts in Rushed Marriage. Lots of interesting points out the new “Allscripts-Misys-I-am-NOT-giving-up-my-name Health Care Systems” company.
Minnesota law will require all healthcare providers to use an EMR by 2015. It provides six-year, no-interest loans to help providers get there. The first two loan recipients are Swift County-Benson Hospital and Mille Lacs Health System, which are borrowing a combined $2.3 million.
I haven’t heard if Dr. Peel is gnashing her teeth on this one or not, but genetic research company Perlegen Sciences announces a collaboration with an unnamed EMR vendor for access to the clinical treatment and outcomes data on about four million patients. The information will be supplied from the EMR vendor’s information warehouse. Perlegen will use highly specific inclusion and exclusion criteria to identify and develop genetic markets for predicting patients’ likely response to specific medication treatments. What I find curious is that the EMR vendor remains anonymous. If this particular EMR company believes providing the data is ethical and not in violation of any customer agreements, why not allow themselves to be named?
Duke University will implement Premise’s PatientFlow Platform to facilitate patient flow across its three hospitals.
Big controversy brewing in Texas over who owns the ankle. Seems like podiatrists and medical doctors are both claiming it’s theirs to treat and are going to court to let a judge decide. Lawyers for the podiatrists claim “you don’t have an ankle” because is really part of the foot…no foot, no ankle. Of course the orthopedic surgeons say that if ankles don’t exist then why do podiatrists want to operate on them. Quite the conundrum obviously. I have been told I have nice ankles and I don’t think my feet are nearly as attractive, so I’m thinking I will go with the MDs on this. If the podiatrists win then I’ll have one less appealing asset.
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in February 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
I’ll confess that I’m paying minimal attention to the RHIO craze. Everybody’s starting one, conferences are showcasing speakers who’ve done nothing more than announce theirs, and tiny grants are getting the whole industry atwitter. It’s like living the dot-com frenzy all over again, irrational exuberance and all.
I’m not against RHIOs, but they’re as annoying as CPOE was awhile back, taking resources away from projects that could provide more benefits to patients without the minefields.
I recently interviewed Denni McColm, an award-winning CIO of a 74-bed rural hospital no different than 80% of those out there. Oh, except that they’re 100% paperless and 100% CPOE, something virtually none of the celebrity CIOs and Taj Mahospitals have been able to accomplish. I’ll listen to her, thanks.
First, Denni believes that organizations should be banned from using the word “interoperability” until they can bring their own electronic information to the table. If your IT house isn’t in order, RHIOs don’t need you. Anything short of everyone’s contributing information equally will cause the whole concept to collapse like an imploded 1960s Las Vegas hotel, so paper jockeys need not apply. Work instead on projects that will help your patients more than the begrudging swapping of routine lab reports with your cross-town competitor. Or, integrate all those systems you already have. Your admission ticket should be a checklist of what data elements you can supply electronically right now.
Second, Denni advocates a patient-centric RHIO model instead of the common payor-centric one. Do you like insurance companies enough to let them control patient information?
By patient-centered, I don’t mean personal health records. People are too irresponsible to reliably collect and store data with life and death importance. On the other hand, they could be given control over the trusted information generated by hospitals, physician practices, and other providers.
Suppose everything resided in an Al Gore-type lockbox that contains everything from discrete electronic data to scanned documents fed over the Internet. Either the patient controls the key (similar to a password) or only they can initiate data delivery to a provider. If they don’t want you to see it, you won’t.
This model makes most privacy concerns go away. It avoids the largely unsolved problem of how you assign some sort of universally mandated patient identifier (aka “political suicide”) to sort out the throngs of people sharing the same name. The patient simply says, “send my data to Dr. Jones” and it’s done. They keep control and there’s no arbitrary “regional” service area beyond which lies a medical no-man’s land.
