News 4/15/09

From HIPAA Hound: "Re: another example of poor privacy practices. Perhaps more disturbing than the loss of the patient data was that affected patients were not notified of the compromised information for a full 30 days." Link. A laptop belonging to Moses Cone Health System (NC) and containing information on 14,000 patients is stolen from a VHA office in Georgia, which was doing quality analysis of the hospital’s data. The hospital said it regrets waiting a month to let the affected patients, employees, and the public know. The laptop wasn’t encrypted, of course, and the hospital didn’t say why sending the VHA a laptop was the best way to get them data. If anyone can think of ways to screw up that the hospital missed, please let them know. And in a similar story, Southwest Mississippi Regional Medical Center finally comes clean to patients after a PC used by the billing company of its radiology group is stolen — in February.

From Skip Stephenson: "Re: diagnosis code for a tree growing in your lung?" Link. Russian surgeons looking for a suspected lung tumor instead find a fir tree growing in the patient’s lung. Also from Skip: a surgery nurse at Dean Health (WI) is called out of the OR by her manager so she could be laid off. Now those are stories you won’t read elsewhere.

From The PACS Designer: "Re: native virtualization. As we hear more about the virtualization concept in daily media presentations, it appears that still more education is warranted since there are still doubts about its versatility. Sun Microsystems has just released a new open source software version for its VirtualBox. It will give experimenters the ability to apply ‘native virtualization’ to their installed systems using a desktop workstation" Link.

From Just the Beginning: "Re: Google Health. Blasted for data inaccuracy & raises questions about data exchange." Link. I don’t blame Google, at least not entirely. Hospitals are so terrible at capturing and exchanging complete, meaningful patient information that billing data is about as good as you can get (arguably better than nothing). Google’s mistake, if it made one, was either (a) not letting patients know that its information is suspect, or (b) trying to roll out a fully functional PHR knowing that it’s way too early to expect much in the way of available information except what the patient is willing to type in, so then dropping back to claims data to sex it up a little.

From Daryle Lamonica: "Re: eHealth Initiative. Interesting way to recruit a CEO. Saving executive search fees?" eHI e-mails out a notice of its job search, providing a direct link to its site to apply via its law firm.

From TrashTalker: "Re: the incestuous relationship between CIOs and their vendors. Sad but true. When is the healthcare industry going to wake up and kick these self-promoting, mostly non-tech CIOs out?" If you’re a Maslow’s Hierarchy of Needs fan, they are just attending to their basic and safety needs, thinking that buying the big-name products is not only safe, but also a better path to a future job should one be needed. And, buying same-vendor application clusters (all clinical apps, for example) from the same vendor provides that "one number to call" peace of mind even though it drives clinicians crazy to be overridden by a CIO looking out for #1. Every provider I’ve worked for, mostly big ones, encouraged clinician input into product selection, but then ignored it in buying more stuff from the same old underperforming vendor. The predictable result: low utilization ("you asked us what we wanted, we did the research, then you just ignored our recommendation and bought what you originally wanted").

From Hello Kitty: "Re: ACS. Rumor has it that while ACS Healthcare Solutions is announcing the Marin outsourcing deal, they are losing Southwest Washington and Princeton." Unverified.

From Cheezborger: "Re: ‘the power is in the network, not the desktop’. While I agree that there is power in simply getting data online now (e.g. access, potential for analytics, personalization, etc.) we can’t put the chicken before the egg. In other words, how do we think the data is going to get there in the first place? We often seem overly focused on the end effects of the EMR without giving enough respect to the concept of GIGO. If we can’t create an EMR that makes it easy to input and read data, then don’t expect too much from the output. While INTEROPERABILITY is a big buzz word due to this network effect concept, I’d strongly argue that the real key is USABILITY – we need systems that allow for easy interaction (better input of data, better display of data) before we need to worry about how they will share data. Said a simpler way, there is no payoff without use. What was so nice about Dale’s ‘story’ was the incorporation of both these facts — creating easier systems to engender utilization, then using the network effect to make the systems even easier and better to use!"

From Da Bear: "Re: Chicago. Chicago is the greatest convention city in the U.S. My company has also exhibited there annually at RSNA. But for crying out loud, can we settle on a month that is actually nice? RSNA is locked in the Daley Machine’s death grip and can’t move off their post-Thanksgiving date. HIMSS is under no such political obligation. Late May is usually wonderful."

From Bill Kinsella: "Re: Qualcomm video. Like the fake article Lyle sent you, the following Qualcomm (or is it??) video is worth a peek. I don’t know whether this was produced within Qualcomm or by a competitor." Link. "We came up with this idea to implant tiny base stations into thousands of pigeons and have them fly around and form a dynamic network." Pretty funny and very well done. Bill sent the YouTube link, but I found it directly on Qualcomm’s site, so they’re going all viral on us.

Now that we’re back into the usual post-HIMSS routine, we’ll get back to the interviews, HIT Moments, etc. If you know interesting people we should talk to, let me know.

Listening: new from Metric, indie/pop/new wave from Canada. Video here. Kind of a Throwing Muses meets the Pixies sound if you ask me. I like it very much.

University of Florida Physicians posts its Epic outpatient project Web page.

The authors don’t claim a high correlation, but this study suggests that states with strict privacy rules have a lower EMR adoption rate, but that the network effect means each hospital that implements electronic medical records increases the chances of others doing the same. I wouldn’t bet the farm on the privacy correlation since I can’t imagine hospitals sit around worrying about that, but certainly the lemming-like behavior of many hospitals makes the second conclusion reasonable.

New York City’s health department uses drug company marketing techniques, such as memorized pitches and free pens and condoms, to educate doctors on desirable practices.

Eric Fishman, MD (of EHR Scope, EMR Consultant, MCM-Medical Content Macros, and Dragon reseller) is the mastermind behind EHRtv, a wide-ranging series of professionally recorded interviews and tutorials by Dr. Eric himself. I’m enamored with the video quality, the layout, and the idea, especially since I saw him doing interviews for it at HIMSS. He captured some of the HIStalk reception and speeches, not easy since we had low light and iffy audio, and it’s a fun watch. He caught a nice speech there by Todd Cozzens of Picis.

Students from four big-name MBA schools participating in a "war game simulation" last week make interesting predictions: (1) EMR resistance will remain high, but P4P may help; (2) there won’t be enough HIT experts to implement all the EMRs being sold; (3) Allscripts and Epic will use cloud computing to drive down the cost of today’s client-server systems and make them affordable to small medical practices; (4) risky EMR implementations will push small medical practices to band together or merge; (5) Kaiser Permanente will take an active role in setting EMR-related best practices and standards; and (6) McKesson will use its logistics and value chain to increase its provider and payor IT offerings. I’ll say this: all sound reasonable, even when taking the dynamics of the organizations into account.

On HIStalk Practice, we’ve got a couple of docs sharing their thoughts about the HIMSS conference.

Excluding the university president and coaches, all of the 21 people at Ohio State University making more than $500K work for the medical center. The university claims that both the jocks and the docs are paid what the market demands even though the university’s own industry comparisons show it pays above its comparable peers in both categories. Isn’t that kind of admitting that nobody would want to work there if it wasn’t for the money? Seems like a trap hospitals everywhere have gotten into – paying more because they think they have to in order to get competent leaders (meaning: bribe them to leave somewhere else for a bigger paycheck just like when universities raid each other’s coaches). Once you’ve established yourself as a generous John, the best-looking hookers will always want more.

I’ve decided that since my day job title isn’t sufficiently lofty and I can hardly put HIStalk on my resume, I’m just going to start calling myself a thought leader and futurist. Those titles seem to be reserved for those willing to anoint themselves knowing that no approval is required, so I’m going to pad my resume. If anyone calls you to check, vouch for me.

ARRA is drawing companies into healthcare that have had zero interest previously, The Washington Post reports. Named: FreightDesk Technologies (cargo trackers turned Medicare auditors), RollStream (partner interactions), and the usual lame, just-started social networking startups (i.e., Web sites) masquerading as fervent healthcare consumer advocates.

Odd lawsuit: a woman dies a few hours after being sent home from a West Virginia hospital’s ED. Two years later, her husband gets an unsigned letter urging him to call an enclosed telephone number to find out what really happened to her. The ED doctor working that night calls back, saying nurses had killed his wife with an accidental overdose, that he had kept the original chart to prove it, and would testify on the family’s behalf. The doctor then allegedly changes his story, allegedly, telling the family there wasn’t really a medication error but he just wanted to get back at the hospital. In the mean time, the family found that the ED doctor had lost his privileges at another hospital, was not certified in emergency medicine, and had been the subject of review by both the hospital and the ED contract employer for poor care. The family is suing the hospital, the doctor, and the contract ED company.

E-mail me.

HERtalk by Inga

From Fisher of Men: "Re: changes at Sage. I hear Sharon Howard from Sage is no longer there and they have hired a new VP of Sales." Unverified, though we did ask Sage and she’ no longer listed on the Sage Healthcare site. The leadership page says Jason Dvorak, formerly of TeraMedica, joined the company this month as senior VP of sales.

From Prairie Statesman: "Re: Illinois. Sure, the weather wasn’t perfect for HIMSS, but at least our governor wasn’t asking for Illinois to be declared a disaster area." Prairie Statesman sent this link with a copy of the Florida governor’s request for federal assistance following severe storms earlier this month. I responded (I think rather cleverly) that Illinois seems to be recovering from its own disaster area, right in the governor’s office.

HIMSS releases attendance numbers from last week’s conference and the numbers are down only slightly from 2008. An estimated 27,500 attendees traveled to Chicago, compared to the 29,100 participants at last year’s Orlando meeting. HIMSS attributes the drop numbers to general economic conditions and fewer personnel staffing exhibit booths. Based on conversations I have had with various health systems, I would also say many organizations sent a smaller contingent than in past years. Apparently the figures are based on registrations, so it’s quite possible a number of organizations ended up not sending everyone originally registered. Regardless, I’d say the numbers are respectable.

This is undoubtedly one of the gutsiest PR moves I’ve seen in awhile. SRS announces that Valley Oak Orthopaedics (CA) de-installed a CCHIT-certified EMR and replaced it with SRS hybrid EMR. The legacy EMR is not named, but the administrator is quoted as saying, "We chose the SRS hybrid after the existing traditional EMR in our practice drained our productivity and became unusable." Obviously it would be fun to know who is being replaced. Will the unnamed vendor speak up or ignore SRS?

A consumer survey concludes that 55% of us want the ability to talk to our docs via e-mail, 42% want to set up a PHR, and 57% want to schedule appointments and complete other transactions online. I think the e-mail and transaction figures look about right. On the other hand, I question whether 42% of Americans really want to set up AND maintain a PHR every time they go to a doctor, get a test result, or add a new prescription. Not too many people have the time or discipline to keep that up. Great idea whose time has not yet come.

Lehigh Valley Health Network plans to leverage the training resources from Greencastle Consulting to enhance its EMR implementations process for its ambulatory care practices. I believe Lehigh Valley is rolling out GE Centricity.

The India tourism ministry is finalizing a plan that would allow medical tourists to pay for one medical treatment and receive a second, smaller procedure for free. That sounds even better than Nordstrom’s annual shoe sale!

Congrats to Jodi Amendola, CEO of Amendola Communications, for her appointment to the board of directors of The X2 Healthcare Network. Jodi’s company is a healthcare and PR firm and X2HN is a not-for-profit organization of women healthcare executives representing more than 50 companies. I don’t know Jodi, but she clearly must be cool and has the PR thing figured out because she lists the HIStalk Fan Club as one of her important professional social networking organizations.

Perot confirms the elimination of 30 to 40 jobs at its Plano, TX headquarters.

Mark Anderson mentioned the term ICE on HIStalk Practice last month, which was the first time I had heard it. It seems to be catching on since I’ve now heard others use the term. ICE is  an acronym for Integrated Community EHR (wow – an acronym that includes an acronym!) Essentially it’s a patient record produced from an IHE (integrated health network, yet another acronym.) BTW, all these acronyms make me LOL!

A federal judge sentences the former president of Roger Williams Medical Center (RI) to three years in prison for corruptly employing a former state senator to advance the medical center’s interest in the General Assembly. Supposedly Robert A. Urciuoli paid former Rhode Island state senator John Celona $260,000 in consulting fees in return for taking steps to support legislation favorable to Roger Williams and to kill bills deemed unfavorable. In October, Urciuoli was found guilty of 35 counts of mail fraud.

If you are a healthcare informatics specialist, you have one of the hottest jobs right now. According to the president and CEO of the American Medical Informatics Association, the recent passage of the ARRA legislation is creating a need for as many as 70,000 health informaticians.

E-mail Inga.

Being John Glaser 4/14/09

The foundation of any high-performing organization is talented, experienced, and motivated staff. Attracting and retaining these staff members requires that the IT organization be seen as a great place to work. Over the years, I have learned that six factors form the foundation of an organization that people want to work for.

1. For any organization to function and for its staff to get work done, it must be organized. Departments must be formed. Processes are needed for making decisions and performing recurring activities such developing applications. People want to work for well-managed organizations.
2. The IT organization must hire well, bringing in the talent, skills, and experience that it needs. If a person turns out to be a less than satisfactory addition to the team, the organization has to handle the situation quickly and with humanity.
3. The IT organization has to help its staff grow and learn. Training and professional growth opportunities are needed and staff must be given time to pursue them.
4. There should be ongoing efforts to improve the work setting. These efforts can range from events such as social functions to tele-work programs to improving space.
5. Organizational problems need to be fixed. Process redesign efforts that streamline requests for new applications. Changes to the organization structure to reduce confusion over accountabilities. At any point in time, the organization is not firing on all cylinders across all functions. Problems need to be assessed and fixed.
6. And finally, a tone must be set. I am not sure that I have a good definition of tone other than it is the climate of the organization. Tone results from the daily actions (or inactions) of IT management and IT staff. It seems to me that the tone of a great IT organization has several characteristics. The actions:

• Inspire and motivate. The work is interesting. We believe that the work is important and we know that each of us is needed if the work is to happen well.
• Exhibit integrity. The actions and words of individuals are true to their values and beliefs. There is little tolerance for dishonesty and “games.”
• Demonstrate courage. There is a willingness to make hard decisions and stand by them. There is a realization that you may personally have to absorb the blame and anger of others.
• Show caring. We reach out to those who need personal or professional help. Disagreements and debates avoid personal attacks. We take the time to give someone a heads-up.
• Are demanding, but tolerant. The organization sets high standards for the work that it does. However, it recognizes that even the best people screw it up from time to time (sometimes in very big ways) and the organization does not eviscerate those who make mistakes.
• Exhibit accessibility. Those who need us can get to us. One may or may not be able to help or help right away, but one is not sitting behind a moat.
• Are comfortable with personal limitations. All of us have strengths and weaknesses. It is important to know yourself and be comfortable with the fact that, in some ways, you are limited. And it is a sign of personal and management strength to surround yourself with colleagues who have the strengths that you do not.
• Being a great place to work is important. While making sure that the necessary factors are in place is a key responsibility of IT leadership, this responsibility is shared by everyone in the organization.

Of all of the factors, tone is the most important. If the tone is a good one, the climate will exist that enables all of the other factors to happen well. And tone is set by everyone.

Making sure that the IT organization is a great place to work is something that each of us does every day.

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

Monday Morning Update 4/13/09

From Ben Mehling: "Re: open source. I can state emphatically that Medsphere is ‘truly open source’. This fact is easily verifiable with a quick visit to http://medsphere.org where anyone can download copies of our software and use them within the provisions of OSI (http://opensource.org/) and FSF (http://www.fsf.org/) approved licenses under which we release software. Medsphere.org is also our community’s central hub for discussion, support and development activities — anyone interested in open source and healthcare is welcome. We’re happy to discuss this with anyone that still has concerns, either publicly or privately." Ben is director of advanced technology at Medsphere.

From MiamiRocksters: "Re: Satyam. Looks like IBM is still in the running." The company will be sold off by the end of the month, with bids due Monday. IBM said it was pulling out because of Satyam’s exposure to US class action lawsuits for accounting fraud, but I bet they’re still in the hunt (building the net present value of the lawsuit risk into the offering price, of course). Two Indian companies have been bandied about as front runners to buy Satyam, but Cognizant, HP, and CSC are also said to be interested. And why not? The accounting scandal was limited to a few hands and the business should still be sound, at least once the bad PR can be soothed. The Pricewaterhousecoopers auditors are still in jail, as should be whomever thought up that ridiculous company name.

From Kenneth Parcell: "Re: HIMSS. It was OK. The traffic seemed lighter, but the transportation was reliable and convenient. My only beef was that the shuttle service to the airport took over one hour. Chicago is a wonderful city and I would definitely enjoy it if HIMSS decided to return. Most interesting technology was Google’s PHR suppository repository. Wish I had a picture, but it looks like a little white capsule with Google written on the side. I assume it is placed in the appropriate orifice where it seeks all health information from the source. When finished, the collected data is linked to your PHR and you can Google search clinical information about yourself, such as ‘Find abnormal growths’ and ‘Am I getting enough fiber?’ Not sure why I saw others rubbing the repository on their lips … perhaps they were salesmen and were confused about where to stick it." So far, the poll to your right is running 2:1 for a Chicago return.

From Being John Doe: "Re: Cerner’s answer to HIMSS?" Link. It’s a Cerner YouTube video about its Second Life world or whatever the fantasy-nerds call it. I have to think all those companies that hired hipsters to create Second Life sites are regretting that decision. I didn’t see or hear Second Life mentioned even once during the entire HIMSS conference.

A New York Times article profiles the use of an EMR (from e-MDs) of a rural doctor, who summarizes as follows: "I’ll never go back to the old system. I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.” This is what I’ve been saying here for years: the main value of electronic records is being able to review and create electronic data from anywhere. Just getting data into an electronic form is where the payoff lives. I’ve argued that HITECH should have rewarded providers for sharing data on a national framework such as NHIN, paying them per patient (or, even better, per record type). Using technology is one form of "meaningful use," but making data available to other providers is more so. The power is in the network, not the desktop.

And in that regard, Dale Sanders, CIO of Northwestern Medical Faculty Foundation (thanks to Dr. Lyle for the link) might change your EMR perception with his phony news article about an EMR created by Amazon.com. It’s a deceptively simple and light-hearted piece, but think about what he’s saying about software personalization, analytics, architecture, and social networking, a contrast of pre-Internet EMRs to what could be given what we know today.

C-Span has video coverage of a White House discussion on healthcare reform led by Nancy-Ann DeParle this past Wednesday. She seems fun.

The AMICAS-Emageon headcount reduction, according to one very informed source, is over 100.

Global nonprofit IntraHealth International launches IntraHealth Open, offering free downloads of celebrity remixes of "Wake Up (It’s Africa Calling)" and accepting donations to support open health software solutions for the developing world.

CCHIT musings: everybody wants CCHIT to "certify" EMRs on everything from usability to the financial stability of the vendor. Is that really necessary? Stimulus payments will be tied to using a product certified by CCHIT (or some other group), so it doesn’t make sense for users of already-certified systems to lose money because their vendor can’t meet new usability standards (even though that provider is actually using the product without complaint). CCHIT was formed to evaluate interoperability and reduce physician risk, back when its certification had little impact on the income of either vendors or providers. We need to be careful about wanting CCHIT to turn into KLAS, churning out a "Top X" ranking instead of certifying minimum requirements and letting the market decide which vendor is doing all the non-essential stuff better. Surely doctors are smart enough to buy wisely.

Ivo Nelson e-mailed to say his ongoing pub event HIMSS was so popular that Encore might do it next year in Atlanta. That’s the home base of the Fado’s chain, about which he mentioned that his deal with a more authentic Chicago pub fell through at the last minute because it decided to close for the weekend (hey, if they’ve got Guinness and a green flag or two, who cares?) I’m also interested in ideas for the HIStalk bash there, assuming I can get sponsors and all that. I have thoughts on just about everything except location since I don’t know Atlanta very well.

A note to all you supposedly expert media people covering Dennis Quaid’s speech: please stop capitalizing heparin. It’s a generic name, not a brand name. Thank you.

Some open source people believe they saw the beginning of mainstreaming of open source at the HIMSS conference. I don’t see that happening. Reason: hospital CIOs were raised under the influence of application vendors, often have worked for them in the past, and even more often hoping to work for them in the future, and overseeing Epic or Cerner shops is a resume builder. CIOs, like the hospitals they work for, don’t like to be the first in their area or size range to do something different. Most importantly, healthcare is driven by special interests, lobbyists, vendor people volunteering for influential committees, and job-creating potential. Open source doesn’t have any of those (not to mention a non-government track record). Even the VA seems to be itching to dump VistA in favor of commercial products (again, rightly or wrongly). When you talk about hospitals using open source, that’s mostly VistA, which would be fantastically lucky to get 1% market penetration. Not a rosy opinion, I know, but I promise to update it when any open source clinician application hits 50 hospital clients. If hospitals aren’t interested even when starved for capital as they are today, they never will be.

Since the President is promising everything to everybody and printing whatever amount of current those promises require, he goes ahead and adds "give all veterans a new electronic medical records system" to his Santa list.

New York offers $60 million in financing for HIT projects, this time targeted to medical home applications.

I see the e-mail update signups have been going like gangbusters, so that box to your upper right is calling your name, at least if you want to be among the first to know important stuff. Inga pores over the stats like a CPA, so it makes her happy.

Odd lawsuit: the patient of a plastic surgeon who claims her face-lift surgery was botched has posted an ongoing stream of nasty comments and videos all over the Web, blaming the doctor. He sued her for defamation for doing so and then, according to the patient, called the mental health department claiming she had e-mailed him saying that she planned to commit suicide live on the Internet, getting her Baker Acted. The doctor says she is psychotic and hurting business for his $5,999 Tax Time Special breast augmentation surgery. Here is her site, with a ton of documentation (seems convincing to me, but I’m not taking sides because both parties sound litigious).

The Conficker worm hits University of Utah’s health sciences schools and its hospitals.

Harris Corp. gets a $14 million, one-year contract to provide an imaging system for 65 DoD hospitals, announced at HIMSS. Also announced: Harris donated $10,000 to the Wounded Warrior Project.

E-mail me.

News 4/10/09

From Big Bird: "Re: AMICAS. They are closing the former Emageon headquarters in Birmingham. Many layoffs announced today."
 
From Leo Sayers Fro: "Re: I enjoyed Chicago much more than Orlando or Atlanta. Thoughts: (1) is Fourth Hanson Brother really saying that Linux has less capacity, is older technology, creates more pollution, and appeals only to hippies who are kidding themselves? Lots of enterprises employ Linux, although they do use some middleman like Red Hat. Lots of people say that Cache is older (and complain about old technology), but InterSystems is successfully supporting a lot of enterprises across industries in this big world. Old technology is not necessarily bad technology. Maybe Medsphere is the way to go given a lack of access to capital and given that lots and lots of residents like their VistA system. I would have a better idea if the VA and DOD were on the same page (and is there still a question about Medsphere truly being an open source participant?) (2) EMRAM Stage 7. Just how many Stage 7 users really use a unified medical vocabulary underlying their clinical documentation, thereby presumably allowing for meaningful analysis (and comparison) of clinical documentation? How many use LOINC for results, not only for clinical laboratory, but waveforms and imaging? How many fully leverage SNOMED? And how can you really determine efficacy if you really can’t evaluate outcomes fully? Are their cancer registries fully linked to their EHRs and data warehouses or their pathology reporting systems? And to think: a common medical vocabulary is a Level 2 requirement!"

From Vendman: "Re: GetWellNetwork. Johnson and Johnson to invest $25 million for a substantial ownership position." I asked Michael O’Neil, founder and CEO, and he says that’s not exactly true. J&J’s development corporation invested $10 million in the company in January, reported here, and has high expectations of its impact on healthcare. That’s it so far, although the companies continue to share ideas and discuss projects. Michael did mention that GetWellNetwork recently expanded its relationship with Catholic Health Initiative and added new accounts with Norton Healthcare and an Adventist hospital.

From The PACS Designer: "Re: ETIAM CD-in. When patients are at the ER with CD’s or DVDs from previous episodes of care, it is never easy to import the image files. Now, ETIAM has a new version of their CD-in solution with enhancements that make it much easier to do the importing of other institutions’ image files into your PACS archive." Link.

From Mark: "Re: CPOE – A New Conceptual Model. Physicians use the iPhone to dictate orders and approve the transcribed order; view clinical results; and dictate reports. Say ‘Potassium Replacement Protocol’, press Send, receive a text alert with HIPAA-compliant link, click on the link to review order, select Approve. Orders flow to appropriate systems and personnel. Fast, simple, and easy." Link to presentation. 

From Dodele: "Re: EMRAM Stage 7 all being Epic. Sounds great, but I believe there are only two that qualify as Stage 7. Still, kudos to Epic for having a system capable of getting them there." Correct: two organizations (KP and NorthShore) with 15 hospitals (12 and three, respectively). It still makes a killer ad for Epic.

From HIMSS Party Dude: "Re: HIMSS parties. Perot Systems and Dell get high marks, but the one that seemed to be most accommodating was Ivo Nelson’s Encore Pub Night at Fado’s. EVERY NIGHT he hosted folks at the pub to free adult beverages. I’m gonna guess that over 300 people were there on Monday night. Great concept – free beer, free food, come and leave when you want – EVERY NIGHT of HIMSS. Simple. And blue jeans are a welcome alternative to my stuffy suit." Sounds nice, at least if you like chain, Atlanta-based fake Irish pubs (and I’m not saying I don’t). Did you know there’s an entire company that builds fake Irish pubs in this country and others? We’ve probably got more Irish pubs than Ireland.

My only real meal in Chicago was here and it was outstanding (and this beer was mild but amazing).

IBM says China’s healthcare reform will create the need for at least $1.5 billion in software.

Medsphere, Midland Memorial Hospital, and David Whiles get some BusinessWeek love.

Listening: Carolina Liar, pop-rock MTV darlings from Sweden (despite the name). Also: obscure Philly hard rockers Automatic Black.

New poll to your right: if you went to HIMSS, would you like to see the conference return to Chicago at some point?

I’m still getting used to being home from HIMSS. Mrs. HIStalk opened the door for me this morning and I tipped her $1.

It was funny to hear several times at HIMSS and at the reception (Todd Cozzens asked for a show of hands) that many people jump on to HIStalk first thing in the morning or sit by the PC at the time they know I usually post. I don’t know what they’re doing (scooping the competition? hoping not to find their names mentioned?) but that’s pretty funny.

Premise, now part of Eclipsys, earns the Outstanding Portfolio Company award from Connecticut Innovations.

Heard at HIMSS and elsewhere, when some pompous ass was asked where he works: "Oh, I work for this little outfit you might have heard of called Oracle." Nobody should have so little self-identity that they can’t come up with something to crow about except who pays them. I heard it again from someone from a snotty university guy.

A reader asked if I’m convinced that it will be CCHIT alone doing the government’s EHR certification going forward. I am, given its clout, connections, head start, and performance. Anyone else feel differently? I know a different group could theoretically be named, but I don’t see that happening.

The Robert Wood Johnson Foundation announces a call for proposals due June 3 for $2.4 million in grants for Project HealthDesign: Rethinking the Power and Potential of Personal Health Records. Up to five teams will be funded for 24-month demonstration projects for up to $480K each. The topic is how Observations of Daily Life (diet, exercise, sleep, pain, etc.) can be used to infer how patients feel and therefore modify their treatments. I had a great idea for offshore call center operators to call patients and ask how they’re doing, but all Americans ever say is "fine."

GE Healthcare announces its Digital Day One program, a service to get Centricity Enterprise implemented in a year or less.

MEDSEEK will integrate 3M’s CDR and vocabulary capabilities into its community portal, providing comprehensive interoperability.

A new JAMA study finds that Leapfrog Group’s safe practices (CPOE, intensivists, evidence-based surgery referrals) are not predictive for patient mortality. "The results of this study support the concerns expressed by physician groups who have discouraged public use of quality measures that have not been fully validated." Leapfrog cranks out a press release (warning: PDF) questioning the number of hospitals surveyed and citing a study with different conclusions, but admits that process improvements don’t always provide better outcomes.

Incoming national coordinator David Blumenthal says that his office needs to tighten the EHR certification process to include usability and their capabilities to support HITECH’s quality and cost goals.

Jobs: Inside Sales Executive, Sunrise Clinical Manager Consultant, Business Development Executive.

Shared Health will make its HIE technologies available to hospitals in some way, but the press release is so self-congratulatory it never really says how (that I can tell, anyway). I was looking for "free" and didn’t see that.

IBA is looking for US distributors for its iSoft Lorenzo Health Studio, hinting that the Australian company would like to get some stimulus handouts like everyone else.

IntraNexus will remarket Mediware’s Ascend pharmacy system to round out its Sapphire HIS. Ascend was the system sold by Hann’s On Software, the California company Mediware bought in November.

Yale-New Haven’s CEO breaks the $2 million compensation mark in 2008.

Odd lawsuit: A Toronto weight loss surgeon who already lost his medical license after sexual abuse claims now faces a $12 million class action lawsuit along with the hospital that employed him. He pleaded no contest to sexual abuse that included a twin sisters on which he had performed bariatric surgery, reportedly telling them that it was every man’s dream to have sex with twins, which he did in his office along with using illicit drugs he told one of them to buy.

E-mail Mr. HIStalk.

HERtalk by Inga

From Dr. G: "Re: HIMSS/Ingenix reception. Thanks for the invite. Boy, you’ve really become the ‘Fantasy Girl,’ at least with Jonathan Bush!" Even though Jonathan’s comments weren’t exactly politically correct, I must admit I enjoyed being called "luscious".

From Smaller Vendor: "Re: HIMSS impressions. The show was okay – it was really more to meet with other vendors. The most exciting booth I saw at HIMSS was … not there. I was very pleased to see the many infrastructure offerings finally bringing true connectivity (Capsule, among others). The Microsoft booth — folks raved to me about the table demos — left me ho-hum (it was really just a new table-based display). As pretty as it was, it was in reality expensive and not high enough resolution."

From Spice Guy: "Re: reception. That was an interesting night! Was talking with Matthew Holt when ‘Shhhh Inga’ (Deborah Peel) came up. Interesting to eavesdrop on their interaction!" Matt Holt, who was wearing a "Inga 2.0" sash, had the opportunity to chat with Deborah Peel (adorned in a "Shhh, I’m Inga" sash.) Suffice it to say that Matt and Dr. Peel don’t see eye to eye on all matters of privacy, though both were perfect guests.

From C-Note: "Re: Ingenix reception. I spent most of the reception going around and accusing people of being Inga, all of whom were honored at the accusation and resulted in great conversation. One person even watched me carefully as I walked by, then as he got to the ‘toe’ part of his head-to-toe scan of me, he started shaking his head. As I made eye contact with him he grinned real big and said, ‘Nope, you’re not Inga – I can tell by the shoes.’"

I’m recovering from my post-HIMSS fatigue, wondering if my feet will ever return to their original non-puffy form. All in all, I thought the meeting was great: tons of informative topics, good speakers, and a fun city. I loved catching up with old friends, chatting with new folks, and spying on our sponsors’ booths. The HIStalk/Ingenix party was in a gorgeous location atop the Trump Tower and everyone seemed to be having a great time. I got invites to a couple of vendor parties and each was very well done in its own way.

Only complaints: I hate cold. I really hated having to pay $3 each day to check my coat. Wish the shuttle buses ran more frequently. Don’t understand why it has to cost at least $14 to get lunch at a convention center. I’d have liked a few more "surf the net" stations since I chose not to lug my laptop around (the iPhone is great for checking e-mail, but not writing anything of length.)

Probably not worth complaining about, but I didn’t win this cool scooter that a magazine was giving away.

Sunday morning, the Olympic International Committee toured the convention center. Everywhere you looked you saw dancing dragons, wrestlers, and tumblers. Also, these two adorable girls in Native American dress.

I spent a fair amount of time waiting for Starbucks coffee the last few days (not exactly a complaint since I did make a conscious choice to stand in the long lines.) I actually enjoyed the opportunity it gave me to talk with strangers about their HIMSS experience. One IT manager told me his large health system typically brings 30 or so people every, year but this year the employer only sent the five who had speaking engagements.

This year’s buzz words: stimulus, ARRA, meaningful use, and interoperability. The "also-ran" words were iPhone and mobility. In the mix you heard discussion about CCHIT and whether or not they provided the de-facto standard. According to CCHIT and all CCHIT-certified vendors, CCHIT is the inevitable standard. If you had a document management-only system or some sort of EMR-lite offering, you stressed the necessity of your offering to get ramped up. A reader shared that the CEO of a large CCHIT-certified vendor told an audience to expect only five major players to remain after everything shakes out.

I tried to check out as many of the smaller vendors as possible and MedKey PHR Systems caught my eye. I’ve said before that I don’t believe the public is ready to take the time to set up a PHR. However, if you are chronically ill, for example, I liked how this technology looked. The device is a portable and wireless PHR that can be worn like a medical bracelet or be on an insurance ID card or on a key chain. It is supposedly "completely" secure and password protected. Data can be synched with the integrated USB port, or wirelessly. I suppose if a big insurance company pushed the technology, the design is convenient enough that I think people would wear/carry it. Although there is still the question of who is going to input the clinical data.

eClinicalWorks and Sam’s Club release details of their new EMR program, which is targeted for the one- to three-provider space. Check out the Sam’s Web site to see of what is included in the offering.

Greenway Medical Technologies announces a strategic deal with Detroit Medical Center to provide PrimeSuite EHR to physicians across Detroit Medical’s nine hospital network.

Streamline Health Solutions reports a net loss of $146K for the fourth quarter and $1.4 million loss for the year. The company posted a net loss of $736K in 2007.

The Texas Senate is considering raising taxes on chewing tobacco and using the funds to help doctors pay off student loans. New physicians could be reimbursed as much as $160,000 for agreeing to work at least four years in under-served areas.

The University School of Community Medicine and IBM plan to build a primary-care medical home pilot project that connects clinical data between the medical school, 325 physicians, and other area care-givers.

Sprint Nextel and GE Heatlhcare sign a multi-million contract with Methodist Healthcare (TX) for a complete wireless infrastructure across its six sites. The setup includes integration with GE’s Carescape Enterprise Access.

My feet are recovering nicely, thanks to my new slippers from Chipsoft. As I was unpacking, I also found some a frosted Oreo, courtesy of HealthPort. Yummy. Next week, back to reality.

E-mail Inga.

An HIT Moment with … Judy Kirby

An HIT Moment with ... is a quick interview with someone we find interesting. Judy Kirby is president of Kirby Partners of Altamonte Springs, FL (formerly Snelling Executive Search).

How would you characterize the healthcare IT job market and how do you it see changing over the next 1-2 years?

The healthcare IT job market is different than I have ever seen. I entered healthcare IT recruiting during the recession of 1992 and have witnessed its peaks and valleys. With the current economic crisis this country is experiencing, healthcare seems to be relatively stable, compared to other industries such as finance or automotive.

That being said, healthcare organizations have investments that have diminished and are struggling with shrinking reimbursement rates. According to Thompson Reuters, the median profit margin of U.S. hospitals has fallen to zero percent. There is a lot of financial pressure on hospitals and nearly half are operating in the red. Many see hope in the stimulus money that will be available for electronic health records. Right now, there is caution and uncertainty in most organizations. They have needs in their IT departments, but are being very, very cautious in hiring and we have seen the hiring time increase.

If the stimulus money for EHRs has the effect that some like Dave Garets from HIMSS Analytics predicts, there will be a shortage of implementation talent in the future. But that being said, as always, there will be positions that are “hot” and those skills that will be in abundance. Two years ago, we encountered many senior healthcare IT managers and CIOs who were approaching retirement age. They are now saying they will remain in the workforce longer and postpone retirement due to their dismal retirement portfolio performance. Healthcare IT positions, especially higher level positions, that were to open by the retirement of baby boomers will open up later rather than sooner.