Maybe some RHIOs work this way. Like I said, I don’t follow them. And, if I can’t see a quick and obvious patient payoff, I probably won’t start following them any time soon. I’ve got plenty of challenges working on clinical system projects that will hopefully save lives right now.
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From Joe Bob: “Re: consultants working on percentage of savings. I find it not only deplorable, but outright thievery and total ignorance. Children’s Hospital National Medical Center is an example. They were a top pediatrics hospital, then a new CEO hired consultants based on percentage of savings. The hospital is out of top 20. P.S. Hasn’t everyone had enough of HIMSS and their organization, or is it just me?”
From The PACS Designer: “Re: One Portal. TPD mentioned the concept of looking at personal health information in the same light as a personal online banking account. Now it comes to light that Denmark has had an online health portal for recording your health history called One Portal since 2003. It could be used as a model for other countries to emulate and get the PHR/EMR process started as an online solution.” Link.
From Niven David: “Re: economic concerns. I would have to imagine many vendors and hospitals are seeing an impact from current economic concerns, with sales slowing and hospitals tightening the purse strings. Any comments or perspectives?”
From Reggie: “Re: Allscripts. There is a rumor that McConnell quit the Allscripts board in disgust at what he felt was a low-ball offer.” It must sting. Allscripts, Glen Tullman, and John McConnell were on top of the world and McConnell’s former company Misys was on the ropes. Suddenly, one bad earnings report sends MDRX stock reeling from the high 20s to below $10, allowing Misys to gain control on the cheap. What could be lower on the HIT totem pole than having Misys as your new daddy? I bet Glen Tullman won’t like reporting to the board-controlling Brits very much. Can two struggling companies combine to make one good one while maintaining their traditionally high prices, complex technologies, and indifferent customer bases, not to mention keeping their antsy shareholders happy as the inevitable product and people consolidations occur? In this market, with nimble competitors nipping at their heels, and with the current economy, let’s just say they’ve got plenty of work to do. I expected a much better outcome for Allscripts. Mothers, don’t let your children grow up to be publicly traded.
Update: John McConnell did resign in protest from the Allscripts board Monday night. See the comment I posted at the end of this article.
From Reggie: “Re: Allscripts. There is a meeting in New York tomorrow where both Misys and Allscripts management teams will answer analyst questions. I am not clear on whether this was an emergency meeting designed to convince obviously skeptical Allscripts shareholders that this is a good deal. On paper, this is a $13 deal, which is why Tullman described it as a ‘big premium.’ Since the stock closed at $9.75, the market has priced in $3.25 worth of doubt about the combined entity’s prospects. Clearly what Allscripts needed was the help of a big operator like GE, Perot, CERN, or EDS. Were any of these companies interested?” Surely others peeked up their skirt and passed before Misys got a turn, although the overused prospect of synergy has led to many a troubled marriage.
From the conference call announcing Allscripts-Misys Healthcare Solutions, Inc. (boy, talk about an uninspiring first decision – that name reeks, at least when it’s not screaming “YOU give up your name – we’re not budging on ours.”) Sounds like some products will not be developed further (the first step to sunsetting, of course). Synergies are predicted. They like the idea of selling into the minimally EMR’ed Misys customer base (which Inga suspects means that Misys EMR and A4’s EMR are goners – they can’t walk in the prospect’s door waving competing systems). They talked about merging a year ago, but Allscripts was too expensive (the stock market took care of that little problem). I heard the two companies huddled hard for days right before HIMSS, which I assume means they desperately wanted to make the announcement there.
Someone sent me the communication sent from Misys to customers. Other than the sudden love between two formerly bitter competitors, the most interesting point was the standard boilerplate, “connect all stakeholders through the continuum of care.” Wasn’t the utterly failed Connect strategy of Misys supposed to do that? And do stakeholders, in the form of customers anyway, really care about connecting to the rest of the continuum of care? Only if you’re trying to sell to hospitals and their affiliated practices, which the new, badly named company will try to do.