There is good news, however. We recently did a survey of healthcare CIOs that showed 31% expect their organization’s IT departments will grow in the next year. 50% said their department numbers would remain the same, and only 19% predicted a decrease in their department staff levels. The survey also indicated that 39% of the respondent’s IT departments are currently actively hiring, 6% will hire in the next three months, and 4% will hire in the next 3-6 months. There are always numerous opportunities out there no matter what the current economic conditions.

The biggest effect the economy has had on our business is the number of possible candidates for positions who cannot relocate because they are upside down in their current homes or live in such a down real estate market that they can not sell their home.

You might think a firm such as ours would have experienced a downturn in the current economy. Just the opposite is true. We are as busy now as we were three years ago. 

What advice would you have for employees to both keep their current jobs and prepare for their next one just in case?

We actually are presenting at HIMSS on this same topic, “Know when to hold them and know when to fold them”, with Jon Manis, CIO of Sutter Health System. The advice for keeping your job is the same for preparing for your next move up on the rungs in your career ladder – you have to be invaluable to your organization and not just taking up space. We have heard from many CIOs they are using this recession as a way to “clean house”, so to speak. All things being equal, they will keep the employees who are doing the best job and have the best attitude. You can train skill sets, but you cannot train attitude, enthusiasm, or a desire to be successful. Those are the traits you need to exhibit.

This is also the time to update your resume. Do it before you are in need of a new position. Don’t list what you have done, but describe what you have actually accomplished in your position. It is much easier to keep track of these accomplishments on a regular basis rather than having to go back and try to remember after the fact. Quantify your results as much as possible. Plus, when having conversations with your boss, it is always nice to be able to talk about your successes.

How is the role of the CIO changing? What should CIOs be doing now?

The CIO role has really changed over the years from a “bits and bytes” individual to a true C-level leader. John Glaser, CIO of Partners HealthCare, and I did a presentation at the CHIME Fall Forum on this very topic entitled “Where are we going? Evolution of the CIO”. Put succinctly, the CIO has to be a true leader, just like any other C level position in the organization. It goes beyond just keeping the systems up and running. That is part of it and a crucial part that can get a CIO fired. But, the role is starting to go way beyond that as CIOs acquire additional departments and different responsibilities.

The CIO of today and tomorrow needs to be reaching out within their organization. They need to learn what leadership “looks like” and become more involved in working on business issues and contribute more than technology. They need to work with colleagues as peers and focus on understanding them and solving their problems. They need to fill domain knowledge gaps and skill gaps. And as we already stated, they never need to rest on their laurels, but focus on future accomplishments and how those accomplishments benefit their organization.

Management of a healthcare IT department requires the same skills as management of any other department. As more and more in the hospital domain becomes “application driven”, CIOs will shoulder more and more responsibilities. We have heard several CIOs mention recently that they have picked up oversight for other departments – even departments such as HR or marketing. You need to know your limitations, and know when and where to find true specialists to handle things you cannot. 

What will the effect of the stimulus package be on the job market?

It will be interesting to see just how the stimulus money does affect the job market. As you reported recently, Wal-Mart is entering the EHR market, and others will jump on the bandwagon to get those funds. The money will have some positive impact on those with strong implementation knowledge and for those in consulting. What the real impact of the stimulus package is will be difficult to predict until all the rules and regulations are ironed out. Any time the government is involved, your guess is as good as mine, but I do see it as a positive for those in healthcare IT.

We have talked with healthcare IT organizations that are already looking ahead to the stimulus monies and planning for the talent they need to embark on the projects that will attract these dollars. 

What kinds of roles and training are available for clinicians who want to get more involved with IT and informatics?

The roles are many and varied, depending on the clinical background. With EHR, lab, radiology, pharmacy, and informatics, depending on the background, there are lots of opportunities for the clinician who wants to be involved in technology. These include everything from a CMIO to nursing informaticist to builder and implementer. The individual needs to look at where they would like their career to take them long term, and then decide the best route to reach that career goal.

We are seeing more physicians and nurses in the CIO role. We are seeing a new position, CNIO (Chief Nursing Information Officer) develop in larger organizations. Consulting firms and vendors are utilizing these skill sets in their business models. As far as training, there are numerous masters’ programs out there and they provide a good education. If at all possible, while pursuing book learning, try to balance that out with hands-on experience. The two paired make a much better skill set than just a degree and no real technical experience. The employment world is a competitive place: degrees, experience, certifications, and a broad range of experiences do make a huge difference in how fast and how far you can move up the career ladder.

On a side note, we would like to mention we will have a name change this month from Snelling Executive Search to Kirby Partners. We feel this name will not create confusion as Snelling has. There are other Snelling personnel offices out there that focus strictly on administrative and temporary employment. Our people remain the same, and our niche remains the same. All we do is healthcare IT recruitment.

From HIMSS 4/7/09

From Evil Knavel: "Re: HIMSS. Do you get special treatment from companies at HIMSS, especially sponsors like athenahealth that seem to get a lot of PR? It seems like it." Guess you missed the part about eating burgers in the hotel and at McDonalds. Only one sponsor knows who I am, so the answer is absolutely not. I am an anonymous peon at the conference, so I’m seeing it just like everyone else (intentionally – I don’t want favors, but yes, I’m sure I could milk the heck out of it if that interested me). In fact, anybody with CIO in their title is going to get treated a lot better than me since they have their own off-limits meetings, vendor giveaways, and fancy event invitations that I don’t get (disclosure: I went to the Cerner CIO event as an anonymous guest of someone, which was cool to a day-jobber like me). FYI, athenahealth is not a sponsor (and disclosure there: they don’t do much marketing, but decided to be an HIStalk sponsor about a year ago just to be nice. I turned them down because that was right after the HISsies and it would have looked suspicious, which we both agreed was the right decision).

From Christi: "Re: reception. I’m ever so grateful to Ingenix for hosting the party. The Trump Towers staff was over the top on customer service – every single staff person was incredible! When I’d ask for directions to something they’d not only tell me where it was, they’d walk me all or part way to it! And the ballroom we were in was gorgeous. What a lovely site and lovely party – thanks for being so cool as to have someone who wants to throw money into doing this." Thanks to Tom for sending over the pictures.

That’s it for me – I’ll be heading home first thing Wednesday morning. I saw quite a few people with suitcases in the hotel lobby today, so I’ll guess that the exodus already started. That astronaut doing the closing keynote tomorrow afternoon may have had more people in his Mir space station than will be in the audience.

My verdict on the conference: nicely done. I actually didn’t mind the weather as much as I thought, but the Saturday start in April really threw me off. The logistics were as good as ever and Chicago and the convention center were fine. My only remaining gripe the cost of hotels. I really wish I had bypassed the Ambassador people and just used Priceline since I paid too much, but couldn’t cancel and re-book without a penalty. 

My favorite giveaway (other than the foam slippers): the tee shirt above from Solution Q, vendors of the Eclipse project portfolio management system. It’s not new humor, but I hadn’t heard it in a while and never from a tee shirt.

VC firm Psilos Group will raise a $450 million healthcare IT fund.

It’s probably just as well that Cerner opted to stay out of town this week since an ugly PR episode might have resulted. This article says that four Chicago mental health centers closed today as a result of billing glitches in the Chicago Department of Public Health’s Cerner system caused it to lose more than $1 million in state funding when bills backed up for over six months.

Someone asked me about ARRA and innovation. They are mutually exclusive terms. ARRA was designed to dump a lot of taxpayer dollars into private hands quickly and forcefully, yet it requires CCHIT-certified products that would take years to develop from scratch. For that reason, it will just boost sales of the same old stuff. If anything, it stifles innovation because all the prospects who might have decided to sit tight and hope for better products will have to spend sooner to get their cut. The most valuable asset any company can have right now is a CCHIT certification, whose value went up multiples with ARRA.

I was chatting with someone earlier this week and he said he hated Citrix. I made my usual comment that it’s like a Denny’s restaurant – always a compromise from what you really wanted. His theory is that the availability of Citrix allowed old, primitive applications live on, providing another layer of workaround that gave vendors an easy out for bad system performance, difficult maintenance, poor security, and lack of a true thin client or Web strategy. The healthcare-only combo of Citrix-MUMPS-Cache is everywhere, of course, and there’s no customer indignation to replace it because it works.

Some guys talking on the escalator this morning said that Rob Kolodner got a standing ovation in his final HIMSS appearance as ONCHIT (and deservedly so). I would be shocked if he isn’t in Atlanta next year, but in the booth of a consulting firm or vendor instead. He confirmed that he’s retiring, but looking for other opportunities. By all accounts I heard, he’s a good guy, humble and fun.

I want to get the autograph of Gay Madden, CIO of The Hospice of the Florida Suncoast, since she’s on the shuttle bus TV every morning (in a Sprint commercial, I think).

I went to a session this morning on digital pathology that was pretty cool. It’s interesting that systems exist to convert slides to massive images that can then be manipulated and studied in a cockpit of monitors rather than through a microscope. The speaker said his company had licensed satellite image processing technology since it works about the same on the cellular landscape as it does the terrestrial one.

UPMC chooses chooses the clinical research management system from mdlogix (the annoying all-lowercase name is their doing, not mine).

Ingenix announces its Care Tracker EMR, priced at $5,000 per year for a solo practitioner. Also announced: RAC software and services that help hospitals comply with the Medicare Recovery Audit Contractor (RAC) program by providing alerts of claims likely to be audited.

Someone told me of an overhead conversation this week in which national drug chain VP said his company hoped to cobble together a simple EMR (enough to claim minimal use) just to get stimulus money.

Jonathan Bush was on FoxBusiness this morning after a late night at the Trump (I don’t know how he does it). The site doesn’t support a direct link, but you can search on athenahealth and look for today’s video. The host opens with a HISsies mention, although not by name: "Jonathan was honored last night as the industry’s figure of the year in healthcare technology." He talks about HIMSS and HIT. The company also announced that its eRX module has received Surescripts certification.

Someone mentioned that it’s ironic that Sun is pitching its NHIN capabilities even as its IBM acquisition went up in smoke, implying that maybe it’s not stable enough to hang the NHIN hat on.

A HIMSS location name that sounds like 1999: "Surf the Net".

The digital pathology session talked about IT as a barrier because of locked down PCs. That reminded me of editorials I’ve written lambasting the lazy IT socialism of treating all users equally (badly) in assuming they are all too stupid and irresponsible to have any control over their PCs. Their ought to be a way to gain responsibility points based on need and ability, allowing higher level users with a defined need to perform simple software installations or OS changes.

Seen on Epic’s booth: every EMRAM Stage 7 hospital uses EpicCare. For a company that says it doesn’t market, that sure kicks the competition where it hurts.

I took a look at iMedica’s new/not new Transition product. It’s the existing product with the knowledge base turned off at a 20% discount, giving an easier and cheaper start. If you want the knowledge base later, you just pay the difference.

The last of the booth observations:

• iMDsoft has a Visicu-like ICU monitoring. I tried to learn more, but the reps were too enamored with each other’s company to want any of mine.
• Corepoint Health (the former Neotool) had a nice booth and seems to have grown considerably in capability and ambition.
• iSoft was demonstrating Lorenzo, which isn’t sold in the US. One rep was, anyway. The others were sitting on the demo station stools playing around with their cell phones.
• AT&T/Cisco Telepresence had a conference room setup in the booth with the big monitors in place, which actually looks like have a conference room since the one side of the table is for virtual participants.
• Medicity had a good crowd.
• I chatted briefly with the ICA person, who explained the company’s CDR and clinical portal that can also be used as an in-house clinical workstation to add capability to existing systems.
• I checked out Bistro HIMSS: $23 (including tax and drink) gets you a paper plate on which to load up pedestrian-looking heat lamp Chinese.
• I miss the blue nametags that distinguished vendors from providers, but that was in a simpler, black and white HIMSS world.
• PatientKeeper had a big rack of smart phones and PDAs running their software to show its versatility.
• I don’t know much about Orchard Software, which had some KLAS information on a booth sign that suggested it’s the highest rated lab system. I’d tell more, but nobody there was paying much attention to my eye-catching glances.
• eClinicalWorks had a bunch of people in the booth.
• There was a good crowd at the Sentry Data Systems booth.
• EDIMS had a nice booth and crowd. Apparently they have a EDIS Lite kind of system with knowledge management, but nobody made an effort to talk to me.

I apologize if you e-mailed an invitation for me or Inga to visit your booth or meet you personally and it didn’t happen. We stayed very busy getting information to write each day’s HIStalk, so we ran out of time.

HISsies 2009 Winners

It’s time now to announce the winners of the 2009 HISsies, the Brutally Honest HIT Awards, as voted by the readers of HIStalk. We don’t claim the results are scientific, but they are always interesting.

• Smartest vendor strategic move: Medicity-Novo Innovations merger.
• Stupidest vendor strategic move: GE Healthcare losing unsatisfied clients.
• Worst healthcare IT vendor: GE Healthcare.
• Best healthcare IT vendor: Picis.
• Best provider healthcare IT organization: Cleveland Clinic.
• Hospital you’d want to go to if facing a life-threatening illness: Mayo Clinic.
• Most promising technology development: Software as a Service.
• Organization you’d most like to work for: Picis.
• Company in which you’d most like to be given $100,000 in stock options: Picis.
• Most overrated technology: speech recognition.
• Biggest healthcare IT related news story of the year: Obama’s position on healthcare IT.
• Most overused buzzword: interoperability.
• “When _(blank)___ talks, people listen,” the person who influences healthcare IT the most: President Obama.
• Best CEO of a vendor or consulting firm: Todd Cozzens, Picis.
• Most effective CIO in a healthcare provider organization: Lynn Vogel, Ph.D., associate professor of bioinformatics and computational biology, vice president, and chief information officer, University of Texas M.D. Anderson Cancer Center.
• HIS industry figure with whom you’d most like to have a few beers: Tom Daschle.
• HIS industry figure in whose face you’d most like to throw a pie: Neal Patterson, Cerner.
• Healthcare IT industry figure of the year: Jonathan Bush, CEO, president, and chairman of athenahealth.

E-mail me.

From HIMSS 4/6/09

Thanks to everyone who attended the reception tonight. Thanks, too, to our speakers and presenters (especially Jonathan Bush), our sash wearers, and the Ingenix folks who ran an efficient check-in process. Thanks also Ingenix and Ingenix Consulting for sponsoring the event. I hope you enjoyed it. It was an honor to have you. I’ll get the HISsies winners up soon.

It was a nice day today, actually, with very little snow and some welcome sunshine. Much better than I expected.

No expensive burger for dinner this time. I had a $5 combo from the McDonalds right by the Trump. I bet I’m the only person patronizing them back to back.

I was ruminating (always dangerous) on the shuttle bus today about all the newfound interest in HIT, but minimally focused on the patient compared to the profit. My conclusion: right or wrong, healthcare is set up under the business model, where allegedly nonprofit hospitals have to earn their keep by cranking out the bills and making shrewd business decisions (as someone told me the other day, some of the meanest executives they’ve known were in nonprofit healthcare management). So, vendors are clearly for-profit, no different than defense contractors. Looking back, one might conclude that the charity/compassion model might have made more sense, but that’s not what we have.

Here’s an interoperability idea: after hearing the cell phones of supposedly tech-savvy IT people constantly going off in the HIMSS education sessions, someone needs to invent a door sensor that automatically turns all phones to mute.

Best session of the day (and of the conference so far): Pat Skarulis of Memorial Sloan-Kettering, on developing an oncology order entry system for what I assume is Eclipsys Sunrise. It was quite cool and the way they handle study protocols, sequential orders, and lab alerts is sophisticated. I can see a lot of interest in how they did it since oncology OE is a tough nut to crack and MSKCC is pretty much an authority. Unlike all the other sessions I’ve been to, nobody left, even during the questions (however, the audience members asked atypically knowledgable and concise questions, so kudos to them).

Speaking of Eclipsys, they had a quite effective back-cover ad in HIMSS Daily Insider today, showing their CPOE penetration. A minor quibble is that both dimensions of the quadrant measured pretty much the same thing (number of hospitals and percent of hospitals) and didn’t show percent of orders or doctors, but it still got the message across.

I’m sure it’s just me, but people walking around with those blue-blinking Bluetooth cell phone earphones look like self-important douchebags.

Our new best friend Dennis Quaid gets some nice USA Today press, saying his new GI Joe: The Rise of the Cobra could be the next Independence Day.

Our rumor reporters had the right idea, but the wrong scope: Dell and Perot announce a partnership involving EMRs and hardware. That’s Dell’s second recent announcement: the eClinicalWorks offering through Sam’s Club was the first.

Noticed during the education sessions: nearly no one pronounces HIMSS Analytics correctly. Also, an increasingly large number of presenters use "sort of" as the modern equivalent of "um", such as "We built sort of a data warehouse, with sort of an essential item being real-time extraction."

More booth reviews:

• RelayHealth’s was nice and cheery, also putting out their HIStalk sign.
• Microsoft had throngs of people again for some reason (the coffee table thingie?)
• Nextgen had what might be the largest and coolest booth (forgot to mention it yesterday). It was like the Hollywood Bowl.
• QuadraMed had interesting stations for each product they were demonstrating.
• Emdeon had cool arcs that spanned their booth, although the three booth mimes seemed to be causing passers-by to steer clear (people really dislike mimes and clowns who try to engage them in some kind of hijinks).
• I made Inga push the Enovate-IT carts to show here how smooth and sexy they feel.
• ONCHIT had a booth, believe it or not, staffed by some rather nice civil servants. They have a handout on how to start on the ARRA grants, which is their main reason for being on the show floor. They said Blumenthal won’t be starting until the end of the month. They also speculated that Rob Kolodner will retire instead of going back to the VA.
• Eclipsys had a quite dramatic and open booth. I forgot to mention it yesterday.
• A trend: I saw no two-level booths, so everybody went from traditional to ranch style.
• It was nice to have the sun streaming in floor-to-ceiling windows over in the 3900 aisle.
• BlackBerry had a cool booth (I think my AT&T Bold was drawn to it).
• AT&T had the telemedicine setup that I always like running.
• IBM’s booth wasn’t very big. Maybe they don’t have enough people left in this country to need a larger one.
• Allscripts still had people packing the booth and spilling out into the aisle.
• Greenway was demonstrating Prime Research.
• Cumberland Consulting Group had a nice wood-floored booth and some friendly people who were starting up conversations with passers-by (an art that every vendor needs to perfect if you’re going to spend big money on a booth).
• The folks at Legacy Data Access e-mailed pictures of their vintage, old-school Pong video game, kind of an early 80s version of the Wii or Xbox for all you youthful types I see all over the convention center.

Industry long-timer Scott MacKenzie (RelayHealth, Cerner) is named CEO of revenue cycle systems vendor Passport Health.

LMS Medical Systems of Canada sells McKesson its CALM OB suite. The company’s been in big trouble for some time, so it was a good move and McKesson gets what I think is probably a pretty good specialty system.

Medicity announces its Q1 business wins, raising its total HIE customer base to an astounding 700. Thirteen new Q1 customers are named, some of them very large. Someone asked me about them today and I was explaining how well they were doing, but I clearly didn’t know the half of it.

Sentillion is giving these little guys away in the booth, USB drives loaded with Advanced Authentication Solution for Direct Access to Cerner, Eclipsys, Epic, Mckesson and MEDITECH Applications. The company also announced a do-it-yourself tool for SSO and CCOW. I think I read somewhere that SSO was one of the top priorities of hospital CIOs trying to get clinical applications used, so I imagine these new announcements are timely.

Also announced: Allscripts Prenatal, a SaaS specialized EHR.

Dewey Howell of Design Clinicals gave me a demo of some new software the company is finishing up involving anticoagulant monitoring for physicians (adding to its medication reconciliation functions). I said last year that the med rec stuff was very cool – highly intuitive, functional, and taking full advantage of third-party drug databases. This is at least as cool. I’ve seen big-vendor applications sold for physician use (often meaning that some bean counters and programmers got together in 1985 to figure out how to capture charges without having to hire keypunch people) and this is how it should be done (and would be if it weren’t for the legacy baggage the big boys have to drag around).

From Blinded by the Snow Storm: "Re: Allscripts. Allscripts might need to do a bit more due diligence. dbMotion only has 2 clients in North America that have initiated a real project: 1) The Bronx RHIO, which currently has an RFP on the street to replace their core functionality, and 2) UPMC, which has an equity investment in dbMotion but has yet to announce any significant tangible benefit despite a multi-year relationship. Not exactly the type of track record that proves true interoperability." I think dbMotion’s long suit is having a ton of users, like entire countries in Europe, and a better product than the ones Misys and Allscripts brought to the table. I don’t think Allscripts will regret it.

From Glad I’m In Sunny CA: "Re: Voalte. Interesting product, but how many nurses do you know that carry iPhones?" Not many – yet. However, that’s because there has been little justification for them. Connect a nurse to a real-time alerting and communicating system using them and they suddenly look like a good deal given corporate rates and ease of use (not to mention their use as a recruiting tool).

From Ex-Broadlane: "Re: layoffs. Broadlane, the third largest GPO in the US, laid off 33 employees today, the majority being in the IT department. Ironically, the cuts come just when they are beginning to reinvent themselves as a ‘Technology enabled Service Company’ which is code for ‘we cannot scale as is and need technology’, hence the irony."

So HIMSS finally admits that both registrations and exhibitors were down. I wouldn’t say they necessarily were dishonest in bragging on the registration rate a few weeks ago, but it’s clear that they put the best spin on what they had to know was going to be the first drop in both critical categories in many years (maybe ever), most likely to stave off a last-minute bandwagon effect that would have made it worse. It would have been a complete disaster without the last-minute stimulus interest.

Speaking of positive spin, McKesson’s clinical systems are "gaining momentum," at least according to its PR people. The proof: five hospitals, some pretty obscure, bought products in 2007 (!) You would think McKesson had developed a lot of new, cutting edge clinical apps instead of continuing to sell the old, multi-heritage software bought years ago from Vanderbilt, HCS, etc. from the flowery wording. Nobody’s asking me, but here’s my advice: build something from scratch and finally get the "buyers, not builders" monkey off the corporate back and catch Cerner while they aren’t selling much either.

Susan Hagerty is named CEO and chairman of Noteworthy Medical Systems. She comes from CompuGROUP, the majority owner of Noteworthy. Larry Dolin stays on the board.

Nuance makes a series of HIMSS announcements: 25 new healthcare customers, a Dragon EHR certification program, and a preview of Enterprise Workstation Version 8.

E-mail me.

HERtalk by Inga

It’s Monday afternoon and still snowing in Chicago. So far today I have had a chance to sit in a few sessions, including one featuring the Ambulatory Care Davies winners. Three different groups were represented, including a solo physician practice, a five-doctor group, and an 85-doctor practice. If I were to come up with a common theme, it would be that ROI is not just about the tangible things, but about soft costs as well (reassigned workflow, paper elimination, faster chart access, etc.) Also, that getting up and running is the hardest part: once you have been live for awhile, it gets better.

I have had assorted conversations with folks about what the "buzz" is this year. Aside from ARRA and how everyone has a solution, a oft-mentioned word is interoperability. Of course, given that the government is making interoperability a requirement to obtain stimulus money, vendors seem to be discussing what and how they are working to make their products interoperable with the world. Seems like we have heard that word before and we still see lots of silos, so we will see if times really have changed.

Another issue mentioned is how providers will be able to fund the up front EHR costs before they are able to receive their Medicare carrots. Many hospitals are claiming they can’t afford to help physicians despite relaxed Stark laws. Not hearing any great answers to this issue yet.

As I was walking I saw some great looking boots. I was pretty proud of my ability to walk and take a photo at the same time.

Overheard: "I am not sure how we will be able to be interoperable with our community when we can even interoperate within our hospital walls."

A few people mentioned that Microsoft’s booth looked quite busy, so I will go see what the buzz there is all about.

I took a guided tour of the interoperability booth (there is that word again) and saw a patient’s history flow from her PHR to the physician to the hospital and to another physician. Looks cool, but the cynical Mr. H pointed out that everything on the floor "looks" cool. One day it will happen, right? I have to say the piece that might be the hardest to implement is the PHR. How many people are really going to spend the time to keep their data current? And how many doctors are really going to trust the data?

From the look of the artwork on display in their booth, I would say Epic is making some money. I enjoyed viewing the various non-traditional paintings and statues situated around the booth. In case you were wondering, the fireplace is still there.

A reader shared details of a Perot-hosted party last night at the Hancock building observatory. "Unfortunately with the snow you could not see much from the 96th floor. Perot could have saved some money and had the same party in the basement. Party was still fun, though."

Yesterday, Mr. H and I walked by the Tech Lab (near HIMSS Central) and peeked in on the blogger round table. Mr. H was actually a bit miffed that he was not invited since he sees himself as one of the original HIT bloggers. Probably didn’t help matters that I was invited, though I declined participation in order to maintain my low profile. If the session were in a bigger room that allowed you to stand unobtrusively and listen in, we probably would have stayed, but the room was a bit too cozy for us.

Official HIMSS attendance numbers as of Sunday: 25,672, which is down 5% from last year. That number is fairly evenly split between professional attendees and exhibitors, which is consistent with previous years.The number of vendors (905) is down 15 from last year. HIMSS folks seem happy.

Someone claiming to be "in the know" says that McKesson did not lay off all their ambulatory sales staff, though a few folks were let go.

I saw the famous Matt Holt from afar today. Also Grizzled Veteran, one of HIStalk’s regular posters. Heading back to the exhibits later this afternoon, then primping for the HIStalk soiree!

E-mail Inga.

From HIMSS 4/5/09

It poured the rain all afternoon and now it’s snowing and blowing like crazy. I have to admit it seemed to draw everyone a little closer at the conference – there was nothing else to do but hang around the exhibit hall. That was OK until 6:00 when the hall closed, triggering a mass exodus to the opening reception. Inga and I took one look at the mass of humanity and left since it would have taken forever to get food or drinks. The band was probably good, but you couldn’t tell because the "room" was like a 747 hangar with a cement floor and high ceilings. The heavy rain or snow or sleet or whatever it was sent everyone to the coat check stations, the taxi stand, and the shuttle buses, so there were long lines at all of those, putting a not-so-great end to the day.

I started this morning by tripping over the giant bag of ads piled at my hotel room’s front door. There was a fake TV show on the shuttle’s TVs, complete with HIT commercials, of course. At the convention center, I thought the girls from Healthcare IT News were going to put someone’s eye out the way they were thrusting issues in everyone’s faces at every escalator and hall intersection (with most of the intended recipients using violent body English to avoid having to take one).

Since the "opening" keynote wasn’t until 12:30, I went to three morning educational sessions. Two were OK and one was horrible. Since I was bored, I noticed how many times in the conference guides that EHR came out HER. Someone needs to help those HIMSS folks customize their Word dictionary.

Lots of people showed up for the 12:30 session. HIMSS had a really good jazz band playing live (Skinny Williams Group). Last year’s official theme, "Now Is Our Time," was apparently taken off life support. Good idea. It was the usual multimedia extravaganza, with some violinists in there. They sounded good, but didn’t get to play much. The most ironic moment of the self-congratulatory HIMSS video was a shot of a wall breaking down with the label "Break down proprietary walls," with the irony being that the names of big companies were plastered everywhere and the repeated reference to the exhibit hall made it clear that proprietary has been berry, berry good to HIMSS (perhaps they meant that even more proprietary vendors should be congratulated for working on interoperability of proprietary systems).

HIMSS board chair Chuck Christian had shaved off his beard, so nobody recognized him. He read of a long list of HIMSS accomplishments, pretty much every one of them related to lobbying the government for taxpayer dollars so that organizations who didn’t want software bad enough to pay for it with their own money could buy it with someone else’s. And if you were there for management systems, forget it — there was no effort at all to even mention the MS part of HIMSS (maybe they should just call themselves HIS). They did mention something called HIMSS Plug In that was said to be a consumer technology social network or something, but I wasn’t clear on what it was or how it’s accessed. No figures were given for conference attendance, but someone said they heard 27,000 which would beat last year (if you believe the number).

Since HIMSS wants to break down proprietary walls, who better than to introduce the keynote than an executive from Siemens, the company paying for that session (and whose executives pleaded guilty of fraud for bid-rigging a PACS deal at Stroger Hospital right here in this very same Chicago not long ago). After a longish video with a deep-throat announcer proudly reading some classic Dennis Quaid cinema titles such as The Parent Trap and Innerspace, out came our keynoter.

I’m going to try to be nice here. Dennis seemed likable, happy to be at the conference, and genuinely complimentary of the HIT work done by people in the audience. He was considerably more wrinkled and hoarse than you see on the movies, but that ear-to-ear grin still lights up even a big room. Applause was polite. I didn’t find him all that charismatic like I expected. He read most of his talk from the TelePrompter (stumbling a surprising number of times – I guess he’s used to getting multiple takes). He flashed pictures of his twins and of the heparin vials he said were "deadly similar" (maybe to a layperson, but they were about as clearly labeled as they could be even in the picture, with one saying Hep-Lock and the other labeled Heparin 10,000 units/ml with slightly different colored labels and completely different colored pop tops – the only similarity was that they were both in the standard 1 ml vial). He proudly announced that his family’s incident had motivated Cedars to spend $100 million on HIT, although you’d have to wonder what other pressing projects got shelved to free up the capital. One thing I agreed with: bar codes need to be universal and interoperable (thank a weak FDA for why that’s not the case today). He said bar code technology needs to be affordable for small hospitals, but didn’t elaborate how that’s going to happen. He pitched smart card medical records and inpatient access to charts by TV or cell phone. He barely mentioned his foundation, to which HIMSS gave him a check for $10,000 at the end. I can’t imagine that anyone in the room wasn’t aware of medical errors beforehand, so I have to question why HIMSS thought this would be a compelling opening keynote (a great number of people rushed for the doors when he started taking the couple of scripted questions HIMSS had put together). But, I saw him in my hotel lobby afterward and he was just hanging out, looking good, and being a regular guy. So, I would say Dennis was just fine, but he probably shouldn’t have been put up there.

Then came exhibit time. The hall didn’t seem busy at all, but maybe it was bigger or perhaps because it was Sunday, things still weren’t in full swing. The energy level seemed low, but everybody was relaxed as a result. Some quick perceptions:

• Booths seemed generally smaller and less elaborate. You could count the booth babes on one hand. There were a couple of magicians, a trick pool shot guy, and some mimes (seriously), but otherwise the in-booth entertainment was dialed back.
• McKesson still had some of that wildly electric blue, but it was toned down a lot.
• I still think Medicity’s spaceship-like booth is the coolest, but that’s just me.
• The HMS waitresses are as sassy as ever, at least when you get the ones who are paid actors and not the HMS employees rounding out their number.
• Kudos to OnBase with their usual sports bar theme, who served up soft drinks until 5:00, then rolled out the hard stuff. I was prowling for beer and was told EMC had some, but they had run out. Sentillion filled the bill admirably even though I clearly wasn’t a prospect.
• If I could pick one company and booth to see that’s clearly got new ideas and strong prospects, I would choose Voalte. They were wearing Pepto-Bismol colored bell bottoms, but demoing a very cool iPhone-based communication and alerting application. CEO Rob Campbell, with a long history of developing technology (PowerPoint and Filemaker) is fun. Booth 1481 is worth a visit.
• The busiest booth was Allscripts, which was mobbed from the time the doors opened until after the lights were dimmed. I don’t know what kind of audience they were getting or what products interested them, but it was packed. Second busiest (but in a relatively small booth) was dbMotion, whose people seemed pretty cool.
• Epic’s booth hasn’t changed and neither has Judy. She never left the time we were there, talked to pretty much anyone who wanted to chat, and displayed nothing to indicate her net worth or place in the HIT universe.
• The aforementioned Siemens had a nice, airy booth that I Iiked probably best of those from the big boys.
• Inga and I liked the Risarc people in 7215, who were manning their tiki hut, wearing Hawaiian shirts and sultry tropical dresses, and pouring rum punch. They did a nice job making it fun.
• I liked Sunquest’s booth a lot, very open and attractive in the green color (although the top looked like a big round trampoline to me). Their "Sunquest – we deliver" totes were the best ones I saw, well made in that bright green with black trim, so I’m taking one of those home.
• Most of our sponsors displayed the "We Power HIStalk" sign we made for them prominently, but Virtelligence gets the nod for putting it front and center.
• Somebody gave Inga and me those little chocolate bottles containing rum. Those were just about the best thing I’ve eaten lately. I wish I remember who had them since they deserve kudos – they can’t be cheap. I would like to have had about five of them since I would have simultaneously gotten both a sugar and and alcohol buzz on.

After all that, I rode the shuttle home in the snow, ate a $15 hotel hamburger alone (funny how Inga reports the same thing below), and hit the laptop for what you’re reading now.

We decided we should feature a smaller, lower key booth with people we liked. Introducing Chipsoft (that’s Paulette above, looking like an unseen giant is about to scoop her up), an HIS vendor from the Netherlands in Booth 6560 (not selling to the US, but interested in European attendees). Those yellow things on the floor are the coolest slippers, shaped like wooden shoes. People everywhere were descending on those people carrying them (like Inga), demanding to know where they got them. Chipsoft will put more of them out Monday, they said.

A reader sent this: "One of the pre-Quaid speakers referred to the American Recovery and Disability Act. Does that make it the AR-DUH?" I don’t know if the TelePrompter was acting up or what, but everybody on the stage muffed their speeches several times.

RSM McGladrey has "Official HISTALK Cynic" and "INGA FAN CLUB" badge ribbons at Booth 8039. As far as I know, that’s the only giveaway or goodie (unlike last year’s Fake Ingas, shoeshines, and other badge ribbons).

We’re supposed to get 1-3" of snow tonight with winds tomorrow of 20-30 mph. Thanks, HIMSS. My hotel TV ran an ad for conventions in sunny San Diego, apparently rubbing it in.

The Sun-IBM deal is off, apparently.

The Medsphere folks sent this picture over. "These photos about sum up the difference between Open Source and non interoperable, expensive proprietary models." That’s a cool PR move that must have required a lot of planning to pull off.

We already ran the rumor, but Allscripts announces its iPhone application. Allscripts also announces a joint solutions deal with dbMotion (maybe that explains the booth crowds), apparently replacing the products that both Allscripts and Misys offered previously.

iMedica announces a new PM/EHR system called Transition. We may need to swing by for a look.

That’s about all I have the energy to write today. There were some announcements today (Allscripts, for example), but I expect most of the big ones will be held for Monday when the news is full-on and the stock markets are open.

HERtalk by Inga

Let me start out by saying: My. Feet. Are. Killing. Me. And I even wore the comfy shoes. Right now I am in my lobby bar drinking an adult beverage, having had a couple of Advils to try to make the feet throbbing stop. And, I probably look like a total nerd typing away on my laptop, but who cares. I’m sitting next to a window and watching some huge snowflakes come down and waiting for my $15 hamburger to be served.

First thing this morning, I attended a CCHIT Town Hall meeting led by Mark Leavitt and Alisa Ray. I was struck by the fact that CCHIT clearly sees themselves as the entity that has established "the" standards, though they acknowledge that the standards committee will tweak the final standards required for ARRA funding. In any case, vendors are sending in their certification applications at an unprecedented rate – something like 45 new applications in the last month, with 39% being never-before-certified vendors.

I also went to the opening session to see Dennis Quaid. Cool live music and video started things off, followed by a rather lengthy intro by Chuck Christian of HIMSS. Christian shared all the great things HIMSS has done over the last year – and one might think they were personally responsible for including HIT in the recent ARRA legislation. So, I think Mr. H was a bit cynical about having Dennis Quaid as the keynote, but I personally thought it was an effective reminder that ultimately this whole HIT stuff is about the patient. Quaid admitted he is not an expert on technology or healthcare. Instead, he is a father, husband, and now an advocate. As I was walking out I overheard this comment: "There’s nothing like a human story to motivate IT. Especially when it involves babies"

Mr. H and I also spent time walking the exhibit hall (see note above about aching feet). The good news is that everyone has a way to help you take advantage of ARRA money. Random thoughts:

Allscripts was amazingly busy every time we walked by. Other booths that appeared to be getting good traffic included Google (why?), dbMotion, athenahealth, and McKesson. Not so busy: most of the other vendors in the ambulatory EMR space and all those small vendors are the outermost aisles. Far and away the best giveaway were the slippers from a Dutch company that looked like wooden shoes (I’d be wearing them if I weren’t in the lobby.) Booth babes are for the most part either eliminated due to budget constraints or simply too 20th century (in either case, I am ok with the demise of booth babes). Mr. H and I were so happy every time we saw a sponsor prominently display one of our signs (anyone see them?) Mr. H and I personally autographed each display, so thanks to all who put them out. By the end of the afternoon, Mr. H and I were getting thirsty for cocktails, so thanks to the folks at Sentillion were able to provide both Mr. H and me our beverages of choice.