Lost in the shuffle: Misys PayerPath and Home Care. They probably should deal off the latter to Sunquest or somebody, but PayerPath has promise with a bigger sales footprint (unless they sell it off for cash to QuadraMed or McKesson, which wouldn’t surprise me since it isn’t even being mentioned in all the pleasantries).
HIStalk ran plenty of speculation from readers that the Misys-Allscripts deal would happen. I admit that I was skeptical, but I said all along that bringing in ValueAct Capital was a sign that Misys wanted to shed its healthcare lines. All of you who called the shot early – nice going. Nobody else was even talking about it until it ran here. Even the high-powered analysts at the HIStalk HIMSS event were buzzing a little because I’d mentioned it the night before, plus HIStalk readers had just voted Allscripts “most likely to be acquired.” Smart readers. I didn’t mention it, but the Allscripts PR person tried to get me to kill the HISsies because Allscripts didn’t want to be named as an acquisition target. For good reason, as it turns out.
Connectologist (you know him) posted a very nice writeup in HIStalk Discussion about medical device connectivity. This stood out: “A perfect day for an IT person is to fix every problem that comes up from their desk, monitoring systems, rebooting servers, documenting support, etc. A perfect day for a biomed is to go to the point of care and work one on one with clinicians solving problems with training, problem diagnosis, and repairs. This is part of the ‘great divide’ between biomeds and IT.” Worth a read.
Thanks to the 134 of you who responded to my consultant survey. Great information. I’ve e-mailed out the results to those who participated and supplied an e-mail address. A reader already contacted me and said the results were helpful in making a career decision, so he or she appreciates it. Also, thanks if you completed my reader survey, which I’ve now closed. I saw some very nice comments there, so I’ll have more about that once I’ve digested your thoughts.
Fair Warning did a webcast last week on EMR privacy and compliance challenges, including HIPAA enforcement. John Wade was one of the presenters and over 400 folks tuned in. It’s archived for playback.
Jobs: Manager of Lab and Pharmacy IT, Clinical Information Systems Analyst, Manager of Clinical Support Systems. That first listing had an ingenious leadoff: “If you attended the HISTALK party at HIMSS, you know that the ‘most significant IT sale of 2007’ was the Epic contract with Cedars Sinai. I guess that would make these the ‘most significant HCIT job opportunities of 2008’. Read on.”
Medical device data integrator iSirona gets a $1 million private placement. Joining its board are industry long-timers Carl Witonsky and Jim Hall.
Ohio State and Wake Forest Baptist choose the ClairVia staffing system from AtStaff.
Little doubt about it: the iPhone will be big in healthcare.
Thailand medical tourism hospital Bumrungrad International, birthplace of what’s now called Microsoft Amalga, installs the first robotic drug management system in Asia, going with Swisslog. The hospital’s CEO, Mack Banner, appears to be an American from his educational background, which I didn’t realize.
The Australian Medical Council will move its Visual Basic systems to the web-based Ruby on Rails platform.
Merge Healthcare delays yet another SEC filing, this time its annual report. I swear its accountant must be a moonlighting shoe salesman from the local H&R Block.
Holy Cross Hospital (FL) chooses the E/Point ED charging application from LYNX Medical Systems (aka Picis).
Two doctors who were sued for $67 million by John Ritter’s family are acquitted. The family already received $14 million in settlements from other clinicians and a hospital. I don’t mean to speak ill of the dead, but I never found his mugging, camera-aware style anything more than annoying, but to each his own. It’s still a shame, of course. Maybe he really would have made another $67 million in future earnings like the suit claimed. Your Honor, I call Adam Sandler to the stand.