I took a few photos and will get those posted soon.I have managed to snap a few nice-looking pairs of shoes and was able to educate Mr. H and what shoes were and were not practical for walking the exhibit hall. Also got caught in the Olympic committee 2016 presentation this a.m., so I took a few shots of wrestlers in their cute outfits.

In the Ribbon Race, i.e., the contest to see who can attach the most ribbons to his badge, I have so far seen two individuals tied for first place. Each had five ribbons. One is the CIO for a large health system in Texas and the other is a consultant, also from Texas. (Everything is bigger in Texas, I guess?) Surely there are some New Yorkers or Californians who can come up with six ribbons to take the lead.

Early night for me before some early morning sessions. Can’t wait for the big HIStalk/Ingenix party Monday night!

From HIMSS 4/4/09

It’s a pretty nice day in Chicawgah, with brilliant sunshine and tolerably cool temps. The locals are out jogging and playing shirtless volleyball like they were Canadians. HIMSS is looking pretty smart in choosing its own city for the conference, but I doubt anyone will be saying that as they slog through the snow the storm will bring Monday. If you see someone smiling, it will be a vendor chop-licking at the certain booth traffic that will result since there’s no golf or other outdoor activity as an alternative (coincidence, I’m sure). Good for them, bad for those of us who enjoy the traditionally warmer conference locales. I even heard one of the HIMSS people saying it was convenient, but not as nice as going somewhere less wintry. Look at it this way: because of the schedule-juggling needed to jam Chicago into the mix, it’s only 11 months until the Atlanta conference.

Why is healthcare so expensive? I can’t figure it out as I sit in a $250 hotel room using a $20-per-day Internet connection and ponder the $26 hamburger (including mandatory gratuity and delivery charges) that the hotel’s room service would like to sell me. (Actually, I pay my own way, so I’m not contributing to healthcare inflation). One of the sessions today was full and someone headed out to get more chairs – don’t do that, they were told, only union members can pick up convention center chairs.

That same $250 hotel just about sweated me out last night. My room must have been 85 degrees and the heat was blasting. No AC, naturally, being a historic hotel full of character (meaning: tiny closets, weird bathrooms, and a maze of halls to find each room). I figure there was some forgotten old guy down in the bowels of the basement shoveling coal into the furnace like he’d been doing since the Truman administration. Solution: I opened the window, which was surprisingly not bolted shut (the hotel must not have a legal staff). Other than the racket each time an El train lumbers by, it’s OK (as long as I don’t think how much nicer a $69 Microtel would be if I’d been smarted enough to book once, spend a little on cabs each way, and still save a bundle).

It looked like the Marines stockpiling supplies before a siege at the conference center. Vendors hauling in their exhibit stuff, food and drink people making sure not to run out of wildly overpriced inventory, and AV people setting up an endless number of rooms. The conference center is actually pretty easy to get around and, as is always the case with HIMSS, is well marked. Some sessions are across the land bridge on the west side, most seem to be on the south side, and the opening reception will be on the east side overlooking Lake Michigan (which attracted me to stroll out to the patio for a look, immediately finding myself locked out of the convention center until a maintenance guy reopened the door).

It was pretty dead at the conference center today, at least in the common areas. I walked by the venture fair and it was overflowing, so I assume ARRA has attracted some people newly interested in healthcare but having no clue about the patient widgets with which we deal outside their financial realm.

The schedule still seems odd. You would think that the opening reception would be today (Saturday) since everything moved up a day, but it’s still Sunday. There’s no morning keynote tomorrow – Dennis Quaid isn’t on until 12:30. One thing is like always: the education tomorrow runs only 8:30 until noon, followed by Dennis, followed by the ceremonial herding of the attendees into the exhibit hall like cattle up an abattoir ramp. Nothing conflicts with the exhibit hall hours, of course, since that’s the entire point of the conference (a smattering of time-conflicting educational offerings notwithstanding). Sunday’s education (not counting Dennis): 3.5 hours. Exhibits: 4 hours.

Rumor heard: McKesson’s board had lost confidence in Pam Pure, believing she was in over her head. She fired all of the company’s ambulatory salespeople right before she herself was defenestrated, supposedly. A WSJ article mentions concerns about the technology division. It says John Hammergren is speaking at HIMSS, but I’m not sure where.

An anonymous reader says that Radianse chairman and CEO Manuel Lowenhaupt has left after less than a year. Steve Schiefen is now listed as CEO on the company’s Web page. The reader speculates the RFID asset/patient tracking company will be sold to Hill Rom.

A reader sent a copy of an e-mail that George Halverson of KP sent out company-wide, bragging that 12 of the 15 hospitals that will be recognized as EMRAM Stage 7 at the conference are Kaiser facilities.

HCS president Tom Fahey e-mailed news of a new Interactant sale: the five-hospital Encore Healthcare LLC (MD). They’re in Booth 7834 if you want to extend personal congrats or just say hi (Tom didn’t ask for the plug, but I figured I’d look it up in the HIMSS guide since it’s right in front of me).

I passed former HIMSS CEO John Page in the hall today. Looking good, running a CEO and entrepreneur support organization.

HIMSS is having some kind of blogger session at the conference. I was not invited. I’m insulted even though I wouldn’t have gone anyway.

TeraMedica announces Smartstore-Ultrastream, a storage optimization protocol that improves the efficiency of image storage and routing for its vendor-independent imaging and information system.

GAO names 13 members of the Health Information Technology Policy Committee, the advisory group that will make policy recommendations for a national HIT infrastructure. Some are familiar names: Marc Probst of Intermountain, Paul Tang of PAMF, and Judy Faulkner, who has done more for HIT adoption than any of them because she’s selling the heck out of Epic to big hospital systems (quick: name any big-name hospital that has bought anything other than Epic in the last year or two. Need more time?)

People keep e-mailing me that Perot will be acquired by Dell shortly. Sounds farfetched, but I said the same about Misys and Allscripts right before HIMSS last year (and ran the rumor for the same reason: multiple reports). Purely speculation, but there you go.

Nine Texas patients, most of them homeless, drug abusers, or mentally ill, made 2,700 ED trips in the past six years, racking up $3 million in taxpayer cost. I bet your first reaction was: irresponsible losers screwing up the system. Maybe your second would be: perhaps the healthcare system gave them no alternative, making a business case for using the avoidable cost to fund options for them.

GE Healthcare, whose name is prominently plastered on the quite nice tote bag being handed out to HIMSS registrants, lays off more employees in Wisconsin.

Taking pictures at HIMSS? Send them my way (or maybe I should start an online album). People seem to like them.

A reader is working with a boutique RIS/PACS vendor that is looking for quality resellers. Not my sweet spot, so if you have suggestions, e-mail me and I’ll pass it along.

A study in contrasts (not the same as a contrast study): a NEJM report says that only 1.5% of hospitals have comprehensive clinical systems, but HIMSS Analytics trots out its own stats saying that, hey, they’re pretty close, missing only a couple of key applications to be there. Count on it: any time anybody publishes a high-profile article (even a research one) that seems to indicate less than rosy industry use of technology (or especially that the technology itself may not be up to snuff), HIMSS will circle the wagons with a rebuttal.

Allscripts cuts revenue estimates, blaming a purchaser preference for subscription-based pricing. Overheard today: nobody’s financing companies that drop ship software like in the old days (say, before last year). True partners make money only when their customer makes money and that’s all that’s selling these days. Welcome to the recession.

My guest editorial in this week’s Inside Healthcare Computing e-mail update: Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached. A key sentence: "The CEO of every company right now, right or wrong, is the former junior senator from Illinois who has never had a real job (I don’t count being a professor or lawyer) or run a business."

If you’re at the conference, welcome to Chicago. I’ll be doing some kind of daily report and I expect (and hope) that people will e-mail the good stuff they hear out and about since that’s the fun of being here.

E-mail me.

News 4/3/09

From Cherry Forever: "Re: political appointments. For the HIT Policy Committee, Minority Leader John Boehner appointed Gayle Harrell. Speaker Nancy Pelosi appointed Paul Egerman. Incidentally, you can find this information if you do a search on ‘HIT Policy Committee’ in the Congressional Record." Harrell is a Republican member of the Florida House who recently railed against the stimulus bill. "One of the scariest provisions of the bill misuses the laudable goal of expanding electronic health records and spends $1.1 billion to create a new bureaucracy called the Federal Coordinating Council for Comparative Effectiveness Research. The intent is to use this new government bureaucracy and electronic health records to monitor the effectiveness of different health-care interventions and medications with the cost of treatment being considered as a factor in determining effectiveness. Such cost-based medical decision-making could eventually be used to allow the government to ration health-care goods and services. A congressional committee report stated that ‘more expensive (treatments) will no longer be prescribed’ as a result of such research." Paul’s an uber-Democrat and was co-founder of IDX and eScription (an interesting mix of social issues plus good old capitalism, the ideal combo if you ask me). If you Google him, the #1 hit is my 2005 interview with him, which was a blast to do.

From Don Frijole: "Re: Dell. Rumor, unconfirmed, that Dell will buy [big consulting firm] and announce acquisition next week at HIMSS. Hope Mr. HIStalk can get to the bottom of this one." The onset of HIMSS always starts acquisition rumors, sometimes true. If anybody has a Dell scoop, give it up.

From HCIT Girl: "Re: GE and Intel. The companies have scheduled a press conference in New York, hosted by Intel Chief Executive Paul Otellini and GE Chief Jeffrey Immelt, to discuss plans to work together to deliver health-care-related technology, including possible applications for health care IT and home health monitoring, according to people familiar with the situation. BTW, you rock Mr.HISTALK and Inga!" She sent that rumor Wednesday and this was announced Thursday: GE and Intel announce they are jointly developing products for remote health monitoring. The pair will invest $250 million over the next five years to develop new technologies in this area. Also, GE’s health care unit will take over distribution and marketing of Intel’s Health Guide home care product. Thanks for saying we rock (not in a chair, I hope).

From Irwin M. Fletcher: "Re: Sutter. Don’t know if you saw your mention in the SF Business Journal regarding Sutter Health. I looked at your site and couldn’t find any mention. The article is titled ‘Sutter Health to postpone hospitals’ and says, ‘But Fry and Chief Information Officer Jon Manis denied reports on the well-known HIStalk health-care IT blog that Sutter is giving up on its $1 billion Epic installation …’ So congrats on being well known!" Thanks – I hadn’t seen that.

From HIT Man: "Re: CMIO. The premiere issue of CMIO magazine is released. From working with many, it is evident that these folks think because they are MDs, they know healthcare IT. Wrong. So, take a look at this issue and notice the language they use. It’s like a bunch of hippies writing specialized articles for themselves. Simply another rag, at least this first issue. One of the problems with HIT adoption is physicians, and now we let CMIOs run HIT work (at least in some places). Amazing how much credential is given to those who effectively can’t even agree on standard dosages from practice to practice. I lament, but let’s empower the IT executive, not the MD that studied IT. Also, Halamka is quoted again. This guy is a relentless media hound. He really should be a PR consultant."

From The PACS Designer: "Re: JeOS. With all the virtual appliances showing up in the marketplace, there was bound to be an mini-operating system to enhance their use. Now, Ubuntu open source software has a Just enough Operating System solution (JeOS), which has been nicknamed Juice. This new solution is bound to show up in new virtual appliances to improve performance and free up valuable bandwidth for other uses." Link.

From Frankie Knuckles: "Re: Chicago food and drink. If you want to get out of the Trump hotel bar, there are a couple good spots close by. Emerald Loop is a pretty good Irish bar (owned by a Notre Dame grad, so you know it’s good). Their curry fries and a few Guinness are a fine meal. Across the street is the South Water Kitchen, with comfort food like meatloaf and fried chicken. And if you want to hang out at a real mobbed-up Chicago Italian place, head a few blocks east to Volare — some good people watching there, and good food too. Just don’t lean against the Cadillacs and Mercedes parked out front."

Other rumors heard: GE is going after a specifically named large ambulatory EMR vendor. Allscripts will announce a new iPhone offering. Cisco will be making an investment in a specifically named physician billing company. All unverified.

Allscripts reports Q3 numbers: revenue up 65%, EPS $0.09 vs. $0.12, but the numbers aren’t really apple-to-apples because of the Misys deal. Both earnings and revenue missed analysts’ expectations, but shares are up a little in after hours trading, adding to the nearly 4% rise before the market closed.

A former dialysis center nurse in Texas is charged with intentionally injecting 10 patients with bleach, killing five of them.

Listening: The Vincent Black Shadow, one of my faves, with a 2008 album I didn’t know about.

Several readers e-mailed to confirm the rumor reported here earlier that Eclipsys development SVP Joe Petro has left (he’s off the Eclipsys Web page, finally, and here’s the 8-K). Also gone, several of them said: Bobbi Byrne MD, SVP for clinical strategy. A reader reports, "The clinical solutions group now reports to Keith Figlioli, who reports to Jay Deedy. Not a clinical person in the hierarchy until you hit the fourth level in the organization."

HIStalk’s two millionth visitor arrived Wednesday afternoon, hailing from Johns Hopkins. March was a record traffic month as well, surprising to me since Inga and I took our respective spring breaks.

Meet Culbert Healthcare Solutions of Woburn, MA, just joined us as an HIStalk Platinum Sponsor. They do clinical systems consulting (strategic planning, EHR readiness assessment, selection and project work), revenue cycle (PM selection and implementation, billing and A/R outsourcing, and operational assessment), practice management (management, CBO, physician recruitment and retention), and IT (interim management, implementation, help desk, interfaces). Doesn’t matter if you work for an academic medical center, a community hospital, or a physician practice group large or small – they can help. Thanks to Rob Culbert and crew for their support.

Medsphere will show OpenVista 2.0 at HIMSS.

Microsoft launches a new low-end server family that can support up to 15 users for less than $1,000 in total hardware and software cost.

JAMA’s editors are on the hot seat after repeatedly calling a neuroscientist "a nobody and a nothing" and saying, "Who do you think you are? You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry." The editors were angry after the neuroscientist brought attention to the drug company ties of a JAMA article author, which JAMA reportedly ignored until it was run in a competing journal months later.

Jobs: MS4 Patient Accounting Expert, Compatibility Test Engineer, Cerner CCL Programmer, Training Consultant.

If you’re going to HIMSS, take a look at our Must-See Vendors List (which, entirely coincidentally, are HIStalk sponsors). If they’re cool enough to sponsor some anonymous blog, they’re worth a look.

I was always curious about McKesson Paragon, a highly regarded small hospital system that escaped what looked like sure sunset death years ago. We interviewed Paragon’s GM on HIStech Report. Products like that will be essential if we’re ever going to move the needle on small hospital EMR adoption (and since there are so many of them, to move the EMR needle in general).

I appreciate the support of new HIStalk Platinum Sponsor Virtelligence, a premier IT consulting firm offering solution advisory and IT consulting services to all types of healthcare organizations (which have given them a 95% repeat business rate). The company has won awards for being a great place to work (consultants average 15 years’ experience) and is listed in the 2008 Healthcare Informatics Top 100. Their "Why Virtelligence?" section of the Web site summarizes nicely: "Delivery-based contracts, low rates, fixed prices and pay on the results." Why not drop by at Booth # 2373 at HIMSS and check them out? 

I’m going to be running around in the cold Saturday and onward to tell you what’s going on at HIMSS. I’ll give you a scoop on the cool and the ugly booths, who’s getting traffic and who’s not, the certain acquisition rumors floating around, and whatever else catches my eye (and ear) as a non-profit hospital peon being ignored by the high-powered, self-absorbed suits. I’m your Everyman on the scene. Happy and safe travels to all.

HERtalk by Inga

From Dick Vitale: "Re: NCAA basketball pool. Is the basketball pool going to get a mention in HERtalk?" I’m blaming the pre-HIMSS rush for my failure to recognize one of our sponsors for inviting Mr. H and me to participate in their company basketball pool. My failure to mention these fun folks has nothing to do with the fact that for the second year in a row I am a loser. Dick, however, does point out that I am in the running for the Consistency Award because my total points/correct points are almost identical to last year (i.e., I am a consistent loser). Rather than hand over the pool winnings to the lucky winner, our gambling friends are giving 50% of the pot to a local charity for needy families. Nice.

From Dutch Treat: "Re: downing Heinekens. If you want something fun to cover while at HIMSS, there is a contingent of about 200 Dutch HIS and vendor people traveling over together for the conference. This is a fun group. I know a bunch of them. They are staying at the Hyatt and have already begun calling it ‘Holland town’ where they say they are having nightly cocktail receptions." "Fun" and "nightly cocktails". Intriguing. And with a name like Inga, I am sure that some of them might be fourth cousins or something.

Insight Health Services enters a seven-year agreement with Perot Systems to provide revenue cycle outsourcing, IT outsourcing, and other practice management tools for Insight’s free-standing imaging center facilities.

Like Mr. H, I was disappointed by the MyHIMSS09 calendar program. If only it would have had a nice, concise print option. I have now put all my picks onto one nice sheet of paper. I have a pretty nice balance between educational sessions, exhibits, and food and drink opportunities.

Hospital Rahway (NJ) is the third hospital in the Robert Wood John Health System to adopt Eclipsys Sunrise Acute Care.

AMICAS completes its tender offer of Emageon and now hold 88% of outstanding Emageon shares.

Capital Area RHIO (NJ) deploys Axolotl’s Elysium Exchange solution to facilitate secure sharing of clinical information.

Beaumont Hospitals (MI) expands its existing Agfa Healthcare IMPAX PACS to include IMPAX Cardiovascular.

McKesson’s Physician Alliance Program signs agreements with three hospital systems to provide their community physicians with EHR solutions. The announcement indicates that VARs will be responsible for selling, implementing, and supporting McKesson’s Practice Partner and RelayHealth solutions to the participating physician offices. Interesting that McKesson seems to be relying on VARS, rather than a direct sales/support team, though that model is similar to the way Allscripts is distributing its MyWay product to small offices.

The VA selects Picis to provide anesthesia record for five of its medical centers. The VA will use Picis’ Preop Manager, Anesthesia Management, and PACU Manager applications.

Nebraska Orthpaedic Hospital selects Surgical Information Systems (SIS) Anesthesia solution.

HIMSS attendees will have a chance to take a five-question survey about the economic stimulus and its impact on healthcare. Beacon Partners will conduct the electronic poll at their exhibit booth (4416) and real-time results will be posted on monitors. I’m stopping by because I want to be eligible to win one of the three iPod Touches they’re giving away.

MEDecision announces its intent to acquire HIE company HxTechnologies. MEDecision plans to inbed HxTI’s HIE technologies into is Alineo and Nexalign platforms.

Good news for all you Call of Duty 2 fans. A new study finds playing action video games may help adults improve their eyesight. In particular, such games can improve contrast sensitivity and benefit those with amblyopia (lazy eye syndrome).

If you originally signed up for the HIStalk/Ingenix reception and your plans have changed, please let the Ingenix folks know. I believe they may have a waiting list going and a few waitlisters are hoping to take any empty spots.

Marin Healthcare District (CA) signs a $67 million, seven-year contract with ACS to provide consulting and outsourcing services. ACS will implement an enterprise-wide EMR and provide revenue cycle services.

Heartland Regional Medical Center (MO) is considering outsourcing some technology services as it moves to Cerner’s EMR. The hospital’s CMIO says the hospital must spend millions upgrading computer equipment or outsource some in-house services. 

Kaiser opens a new hospital next to its existing flagship LA Medical Center. The $600 million, 400-bed facility is designed to withstand a major earthquake, features 85% family-friendly private rooms, and includes all the latest technology.

Surescripts names former Mastercard executive Harry Totonis as president and CEO. He replaces JP Little and Rick Ratliff, who have served as co-CEOs since RxHub and  SureScripts merged last year.

My next update will be coming direct from Chicago! I’ll be the one wearing a coat.

E-mail Inga.

CIO Unplugged – 4/1/09

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

Welcome, Welkommen, Bienvenu, Bem-vindo, Bienvenido, Vítaný
By Ed Marx

My family will host our 6th foreign exchange student this Fall. Anne will join us from Germany and stay through the academic year. Our “extended” family has expanded over the years, and these former students are now doctors, teachers, and actors. We keep in touch with several of the girls and have even visited a couple here and abroad. The experience of a single exchange—the families, students, cultures—has enriched our world.

I serve on the global healthcare CIO council for a fortune 50 company. Each year a dozen of us gather from around the world to help drive corporate strategy. We get a glimpse into the future and where the industry is headed as it relates to technologies on the horizon. We share challenges and solutions. We commiserate. We learn. We advance the corporation, our employers, and ourselves. It is rich.

Around the table this past week, I sat with CIOs from Brazil, Japan, USA, Singapore, Greece, UAE, Taiwan, Bulgaria, Mexico, Canada, Australia, and England. (How fitting that the International Olympic Committee shared the conference facility with us in Chicago.) Although we contributed and advanced the mission of the council, the biggest benefit came from the transparent sharing amongst CIOs. I’m not able to share council specific outcomes or where my organization is headed strategically, but I can offer these key takeaways:

· Innovative ideas to remove culture as obstacles to transformation

· Creative organization hierarchies that enable velocity

· Leading from the center

· Progressive management of vendors

· The world is flat and we have more in common than you think

· Negotiating the C-Suite more effectively

· Leveraging specific technologies to enhance mobility

· Expanded vision

I gained more from this intimate exchange than I could have attending a week long mega-conference or reading a year’s worth of subscriptions. I established relationships with 11 peers who I can call on as needed. We forged budding bonds through time spent together and found that we have a common burden and shared passion. Their diverse backgrounds opened my eyes to fresh thoughts and strategies. Some of us have already exchanged additional ideas and materials to further our organization’s success.

The council sponsor benefitted and they will develop enhanced products and services to meet our future needs. Our employers will benefit from this investment as we bring back executable ideas for both strategic and operational advancements. And I, like my peers, have personally benefited through this mutual exchange of ideas, cultures, and personalities. May sound trite, but I believe the world is a better place now.

Seek opportunities on different levels to share in global exchanges. I’m looking forward to what we’ll learn from Anne this forthcoming school year.

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

Readers Write 4/1/09

Comments on Ricky Roma
By Cliff Dickerson

I’ve spent most of my career on The Dark Side, but I rarely have considered it to be that.  Maybe I’m going to always be naïve, but it’s where I’ve witnessed innovation and achievement.

• I took pride in seeing the glee on the face of the DP director when transmission of the day’s billing was transferred in less than five minutes after removing the cartridge (yes, cartridge) from the Four Phase HIS and inserting it into the Four Phase front-end of a time shared financial system. It beat a day spent key punching by multiple employees.
• I was ecstatic when the ER nurse (pre-ED days) most vocally opposed to the new system told me that she loved it.
• I was pleased to know that in less than six months we had registration and ADT up, something that some major medical centers spent two to three years developing in-house or that the IT staff in the early days in a turnkey operation was a fraction of that where in-house development was occurring.

Trained as a biochemist and working in a hospital clinic lab, I fled early on to an HIT vendor. I knew that my happiness was not to be found being a bench tech. (Retention of medical technologists is a tricky act. The University of Illinois Circle Campus, in fact, eliminated its medical technology program upon realization that its graduates were not going to work for healthcare providers, but rather for biotech and pharma companies.)

The vendor life, while often paying more than on the provider side, has its disadvantages. Living out of a suitcase is not fun. Missing out on activities with friends and families is a real drag. 20+ hours of commuting is not so fun either. (When I first started, I left on Sunday afternoons and got home sometime Friday nights. It’s different now. People just don’t want to do that.) 

Oh, and pay? I’ve seen some delivery organizations pay almost as much for its employees as a vendor does. $10K or $15K just doesn’t make up for long commutes and long days.

Now, I could go down a different road. Healthcare organizations traditionally have not paid IT salaries competitive with other companies. (Nor do they spend the same amount of money on IT traditionally – maybe you do get what you pay for.) And, boy, are they surprised when their clinicians turned informatics specialists say that they won’t work more than 40 hours a week unless they get overtime. But, that’s a whole other discussion about something that’s not necessarily unique to American healthcare delivery systems, but pandemic in our culture. We talk about balance, but don’t play the game.

I don’t discount anyone for wanting to make a profit – even not-for-profit health delivery organizations like to do that – and many of their employees and associates profit very well in doing so. Perhaps I should be more cynical in viewing publicly traded healthcare software vendors, but can I fault them anymore than I could fault Chase or Oracle or Phillips? No, I just can’t. (I do think that the American system has some problems. I do think that our American companies often make decisions that are poor in the long-term. I do think that we need to rethink our executive compensation system.)

Value: if someone is willing to pay $3 for $1 of value, well, I figure that they must be getting $3 of value. Or at least feel that they do. Maybe I’m a bit biased because I spent a lot of time studying pricing while working for vendors.

I’m not sure where the 66% failure rate comes from, but it does point out the need for clearly defined, achievable return on investments before the ink is signed. So many people don’t want to do their homework in advance. Technology in and by itself is no balm. It’s the implementation. How you use it. How you promote it. How you plan to ensure success.

I had a CIO teaching a class at a university ask me for a paper or case study about how poor project management lead to the failure of a project. I couldn’t find one. No one really wants to write about or talk about their failures.

Next Generation Hospital Laboratories Become a Driving Force in the Future of Diagnostic IT
By Richard Atkin, President and CEO, Sunquest Information Systems

When Sunquest became a private corporation approximately 18 months ago, no one predicted the tumultuous economic conditions and events that would be taking place in the U.S. and worldwide. And we now know how important the healthcare IT industry’s role will be in helping deliver increased access to care, with improved outcomes, at lower overall cost.

Back in October 2007, we saw a great opportunity for best of suite diagnostic IT solutions and publicly stated the strategic goals that we believed would best serve the current and future needs of our customers. We committed our focus and resources towards enhancing the automation capabilities and clinical workflow of Laboratory Information Solutions, improving patient safety, helping hospitals maintain profitability through outreach services, and to becoming a driving force and leader in the exciting area of predictive and personalized medicine. Now, with the dramatic changes over the past year, these same goals are even more relevant and delivering against them remains our top priority.

We must remember at all times that healthcare delivery is largely local and must be very patient centric. The role of the hospital laboratory in the continuum of care and the effectiveness of the Laboratory Information Solutions it uses are playing an increasingly important role in the successful delivery of clinical care inside the hospital and outside in the community. With approximately 70% of clinical decisions based on results generated in the clinical laboratory, the operational efficiency of the laboratory is critical to the effective delivery of safe, timely patient care. Laboratories are becoming information hubs for patient care, business operations, revenue growth, and the successful development of new technologies for predictive and preventative medicine.

The emergence of the hospital laboratory as a strategic, revenue generating service line, central to the goal of cost effective healthcare delivery is a development we are dedicated to supporting.

Automation & Workflow Efficiency
Laboratory services are central to healthcare delivery. Hundreds of care plan and treatment workflows are dependent on decisions that use lab results – admissions, discharges, medication decisions, follow-up testing and dietary orders to name a few. The shorter and more certain the lab result turnaround time, the faster patients and care providers can make diagnostic and care plan decisions, and the more effective those decisions will be.

Laboratory information systems must not only track, route and manage samples, but also interconnect with the overall Health Information Systems and EMRs being used within hospitals and with systems being used by external physicians and laboratories. By doing so, the transition from inpatient care to outpatient and vice versa is eased, vital resources are used more efficiently and the patient experience is enhanced.

Patient Safety
Patient safety is obviously a top priority for healthcare providers. At Sunquest we developed the concept of the Five Rights of Laboratory testing to champion the contributions the lab makes to the safe delivery of care.

Additionally, we have introduced several new products that support our customer’s goals for improving patient safety, including a closed-loop transfusion management solution. Our automated Specimen-Collection Management system integrates with the LIS and blood bank system, and utilizes wireless handheld devices and bar-coding to ensure positive patient ID at the bedside.

Closing the loop on the blood administration process, the Transfusion Manager solution is specifically designed to support patient safety processes at the bedside by automating nursing workflow and reducing preventable errors from occurring during the transfusion process.

These solutions in use at dozens of our customer sites have succeeded in reducing specimen collection errors to virtually zero at every site where deployed.

Expanding the Community Footprint
In challenging economic times, hospitals must leverage their laboratory as a strategic asset to their overall business operation and revenue generation. A single admitting community physician represents an average of $1.5MM in annual revenue to a hospital. An effective outreach program builds physician and patient relationships while enhancing the reputation of the hospital in the community.

The ability to effectively manage these community relationships is an important strategy for hospitals and the reason why we made two strategic acquisitions in Q4 of 2008.

First we acquired Anglia Healthcare in the UK for their complementary product portfolio of web based communications and messaging solutions. As a result, Sunquest now has the market-leading position in the UK with over 60% market share for laboratory orders and resulting solutions and the technologies to address the broader EU market with solutions that meet the region’s protocol standards and language needs.

We also acquired the Outreach Advantage portfolio from PAML, Spokane, WA. These solutions provide a strong complement to our existing offerings, adding courier, logistics, CRM, and business intelligence applications. The Outreach Advantage portfolio, together with our LIS and revenue cycle solution, results in the single most comprehensive outreach business management suite in the industry.

Predictive & Preventative Medicine
Patient diagnosis and treatments through molecular and genomic testing represent an area of explosive growth, great promise, and significant challenges.

Molecular diagnostics is generating more than 30 million tests annually in the U.S., with dozens of new procedures introduced every year. We are strategically committed to providing the solutions that will enable laboratories to be a leading force in the upcoming revolution with predictive and personalized medicine.

Nearly 85% of our customers already perform molecular testing and interface their instruments and systems with our LIS. One leading example of this is Nationwide Children’s Hospital, who has used its expertise in molecular diagnostics testing for infectious diseases to successfully grow its outreach testing services to support an international market.

Emerging technologies in genetic testing, digital analysis and whole slide imaging are creating a new paradigm for diagnostic medicine. Certainly the workflow inside the laboratory will dramatically shift, but even more significant is the impending transformation in healthcare delivery outside of the laboratory. Pathologists and lab professionals must become more active, visible members of the care team. To do so effectively will require collaboration, communication, and results interpretations that comprise actionable information, not just data.

Conclusion
This is both a very challenging and very exciting time to be in the healthcare industry. As vendors, we must develop and implement new solutions, in partnership with care providers, which make the industry more productive while also helping in the transformation of healthcare delivery. Connecting the laboratory to the continuum of care in the community and facilitating the transition to personalized, predictive and preventative medicines have the potential to revolutionalize patient care, improve wellness, reduce the cost of healthcare over lifetimes, and enhance quality of life for all of us. Sunquest understands its role and shared responsibility towards meeting the healthcare industry’s challenges and opportunities. We are dedicated to creating diagnostic information solutions that enable hospitals to fulfill their missions.

Will $20 billion Solve This Problem?
By Frank Poggio, The Kelzon Group

There was a poignant opinion editorial in the Chicago Tribune this Sunday that got my attention, written by Candy Schulman, entitled “There is a human in that bed”. It caught my eye and got my empathy because I lived that same experience about a year ago. There were however, two major differences. First it happened in a different hospital in a different state. Second, since I have worked in the hospital world as an administrator, systems supplier, and consultant for thirty-five years, I had a better understanding of the issues and therefore was able to force a faster resolution. As I read Candy Shulman’s article I kept asking myself, as I did a year ago, what is really wrong with this ‘system’ and what can be done about it? Also, I kept thinking will $20 billion solve this problem? Let me tell you a little about both stories before I give you my assessment and prognosis.

Candy’s Story – Dumped in the Driveway
Candy tells about her frustration in caring for her elderly mother while an inpatient at a local hospital. Two of her biggest problems came in simply getting her mother discharged at a reasonable time, and the lack of coordination with hospice care. The statement I most reacted to was, “After her month long hospitalization and three weeks in rehab, I tried all day to get her discharged, but ran into a hospital quagmire when I could not get anyone to sign the discharge papers. Finally, at 6 p.m., I left, believing I’d repeat the arduous process the next day”.

“Two hours later the rehab facility sent a bedridden, demented old woman home in an ambulance—alone. I wasn’t called to accompany her home, nor was her devoted live-in aide, Nellie (I was taking her out for a bite to eat after a long, tiring day). My poor confused mother was suddenly dumped into an ambulance. In the driveway of her apartment building, the driver seemed surprised that no one was there to take care of her.”

Candy Schulman’s complete article can be found at: http://www.chicagotribune.com/news/chi-oped0329humanmar29,0,552996.story

My Story – Who’s on First?
In February of last year, I lived through a similar experience. My 88-year-old mother, after years of struggling with CHF and COPD, was admitted to a Florida hospital. After a few days of hospitalization, we were told there was nothing that could be done and death was only a month or two away. My family decided the best course was to move her home and get the local hospice involved to supplement the efforts of me and my sister. I had spoken at length with her cardiologist, internist, and case worker and agreed this was the best course.

Needing a day to work things out with a local Hospice program, the hospital agreed she would be discharged in two days. I lined up the Hospice services to come to her home to set up the medical equipment, complete their assessment and explain to her their plan and what would transpire. Although my mother was severely physically impaired, she was of sound mind and fully cognizant of her surroundings to the day she died.

On the agreed-to day of discharge, I went to the facility to get her at 9 a.m., thinking that by 10 or 10:30 a.m. we’d be on our way. The day before, I told the Hospice staff we would be at her house by 12 noon and they then could commence their process.

To make a long story short, I did not leave that hospital until 1:30 p.m. that day, and then it was only because having worked in a hospital earlier in my career I knew how disjointed things can get. I personally tracked down the admitting doctor (not her cardiologist or internist) and brought him to the room to write the discharge orders and sign it. That was at 12:30 p.m. and still a number of other nursing and related tasks had to be completed. All the while I was running around the hospital, and in and out of her room, my mother kept asking, "Don’t these people know what they are doing and when can I go home?” I kept answering, “No they don’t, and if we’re not out by 2 p.m., we will leave AMA!”

What Went Wrong?
Everything involved with communication, coordination, and follow-up. No one knew who was on first, who had main responsibility, or what needed to be done next. As best I can tell, everyone involved was waiting for the next person to do his/her task, when in fact many of the tasks could have been done concurrently. Meanwhile this hospital has been using one of the leading HIS packages in the country for more than a decade.

So let’s spend $20 billion on new HIT/EMR systems like Cerner, or Epic, McKesson, GE, Siemens, or Meditech — whatever flavor you like. It won’t matter. Although they may help a little, in my opinion, none of them can solve this problem. Here’s why.

The problem Candy and I described is not a data storage (EMR) or transactional (HIS) problem. It is a communication, coordination, trans-departmental workflow and management problem. Yes, HIT vendor systems can do communication, but they do very little, if anything, for work flow coordination and communication and almost nothing outside of ancillary medical services. These systems are great at ordering an x-ray and making sure radiology does the prep work, then delivering the results to clinicians and placing an image in the EMR. But what if that patient needs a dietary consult and the dietician comes to the room while the patient is still sitting in x-ray, one hour late for a test that was to be done at 1 p.m.? They almost totally ignore non-medical support services such as social work consults, dietary reviews, transportation needs, patient location or education, timely discharge orders, and more. Such tasks typically fall to nursing to ‘manage’. Inevitably one or more falls through the cracks, and when one fails the whole process collapses and the patient suffers.