What else could they mess up? Haywood Regional Medical Center (NC) fires a nurse and former Army lieutenant colonel for giving state inspectors information about hospital medical errors committed there, saying the Army taught her to discuss and fix problems, not hide them. She’s suing. So is another former hospital employee turned whistleblower who was canned for giving CMS information about medication errors (CMS agreed and stopped reimbursement to the hospital). The loss of 68% of the hospital’s revenue led to the resignation of the hospital’s CEO, board chair, HR director, and nursing VP. Now the hospital is fighting the press to keep the former CEO’s compensation private despite its being public record. The board is thinking about selling the facility. Good idea.
Inga’s Update
DR Systems announces nine new contracts for Unity RIS/PACS worth more than $3.8 million.
Thomson Healthcare releases its 15th annual 100 Top Hospitals. To come up with the winners, Thomson analyzes data from Medicare Provider Analysis and Review data for 2005 and 2006 and Medicare cost reports for 2006 and evaluates hospitals on eight measures of clinical quality, operating efficiency and financial performance.
Does anyone care to explain this MedCom Soft press release for me? Is there: 1) no real message at all; 2) an announcement they want to increase US marketing efforts; or 3) a well-hidden announcement about “right-sizing” the organization?
Walgreens announces its new Health and Wellness division that will manage its health centers and pharmacies located at large-company work sites. They are also buying a couple of companies providing work site health centers, raising their total number of work site and retail health clinics to 500. Walgreens estimates the potential for onsite work site clinics will grow to 7,600 corporate campuses with at least 1,000 employees each.
One of our fun sponsors asked Mr. H and me to participate in a NCAA basketball pool (I am not naming them in case the IRS reads this blog, even though they claim winnings go to charity). I was hum-ho on the whole thing until I read this section of the memo sent to all employees: “This year, we have added a Group Message Board option, which is a convenient outlet for those of you who may want to elaborate on their respective bracket picking strategies, defend seemingly half-witted picks, talk smack, or just have daily alternative to your Mr. HISTalk addiction.” I may have to participate to ensure folks don’t inappropriately make basketball more important than HIT gossip. Since I like winning and don’t really consider asking for advice equates to cheating, feel free to send me your best picks.
From Insider Outsider: “In regards to your note about Bill Gates appearing before the US House Committee on Science and Technology, and his predictions, my only response is …yawn. Bill G. has never been one to have very good or accurate predictions. He is usually very general – ‘technology will get smaller and faster’ (duh) or he is very wrong ‘within 5 years, all computers will use voice commands and the mouse will disappear’. Billy G. predicted that spam would be solved in 2 years (still waiting), that OS/2 would be the most important operating system of all time, that no one would ever need more than 640k of memory, etc. Yeah, he’s gotten some right, but even a broken clock is right twice a day. He made his fortune by buying someone else’s technology and reselling it. He’s the used car dealer of technology. As for the future, his best picture of the future is to look at what Steve Jobs is doing and to copy that.” Yeah, but he’s rich. Doesn’t that count for something?
My favorite part of the interview with eClinicalWorks Girish Kumar Navani was is brief commentary on various vendors. You have to be pretty confident to swagger the way he did.
Thanks for all the Linked-in invitations. (Do people like Linked-in and other network sites because it makes them believe they are popular – or at least have friends?) Regardless, it helps me with my swagger.
Misys announced this morning in London that it will spin off its US-based Misys Healthcare Systems and merge it with Allscripts, paying $330 million in cash for a 54.5% stake in the combined entity through a complex financing arrangement that also involves hedge fund ValueAct Capital, which will underwrite a new share placement to finance the transaction.
Glen Tullman of Allscripts will remain CEO, while Misys CEO Mike Lawrie will become chairman of the board. Misys will appoint six board members, with four from Allscripts. Allscripts shares will continue to trade under the MDRX ticker and the new company’s headquarters will be in Chicago.
The announced name of the new company is Allscripts-Misys Healthcare Solutions Inc.
Misys shares are up 20% on the London Stock Exchange.
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The poem: Well, it's not it's not the usual doggerel you see with this sort of thing. It's a quatrain…