Unfortunately, this problem is pervasive across health institutions as identified by a recent report issued by the National Academy of Sciences – Institute of Medicine (IOM) entitled Computational Technology for Effective Health Care: Immediate Steps and Strategic Direction. The report states: “Health care decisions often require reasoning under high degrees of uncertainty about the patient’s medical state and the effectiveness of past and future treatments for the particular patient. In addition, medical workflows are often complex and non-transparent and are characterized by many interruptions, inadequately defined roles and responsibilities, poorly kept and managed schedules, and little documentation of steps, expectations, and outcomes.”

If you still do not believe it is pervasive, then answer these simple questions. Does your facility have a time of discharge policy? If yes, what percentage of the cases hit that time within 15 or 30 minutes? Of course if you can’t answer either, that’s proof enough.

During my years as a hospital CIO /CFO and as a system’s developer I believed that the ever-expanding HIS tools and developing EMRs would someday address this problem. Today, after many years of hands-on experience at all levels, I am convinced they cannot and will not. In a nutshell, I have come to the conclusion this in not an information technology problem. It is a work flow process problem, a communication problem, and lastly, a management problem. It is not a department problem, but an inter-department or enterprise problem. An HIS /EMR can help solve it, but using those tools alone you are doomed to fail.

What is Needed?
The seemingly simple goal of implementing a set discharge time and meeting it has many challenges such as poor inter-department coordination and poor integrated work flow. Inter-department resource coordination founded on solid work flow documentation and monitoring tools is critical to successful patient flow and meeting discharge targets. Fortunately there are many sophisticated work flow tools developed outside of health care that can be used to help achieve better patient flow and control. Private industry has used tools such as optimization, production coordination, queuing analysis, and sophisticated enterprise scheduling for decades. Some of these are finding their way into health care now, but very slowly.

These tools go beyond electronic bed boards and digitized paper forms, both of which are needed but only address the symptoms. Hospitals need to know real time where they stand for any given patient. In effect, a Gantt chart or patient critical path for all activities is needed to meet a specific goal or target discharge time. Remember, a delayed discharge costs the hospital money and it’s the primary reason for ED diversions, which typically lead to large ED capital expenditures.

Proper coordination of all services (ancillary and non-ancillary) can help hospitals get through these tough times. It’s not easy, but by better utilizing your current resources, (staff, equipment and technology), through better work flow coordination, you can significantly improve patient throughput to drive improved productivity, reduced costs, enhanced revenues, and most importantly, increased patient satisfaction.

While in the hospital my mom, and I would believe Candy’s mom, received excellent medical care from some very dedicated and overworked people. But what we remember most clearly was the bungled discharge process that colored their entire stay. Medicare starts this year to measure patient satisfaction, so bungled discharges will soon become a costly mistake.

News 4/1/09

From Tyrone C. Earl: "Re: Pyxis. 800 people laid off today. The regional manager came in today to tell us that one of the people was our PM for our go-live this week (nice timing). He said we had to wait two hours before we told anyone." The company just announced that it will eliminate 1,300 jobs when it spins off CareFusion. The announcement mentioned 800 layoffs, so maybe that’s not a coincidence.

From Eclipsys Layoffs, aka A Passage to India: "Re: Layoffs. Once again the ‘leadership’ at Eclipsys has cut 100 (give or take) positions. So what exactly have Eclipsys stockholders gotten from Andy’s multi-million dollar leadership team? Lower stock price, fewer sales, and an employee base that’s being slowly exported to India." Unverified, although someone I know got the axe and also gave the 100 number, mostly from development, and also said that development SVP Joe Petro resigned (but he’s still on the Web page, so I’m not sure about that). I would blame the economy more than the company.

From Alexander B. Fitzhugh: "Re: BearingPoint. Healthcare consulting (which consists of the Federal, Provider and Payor practices) is part of the Public Services business unit. The information in the link you provided is correct, Deloitte intends to buy PS. According to Kelvin Womack (VP and sector lead for Healthcare), almost all employees within Healthcare are going to move over to Deloitte."

From Anony: "Re: GE. Harrison Hospital (Bremerton, WA) selects GE Centricity for its 25 hospital physicians. Also purchased were 100 licenses for a community Stark offering and GE’s Health Information Exchange (HIE). Expect a press release in the next week."

From Kat & Mouse: "Re: McKesson layoffs. A good source states the layoff was around 600. The source was one of them, given severance and time to find new job. Source stated that McK had over-expanded last year – nothing to do with issues related to the stimulus." Unverified.

From Yancy Derringer: "Re: KPIT. Insiders say 400 more will be let go in June. The IBM announcement was rumored the day the new CIO came to KP because he did the same thing in his last two jobs (both outside healthcare) and the new VP he hired did the same." Props to Dr. Mark Craig, who rumor reported to me in October 2007, "The prevalent rumor is that the new CIO and his new hires are on an outsourcing train and the train is powered by IBM.”

From The Beeb: "Re: Second Life used to teach doctors." Link. Imperial College London’s interactive hospital simulation is used to teach third-year med students. The on-screen characters resemble faculty members, students review recordings of real-life patient breathing, and the game stops if students forget to wash their hands.

From New York Cynic: "Re: move. Lori Evans, 39, rising Health IT star Deputy Commissioner 4 NY Office of Health Information Technology Transformation has left after only 2 years and is positioning herself for her next move. Although she was anticipated to be CEO of the National eHealth Collaborative, this has been put on hold as the role of NeHC is in question under the stimulus plans policy committee. Her connections to the previous administration (Brailer) precludes any position with the current administration or ONC but watch for some serious re-branding to occur."

From People Love to Gamble: "Re: prize. What prize will you be giving to the 2 millionth visitor to the site? ;-)" I like the idea, but there’s no way to identify who the visitor is. And, it looks like I’m out of time to think about it since the magic number will be reached sometime Wednesday or Thursday at the usual rate. It’s a good time for me to thank the people who read and sponsor HIStalk. I remember with total clarity when I was thrilled to look at the e-mail list and see 31 subscribers (now at 4,000) and to see that long-awaited first thousand page views (now at over 3 million). I’m just as thrilled and surprised now.

Listening: Crack The Skye, the new release from Mastodon, the Grammy-nominated, 70s-sounding (Sabbath meets Green Carnation) new wave heavy metal that covers Stephen Hawking, Czarist Russia, and astral travel. Diggin’ it.

If you RSVPed and are coming to the reception Monday, we’ll probably start our little program at around 7:45 or so (the event runs 7 until 9). We’re playing it by ear, but I was thinking that leaving some networking time afterward would be fun since we may recognize a few people from the podium that you’ll want to chat with. And if you have signed up, please make sure to respond the confirming e-mail from Ingenix since we’ve got waitlisted people who would be happy to take your spot if you can’t make it after all. I’m heading out to Chicago early, so I will report from there starting Saturday evening, enjoying the snow and freezing (not).

Speaking of HIMSS, here’s our list of who you should see in the exhibit hall, those sponsors who keep the presses pressing right here. These are the cool people. Want a nice, printer-ready copy perfectly formatted for taking along? Here you go. Tell them thanks for sponsoring HIStalk, will you?

Among those companies making the short list to provide a new national pathology system for Wales: Cerner and InterSystems.

Over on HIStalk Practice, we did an "HIT Moment with …" Michael Stearns, president and CEO of e-MDs.

A nice piece on Cleveland Clinic’s HealthVault pilot, highlighting one hypertensive patient’s experience. Says a doctor there: "We’ve not been connecting as well as we should have. I think this is where the future is."

Nicholas Casabona is promoted to CIO of Winthrop-University Hospital (NY).

Rich Temple, CIO at AristaCare Health Services (NJ), tells me he’s signed a contract to implement business intelligence tools from ABS System Consultants as the Canadian company’s first US LTC customer.

Quest Diagnostics is quietly releasing a free iPhone application that will run the Care360 physician portal of its subsidiary, MedPlus.

E-mail me.

HERtalk by Inga

From Clueless: "Re: What to wear? Inga – can you advise re: dress code at the HIStalk/Ingenix soiree?" Good question. As Mr. H babbles on about recommends which education sessions to attend, I am glad that someone has the good sense to be asking the important questions. So, always start with the shoes. The weather on Monday is currently forecast for a high of 39 degrees and rainy, with snow and freezing weather by the evening. Clearly not conducive to high-heeled stilettos, which would be the preferred footwear for such a festive occasion. Unless you are staying at the Trump Hotel and simply taking an elevator to the party, such shoes will be a challenge. If you bring a large purse, you could always change out of your ugly shoes and into elegant footwear once you arrive at the hotel. But, gentle reader, I will let you figure that out those logistics. Once you settle on shoes, nothing else really matters. However, I will say that last year we had everything from lovely cocktail dresses and suits to those just-off-the-exhibit-floor khakis with tacky golf shirts that shout the name of one’s employer and are ill-fitting on 90% of all wearers. Don’t worry if you are appropriately dressed. We really just want you to have fun and say very loudly how much you love Mr. H and Inga. 

From Confused: "Re: Pink pants at HIMSS….Is this going too overboard? We want to stand out, but I think this might be pushing it. Currently we plan on wearing black t-shirts with the following logo and khaki pants. Your feedback is greatly appreciated." After suggesting to Confused that only real men can wear pink, Confused said that was enough of a challenge to his team’s collective manhood that they decided the pants were a go. I’m hoping they’ll show off the fancy pants at our HIStalk/Ingenix gathering.

From Pacstech: "Re: RealAge Response. Thought this might interest you. I thought the same thing as New York Cynic after taking their ‘survey,’ carefully opting out of any offers (many) to have them send me health related info." Pacstech forwarded us a copy of a note he received from the RealAge people, who claim the information people provide "is never shared" with advertisers or anyone else, though if you opt for e-mail offers, you will get links from advertisers. I asked privacy rights advocate Dr. Deb Peel for her take on the note and here was her response: "The most important point is how can we trust them or any other health-related website? They all say they never do anything wrong, but where is there any objective evidence, proof of what they say, or certification by an independent outside consumer-led certification organization?  No trust without verification. Those who handle Americans’ sensitive personal data all promise great things but when it comes to our MOST sensitive personal information (health information) we need verification. (We are trying to launch our privacy certification later this year.)" All I can say is that I took the RealAge test a few months ago and was pleased how it so accurately shaved several years off of my not-real age.

The ever-humble Mr. H hasn’t mentioned this recently, but it looks like HIStalk will hit the 2,000,000 visitor milestone by the end of the week. Mr. H is the genius behind HIStalk, so if you are a fan, send him a congrats, kudos, felicitations, or a thatta  boy. And thanks for reading.

Eclipsys announces that Lahey Clinic will implement the Sunrise suite of clinical products for its two-hospital delivery system. Lahey will also add Eclipsys’ clinical and financial decision support solutions.

West Carroll Memorial Hospital (LA) implements Healthland’s EMR solution for its 33-bed hospital.

Motorola and Vocera sign a joint marketing deal to offer the Vocera system on Motorola’s VoWLAN smartphones.

We interviewed Linda Peitzman, MD, CMO of Wolters Kluwer Health Clinical Solutions, on HIStech Report.

British doctors find that using maggots to treat leg ulcers is just as effective as using gel. Both are similar in cost, but the maggot alternative is a viable option for remote areas without access to good medical care. Unfortunately, the maggot treatment is more painful. Ick.

Suburban Hospital Healthcare System (MD) selects McKesson’s Horizon Clinicals and revenue management solutions.

An engaged front-line team, supported by an electronic health record and a clinical care registry, is credited with reducing the deaths of patients with coronary health disease by 73 percent, according to the results of a Colorado program piloted by Kaiser Permanente. The pilot care program linked pharmacists, nurses, primary care physicians, and cardiologists and included such tactics as proactive patient outreach, education, lifestyle adjustments and effective medication management.

AT&T and Mednet Healthcare Technologies partner to help doctors and patients remotely monitor heart arrhythmia through personal mobile devices. Using Mednet’s HEARTRAK External Cardiac Ambulatory Telemetry solution, heart monitor data is transmitted via Bluetooth-enabled cell phones.

Western Maryland Health Systems (MD) plans to implement Agfa Healthcare’s IMPAX Cardiovascular imaging and information management solution when it opens its new Regional Medical Center later this year.

Streamline Health Solutions announces that a "leading West Coast university-affiliated surgery department" will implement its enterprise document management and workflow solutions. The "unnamed" university is easy to identify if you view the link to the press announcement. This is the second time we’ve noticed Streamline declining to name their client in the actual release, but revealing it in the link. Perhaps they are intentionally revealing the client’s identify in this subtle way so people like me can feel like a smarty-pants.

Blood Centers of America endorses Mediware’s blood center technology product strategy. Member blood banks will now have access to special Mediware pricing.

Kaiser fires 15 hospital workers and disciplines another eight for peaking at octomom Nadya Suleman’s medical records. Suleman’s attorney suspects the employees were trying to find information on the sperm donor.

After paying contractors billions to create the DoD’s AHLTA military EMR system, officials introduce a plan to re-shape the system. The new strategy seeks to improve provider satisfaction, improve reliability, and strengthen data sharing throughout the DOD and the VA.

Oakwood Healthcare System (MI) selects PatientKeeper to streamline physician access to its clinical information.

E-mail Inga.

Pam Pure Leaves McKesson

McKesson announced this morning that Pamela J. Pure, executive vice president and president of McKesson Technology Solutions, has left the company as of yesterday. No reason was given for her departure and no replacement was named.

Mr. HIStalk’s Must-See Vendors for HIMSS 2009

Allscripts

Booth 1303

Contact:
Todd Stein, Senior Manager/Public Relations
312-506-1216
todd.stein@allscripts.com

The new Allscripts is the clear leader in software, services, information and connectivity solutions that empower physicians and other healthcare providers to deliver best-in-class patient safety, clinical outcomes and financial results. Nationwide, more than 150,000 physicians, 700 hospitals and thousands of other healthcare providers in clinics, post-acute care facilities, and homecare agencies utilize Allscripts solutions to automate and connect their clinical and business operations. Together with our clients, Allscripts is transforming our disconnected ‘healthcare’ system into a connected system of ‘health.’

Allscripts Says: Do you know why The Time Is NOW to adopt electronic health records? Learn more about the Stimulus incentives at the Allscripts booth (1303) at HIMSS. We’ll be talking about why you should begin taking steps NOW toward implementation.

API

Booth 2007

Contact:
Jim Klink, VP of Sales
262.670.2711
jim.klink@apihealthcare.com

API Healthcare is the leading provider of human capital management solutions to the healthcare industry including time and attendance, staffing and scheduling, patient classification, payroll, human resource, and business intelligence. Founded in 1982, API Healthcare has more than 600 installations in the North America, with clients ranging in size from 500 employees to more than 30,000 employees. The company’s Payrollmation® system has been rated by KLAS as the top time and attendance system for the last seven years.

API Says: As the experts in optimizing human capital management in the healthcare industry, we can help with some of your most pressing business concerns: minimizing labor costs, increasing employee satisfaction and improving patient outcomes.

ATT

Booth 612

Contact:
Tammi DeVore, Sr Healthcare Marketing Manager
206.422.2416
tammi.devore@att.com

www.att.com/healthcare

AT&T Mobility is the leader in healthcare communications, combining innovation and industry experience to use technology in new ways and in new places. We are committed to helping you transform healthcare delivery by wirelessly enabling clinician workflow. Using our ecosystem of alliance vendors, AT&T provides products and services that meet your goals of improved patient care and business productivity.

AT&T Says: Discover new ways to mobilize your clinicians, launch new telehealth solutions, and integrate devices within the Healthcare enterprise system. Interact with innovative technologies, speak with specialists and discuss unique solutions for your organization.

AT&T will demonstrate cellular and WiFi communication solutions for healthcare providers which enable delivery of real-time data via smartphones and other mobile devices. These solutions include Enterprise Paging, Results Reporting, Alerting, ePrescribing, Physician Portals, Homecare, Decision Support and Communications for healthcare professionals. All solutions serve to improve the quality of care and improve the efficiency of operations.

Caretech

Booth 7030

Contact:
Jody Meehan Director, Marketing & Communications
(248) 823-0900
www.caretechsolutions.com
jody.meehan@caretechsolutions.com

CareTech Solutions, Inc., an Information Technology and Web Products & Services provider for hospitals and health systems, is committed to creating value for clients through customized, flexible solutions that contribute to improving patient care while lowering healthcare costs. From implementing emerging technologies to supporting day-to-day operations, CareTech offers clients expert services across the entire patient data lifecycle.

CareTech Soluions Says: CareTech Solutions won a coveted 2008 Best in KLAS award for the IT Outsourcing (Extensive) market segment, as ranked by healthcare executives and professionals in the 2008 Top 20 Best in KLAS Awards report. CareTech’s Best in KLAS distinction follows the company’s achievement of market-leading overall performance scores in KLAS’ 2008 Extensive IT Outsourcing Study.

Cumberland Consulting Group

Booth 4475

Contact:
Jim Lewis
Managing Partner
(615) 373-4470
jim.lewis@cumberlandcg.com
www.cumberlandcg.com

Cumberland Consulting Group is a national technology implementation and project management firm serving ambulatory, acute, and post-acute healthcare providers. Through the implementation of new technologies, we help our clients advance the quality of care they deliver, and improve their business performance. Cumberland is also a great place to work, placing fifth on Consulting Magazine’s 2008 ranking of America’s Best Small Firms to Work For.

Cumberland Consulting Group Says: Learn about a new alternative. We are a relatively new company with an excellent delivery record and a lean operating model that allows us to deliver big company results at a very attractive price. Our clients appreciate our business approach and the small firm commitment and attention we provide. We love our work and we take the success of our clients very personally.

dbMotion

Booth 2603

Contact
Eclipsys Corporation
Three Ravinia Drive
Atlanta, GA 30346-2156
Toll-free: (800) 869-8300
PeakPractice Sales: 877-633-6683 x657

As The Outcomes Company®, Eclipsys offers advanced integrated clinical, revenue cycle and performance management software, clinical content and professional services that help healthcare organizations achieve improved clinical, financial and operational outcomes.

Eclipsys Says: Visit Eclipsys in Booth #2603, Hall A, during HIMSS09 to see how real organizations with real challenges are using our solutions to drive performance and improve outcomes. In addition to our Sunrise Enterprise ™ solution suite, we’ll showcase our Web-based Eclipsys Practice Solutions, the cost- and resource-efficient practice management and EMR solutions, along with our new Eclipsys Performance Management solutions—(Sunrise EPSi™, Sunrise Clinical Analytics™, Sunrise Patient Flow™) that create actionable information to guide the timely, enterprise-wide intervention critical to positive performance.

e-MDs

Booth 4459

Contact:
Andrea Lesh, VP of Sales & Marketing
512-257-5200
www.emds.com
sales@e-mds.com

e-MDs is a leading developer of healthcare software solutions, including clinical, financial and document management modules designed to automate medical practice processes and chart management. With e-MDs, medical practices can visit, code and bill with a single application. e-MDs – Charting The Future of Healthcare.

e-MDs Says: Come see the integrated EHR/PM solution Top Ranked by medical societies, including the AAFP and ACP, for its Functionality and Ease of Use. Get a hands on demonstration of the most flexible, scalable and user friendly solution on the market today, and ask about our “next generation” product line coming very soon.

Enterprise Software Development

Booth 7927

Contact:
Joseph Torti, President
5151 Monroe St. Suite 101
Toledo, Ohio 43623
www.enterprisesoftwaredevelopment.com
419-841-3179
jtorti@enterprisesoftwaredevelopment.com

Enterprise Software Development is a leading independent consulting firm dedicated to assisting healthcare organizations with their diversified business and Information Technology needs. Our services and solutions include IT management consulting, supplemental staff augmentations, clinical and system transformation, implementation and integration, as well as education and training in Cerner^®, Siemens^®, Epic^®, Eclipsys^®, MEDITECH, and McKesson systems.

Enterprise Software Development, LLC Says: Stop by and learn how our consultants allow your staff to focus on what they do best and help you make sure you have the tools you need to implement facility wide configuration, project planning, and training for executing your new or upgraded system. Our consultants can integrate with your staff at a professional level and compliment your team. We are a simple solution with a personal touch to your Clinical transformations.

GetWellNetwork

Booth 3413

Contact:
Michael Schram, VP, Sales
240.482.3200
mschram@getwellnetwork.com
www.getwellnetwork.com

GetWellNetwork works with leading hospitals to engage patients in their care. Transforming in-room televisions into an interactive resource, patients are invited to get involved in their education, safety, service, discharge preparation, and more. The result is first felt by patients, then measured in improved satisfaction, quality and operational performance.

GetWellNetwork Says: Stop by our booth at 11:15 am on Tuesday for a special presentation with Russ Branzell, Chief Information Officer at Poudre Valley Health System, and find out about the impact that Interactive Patient Care is having on their care process and IT operations.

Greenway

Booth 3910

Contact:
Rebekah Green, Marketing Analyst
866.242.3805
info@greenwaymedical.com
www.greenwaymedical.com

Greenway Medical Technologies is a leading provider of an integrated, single-database electronic health record (EHR), practice management and interoperability solution for physician practices and hospital community EHR strategies. Greenway’s CCHIT Certified® 08 ambulatory EHR solution, PrimeSuite® 2008, streamlines a practice’s clinical, financial and administrative processes while increasing practice profitability.

Greenway Medical Technologies Says: With the recent passing of the American Recovery and Reinvestment Act of 2009 “the stimulus bill”, physicians and medical practices have more incentive now than ever before to adopt an EHR solution. Greenway Medical solutions are designed to maximize return on investment while enhancing the quality of care physicians can provide their patients.

Healthcare Growth Partners

Booth 3081

Healthcare Growth Partners provides investment banking and strategic advisory services to small and mid-size, high-growth companies with an exclusive focus on healthcare information technology and technology-enabled services. With this focus, the firm leverages its experienced management team, strong execution capabilities, and deep network of contacts within the industry to provide efficient and high value processes for clients.

Informatics Corporation of America (ICA)

Booth 3476

Contact:
John Tempesco
Vice President, Client Services and Marketing
Main Office (615) 866-1465 – Cell (803) 351-8161
www.icainformatics.com
john.tempesco@icainformatics.com

Informatics Corporation of America (ICA) was created with nationally renowned Vanderbilt Medical Center to take innovative technology developed by Vanderbilt physicians to the broader healthcare market. Today ICA is unmatched in its ability to deliver a cost-effective, proven solution that leverages complete data across clinical settings to aid decision-making and improve patient outcomes.

ICA Says: Drop by the ICA booth and talk to Dr. Jonathan Anderson of the Health Information Exchange of Montana about how physicians use the ICA solution to improve care in northwest Montana.

Ingenix Consulting

Booth 626

Contact:
800-765-6897
impact@ingenix.com
www.ingenix.com
www.ingenixconsulting.com

Ingenix is a leading technology company working to improve healthcare through the power of information. Ingenix helps to enhance efficiency, accuracy, and quality in thousands of payer, hospital, physician, employer, and public sector organizations. Ingenix Consulting is a premier, data-driven health and human services consulting organization.  We have over 1,000 consultants with experience working with hospitals, physician practices, health plans, employers, government agencies and pharmaceutical companies.  This scale and exclusive health and human services focus set us apart.

Ingenix Says: See for yourself how our combination of information, technology and expertise can help you improve quality while reducing administrative burdens, meet the challenge of ever-expanding regulations, and thrive in a down economy. Stop by booth #626 to watch a presentation by one of our industry experts or to chat about your challenges.

McKesson

Booth 1213

Contact:
Joey Nord
McKesson
5995 Windward Parkway
Alpharetta, GA 30005
404-338-2414
Joey.nord@mckesson.com
www.mckesson.com/mpt

McKesson is a leader in software, automation, services and consulting to hospitals, physician practices, imaging centers, homecare agencies and payors. We also provide interactive connectivity services that streamline clinical, financial and administrative communication for healthcare stakeholders. The result? Care that is safer, more efficient, and better connected.

McKesson Says: McKesson experts will be available to discuss: healthcare IT incentives included in the American Recovery and Reinvestment Act and possible implications for hospitals and health systems; how IT can help improve care quality and productivity; eligibility and coding solutions that can positively affect cash flow and financial performance now; services to leverage existing IT and enable you to prepare for the Recovery Audit Contractor (RAC) program, manage the audit process and mitigate future risk.

Medicity

Booth 4443

Contact:
Greg Miller, Sr. Vice President Sales & Marketing
(801) 322-4444
www.Medicity.com
Sales@medicity.com

Medicity is the market leader enabling clinicians to access, exchange, share and collaborate with patient-centric clinical information located in disparate systems across multiple care locations. By leveraging Medicity’s Care Collaboration Platform, physicians, hospitals and Health Information Exchanges (HIEs) optimize clinical workflow, enhance patient safety and deliver cost-effective, efficient healthcare to patients and communities.

Medicity says: Medicity’s unique single point of access to clinical data, aggregated from disparate systems across care locations, empowers hospitals, health systems and HIE’s to deliver superior quality, more cost-effective, highly efficient and better coordinated healthcare.

MEDSEEK

Booth 1238

Contact:
Rich Grehalva, SVP Marketing & Consulting Svcs.
www.medseek.com
rich.grehalva@medseek.com

MEDSEEK provides healthcare organizations with enterprise eHealth solutions to fully engage and strengthen relationships with key constituents – physicians, patients, employees, and consumers. By connecting information and communities to foster an enhanced experience with the organization, hospitals will improve community advocacy, revenue and patient acquisition/retention, physician relations, and clinical decision making.

MEDSEEK says: Enhancing the experience is an expectation of all users within the healthcare community. A key to improving revenue while decreasing expenses is through the effective use of enterprise eHealth solutions. Visit us at HIMSS in Chicago to learn how we are improving the overall experience of patients, consumers, clinicians, physicians and employees, and to hear details about our HIE/RHIO solution.

NextGen

Booth 1242

Contact:
NextGen Healthcare Information Systems, Inc.
215-657-7010
http://www.nextgen.com/
sales@nextgen.com

Hospitals and practices use NextGen because we offer the market’s leading ambulatory EHR and practice management system, featuring interoperability with numerous inpatient systems, specialty content to ensure fast user adoption and standardized data capture, and enterprise architecture to support large, multi-specialty sites. Increase your operational efficiencies with a NextGen® system. Visit us at HIMSS booth #1242 and at the Interoperability Showcase.

NextGen Says: Learn from Next Healthcare how your hospital or practice can take advantage of reimbursements and grants that are available through the healthcare stimulus bill. Our government affairs department, and our grants and funding team are staying abreast of the latest developments. Grant money is now available for Indian Health Centers and for non-profit Community Health Centers. Find out how NextGen can help you.

Nuance

Booth 1448

Contact:
Elizabeth Swanson, Marketing Assistant
781-656-4300
elizabeth.swanson@nuance.com

The eScription platform from Nuance Healthcare is the leading software for computer aided medical transcription. With eScription, intelligent speech recognition software turns clinician dictations into formatted draft documents that medical transcriptionists-whether in-house or outsourced-quickly review and edit, often doubling productivity, reducing turnaround times, and cutting costs. Customers are continually satisfied with the eScription platform, resulting in a "Best in KLAS" award for the past five consecutive years!

Nuance Says: Come by the Nuance booth to see speech recognition solutions that can help your healthcare organization save costs and increase efficiencies such as the 5-time, Best in KLAS award winner, eScription.

PatientKeeper

Booth 2917

Contact:
Lauren Tilelli, Marketing Programs Manager
617-987-0465
www.patientkeeper.com
ltilelli@patientkeeper.com

PatientKeeper software improves patient care with a single information environment for physicians—available anytime, anywhere. We make this possible with integration technology that unites patient information across hospitals, physician practices, and communities. With PatientKeeper, hospitals and their physician communities are better aligned—to improve clinical efficiency, achieve patient safety goals and a healthier financial bottom line.

PatientKeeper Says: PatientKeeper says to stop by their booth to learn how you can extend your existing IT investment with hospital and community-wide connectivity – to improve physician affinity and establish a foundation for HIE. Also learn how PatientKeeper’s revenue cycle applications are helping facilities improve cash flow and uncover missing charges.

Premise Corporation   
(now part of Eclipsys)

Booth 2603 (Eclipsys)

Contact:
www.PremiseUSA.com
www.eclipsys.com

Premise Corporation, the nation’s leading provider of enterprise-wide, clinically focused patient flow solutions, is now part of Eclipsys – and Premise solutions are now Sunrise Patient Flow^TM. Endorsed by the AHA and used by dozens of top-ranked and magnet facilities, Sunrise Patient Flow is the only patient flow solution that provides automated workflow and communications coupled with clinical visibility in a single system – a unique combination that drives key performance improvements while also ensuring the highest quality care. And, now with more resources and a comprehensive portfolio of products, we’ll not only help you drive efficient patient flow processes, we’ll also help you achieve real outcomes in operational performance.

About Eclipsys
Eclipsys is a leading provider of advanced integrated clinical, revenue cycle, and performance management software, clinical content and professional services that help healthcare organizations improve clinical, financial, operational and client satisfaction outcomes. For more information, visit www.eclipsys.com or email info@eclipsys.com. For details on the Sunrise Patient Flow solutions, see the current Premise web site at www.premiseusa.com

QuadraMed Booth 2023

Contact:
12110 Sunset Hills Road
Reston, VA 20190
703.709.2300
http://www.quadramed.com

QuadraMed develops IT solutions that enable healthcare organizations to simultaneously improve the documentation, quality, safety, and efficiency of patient care along with coding, billing, and collections functions – from initial patient contact through discharge. QuadraMed’s Care-Based Revenue Cycle solutions help hospitals grapple with the business realities of healthcare: the need to achieve financial strength year after year so they can fulfill their mission of providing quality care.

QuadraMed Says: Take our survey at http://www.quadramed.com/himss09/ and receive a free gift!

RelayHealth

Booth 2051

Contact:
Janeen Cook
1145 Sanctuary Parkway, Suite 200
Alpharetta, GA 30004
770.237.7918
janeen.cook@relayhealth.com
www.relayhealth.com

RelayHealth provides you the ability to create a complete healthcare exchange connecting patients, providers, payors, pharmacies, financial institutions and pharmaceutical manufacturers. It offers interoperable, SaaS clinical, financial and pharmacy connectivity services which accelerate improvement in the quality of care, ensure financial health and create workflow efficiencies.

RelayHealth Says: Financially secure healthcare leader in search of providers looking to get connected. Should be open to long-term commitment to success and prepared to consider interactive solutions. Are you ready for a partner to rock your world? If so, visit RelayHealth at Booth #2051 and find out why you need to get Care Fully Connected.

Sage

Booth 4404

Contact:
2202 N. West Shore Blvd.
Tampa, FL 33607
813.202.5000
http://www.sagehealth.com

Sage Software provides solutions that allow practices to optimize the patient’s experience while enhancing the practice’s bottom line. Our industry-leading three-pronged approach includes products – including practice management, electronic health records and business intelligence software – thirty years of experience, and connectivity that enables electronic communication between practices and other providers, payers and facilities

Sage Software Says: Stop by to see how we connect practices to hospitals, laboratories, payers and patients. We’ll also show you how to make structured documentation look more natural and narrative.

Sentillion

Booth 743

Contact:
Jennifer Haas, Director, Communications
978-689-9095 ext. 262
www.sentillion.com
jhaas@sentillion.com

Sentillion has successfully combined patented technology with a deep understanding of the healthcare industry to deliver the most comprehensive set of solutions for single sign-on, identity management, clinical workstations and desktop virtualization. Sentillion is the only identity and access management company whose solutions are used daily by over 400,000 caregivers in leading healthcare organizations across North America and the United Kingdom.

Sentillion Says: We will be debuting several exciting new technology solutions and as part of this, guests will have an opportunity to win a Flip Video and other great prizes. Stop by and while you’re in our booth grab a drink (in-booth Happy Hours occurring Sunday-Tuesday, 4:30-6:00 p.m.) and pick up a Sentillion green fish plush toy.

Sentry Data Systems

Booth 7263

Contact:
John Peebles, CIO
800.411.4566
www.sentryds.com

Sentry Data Systems saves you time and money. Sentry offers healthcare business intelligence technology solutions that address a variety of operational, workflow, compliance, and financial challenges found within hospitals and pharmacies. These products include the hospital pharmacy management application Sentinel RCM™ (Revenue Cycle Manager), retail pharmacy transaction processing platform Sentrex™, and the healthcare business intelligence application HealthBIT™ (Business Intelligence Technology). These products run on top of Sentry’s healthcare cloud computing platform, Datanex™, which is available to independent software developers and other healthcare entities.

Sentry Data Systems says: TURN YOUR DATA INTO REAL TIME INFORMATION. In order to succeed and remain viable and competitive, hospitals and other providers need information to make decisions, which result in hard-dollars savings and revenue creation.

Sunquest

Booth 7522

Contact:
800-748-0692
www.sunquestinfo.com
sales@sunquestinfo.com

Sunquest Information Systems, Inc. delivers the market leading LIS and outreach solutions designed and implemented to fulfill the business objectives of today’s healthcare leaders. Built on the reliable technology required for mission critical applications, Sunquest solutions provide the foundation to optimize the healthcare experience; deliver safe, effective, and timely patient care; expand community reach; and transform the delivery of healthcare with predictive and personalized medicine.

Sunquest says: Sunquest proudly sponsors healthcare leaders speaking on the Five Rights of Laboratory Testing; how successful organizations deliver on the promise of safe, effective care; and what the future of healthcare IT might look like. Visit http://www.sunquestinfo.com/PressEvents/Pages/HIMSS09.aspx for the booth speakers’ schedule and to register for our limited seating breakfast presentation on Monday April 6.

TeraMedica Healthcare Technology

Booth 1248

Contact:
Katie Brahm-Barrett, Marketing Communications Manager
10400 Innovation Drive, Suite 200
Milwaukee, WI 53226
Toll-free phone: 866.290.8880
sales@teramedica.com
http://www.teramedica.com

TeraMedica Healthcare Technology’s Evercore ® – Clinical Enterprise Suite software solution connects images, documents, video, sound, or any other information to any EMR/EHR. Evercore provides vendor independence by connecting multiple PACS to any storage system, thus bringing an end to data migration. The solution also manages your data’s lifecycle with clinical-based policies.

TeraMedica Says: TeraMedica is Driven to Optimize – visit our booth #1248 to learn more!

– Driving increased referral revenue by enabling clinicians to work smarter and more efficiently

– Extending image content to the Personal Health Record and patient portals

– Enabling true control over clinical image content using clinically aware data retention policies

Vitalize Consulting Services

Booth 3055

Contact:
Cyndi Vely Cahill
Senior Vice President
610.444.1233 x103
www.getvitalized.com
ccahill@getvitalized.com

Vitalize Consulting Solutions, Inc. (VCS) provides a wide variety of clinical, business and IT solutions for healthcare enterprises across the United States and Canada. Our comprehensive range of programs and services includes system implementation, optimization, custom reporting, technology and integration, education and knowledge transfer in the Cerner®, Siemens®, Epic®, Eclipsys®, MEDITECH and McKesson solutions. Experience VCS. IT’s what differentiates us.

Vitalize Consulting Services Says: Be part of the solution at HIMSS. VCS recognizes that times are tough, so this year we are rallying our HIMSS audience to support one of Chicago’s overburdened food banks. Stop by booth #3055 to pick up a goodie and help erase hunger in the Chicago community.

Wolters Kluwers

Booth 1045

Laura Gilbert
Director, Marketing Communications
Clinical Solutions
612-313-1506
laura.gilbert@wolterskluwer.com
www.pointofcareapplications.com

From diagnosis and treatment to documentation and coding, Wolters Kluwer Health Clinical Solutions provides end-to-end software solutions and clinical content encompassing the full continuum of care under such universally recognized brand names as UpToDate®, ProVation® Order Sets powered by UpToDate® Decision Support, Medi-Span®, Facts & Comparisons® and ProVation® Medical.

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Monday Morning Update 3/30/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail me.

News 3/27/09

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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HERtalk by Inga

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Inga.