Being John Glaser 11/10/10

Meaningfully Using Industry Buzzwords at Home

With the HITECH and ACA legislation and rules. many new phrases and words have been introduced and old ones have gained additional prominence. I have found that these phrases and words also have use in several situations at home. See some examples below.

Death Panel. Your sixteen-year-old son returns home drunk at 2 a.m. after a long Saturday night. He parks the car sideways on the lawn. You and your wife are sitting on the couch in the living room waiting for him. As far as he is concerned, you and your wife are a death panel.

Stimulus funds. Your spouse shows you the new clothes that she bought. You like the clothes, but are mystified by the apparent need for new clothes when the old clothes aren’t that old and you liked those too. Moreover, the clip-on tie you had in third grade is still good and forty years later you still wear it from time to time. You don’t realize that the household income is really a stimulus fund to keep retailers employed.

Data exchange and interoperability. Your daughter (a senior in high school) wants to spend the weekend with her new boyfriend, who is a freshman at a local college. You, recalling quite well what’s always on the minds of young males, say “No.” Your daughter protests, “But Dad, it’s not what you think. I will be staying at his cousin’s (who is a girl) dorm room. Nothing will happen!” You think – I don’t believe that for a second – and again say “No.” You and your daughter are engaged in data exchange, but there is no interoperability going on.

Certification process. The first time you met him, you instantly liked your daughter’s new boyfriend. The second time you met him, you engaged him a lengthier conversation and discovered that he is a moron. The third time you met him, he had been invited for dinner and was clearly stumped by the role of the napkin. You decide that you and your daughter need a new boyfriend certification process.

Meaningful Use. You notice a dead tree in the yard. You find your chain saw and install a new chain. You assure your wife that you know how to fell this tree so that it won’t hit the house even though the tree is close to the house. You miscalculate and tree branches take out the kitchen window. Your spouse is less than impressed. You are clearly not a Meaningful User of advanced technology.

Bundled Payment. You are arm-wrestling with a new car salesman over the price of a car. He mentions all of the features that come with the base price – seats, steering wheel, front window, headlights, and an engine. He informs you of all of the extras – roof, glove compartment, and radio. You want the extras for free. Plus you want a sun roof, Jacuzzi, and toaster. You and he are negotiating a bundled payment.

The great thing about words and phrases is that they have so many uses and meanings.

John Glaser, PhD, FCHIME is CEO, Health Services of Siemens Healthcare. He describes himself as an "irregular regular contributor" to HIStalk.

News 11/19/10

From Karen: “Re: Meaningful Use: Doctors Have No Choice. Written by my husband, but still true!” Jim O’Connor, MD of MDcohort makes the argument that Meaningful Use isn’t as voluntary as it sounds, offering as evidence: (a) CMS will start imposing penalties on EMR non-users in 2015; (b) private insurers will tie MU to their P4P programs; (c) MU will apparently be made a requirement for renewal of board certification; (d) states can impose their own penalties, possibly even requiring MU for medical license renewal.

Ed Marx has a lot of fans here, so if you want to read more from him, he has posted a special article about his relationship with his daughter on Texas Health Moms, a site managed by his employer, Texas Health Resources.

Listening: new from Guster, which I’ve mentioned before. Solid, harmony-driven alt-pop (kind of R.E.M.-y to me), but they’re also funny: they enlist fans to sell CDs and sometimes open their own shows in disguise. If you’ve heard any of their stuff, it was probably Satellite.

Timing is everything: just after Aurora Health Care (WI) announces plans to eliminate 175 jobs in a cost-cutting effort, the press gets wind of the $8.2 million its former COO was paid upon his retirement last year. They make the standard excuses (accrued benefits, they have to compete with for-profits anxious to hire away executives who have spent their entire lives in healthcare, etc.) but I note that they paid the CIO $739K and the CEO got over $2 million according to their most recent tax filings. They have 30,000 employees, so maybe that seems reasonable by inflated non-profit salary standards these days. We may suck at population health in this country, but we lead the world in the executive-to-grunt compensation ratio.

The Aurora guy, who wasn’t even the CEO, made even more than Cerner CEO Neal Patterson, who took home $3.3 million in 2009, a little less than he made in both 2007 and 2008. And speaking of Neal, I’m clearly not at his level of business acumen because this just seems weird: he and Cliff have renamed their soccer team from the Kansas City Wizards to Sporting Kansas City. They’re doing some kind of membership thing, apparently, but that name sure make a weird fan cheer.

Think this will reduce healthcare costs? Mayo Clinic is building proton-beam cancer treatment centers at its Minnesota and Arizona locations. The price tag: $370 million.

On the sponsor-only HIStalk Jobs Page: Director Technical Readiness, Implementation Consultants and Project Managers, Healthcare Consulting Leader, Account Executive. On Healthcare IT Jobs: Program Manager IT Implementation, HED AdminRX HArx Remote, Implementation Engineer – Integration, Epic Inpatient Opportunities.

A New York Times article describes the problems San Francisco Department of Public Health is having with its $11.2 million Avatar EMR from Netsmart. Conversion problems caused delays in Medi-Cal payments to individual therapists and some therapists and social workers are complaining that using the software is eating into time for patient care. A post-implementation audit showed that mental health services volume dropped by 55% and substance abuse by 32%, with the deputy financial officer concluding that, “It’s pretty clear none are getting Avatar.” A social worker agreed: “This is not the job we accepted when we chose to do clinical work for the city.”

Strange: a Walmart pharmacist is disciplined by the Maine regulatory board for dispensing zolpidem instead of Zoloft to a patient. Before his own drugstore went bankrupt, he was also found to have overbilled the state by $1.6 million. The odd part: he’s a state representative in line to become the next speaker of the House.

The VA will develop two prototypes of Aviva, a virtual implementation of its VistA system and its apparent replacement, according to its just-released Fiscal Year 2010 Performance and Accountability Report. I thought they already had demonstrated the prototype earlier this year, but maybe this is something new.

Verizon will offer free credentials to providers in starting in January that will allow access to its Verizon Medical Data Exchange. It offers a provider portal, a secure inbox, and connections to the Verizon Health Information Exchange.

E-mail me.

HERtalk by Inga

From MrSoul: “Re: Kindle It. Encourage your readers to tell the publisher of Connected for Health to publish in Kindle so we can read it on our iDevices! There is a link on Amazon to do just that and then they can have this great resource always on hand.” I would think a book like this would already be in digital format!

West Penn Allegheny Health System selects athenahealth’s RCM service for its 600-doctor physician organization. They are apparently replacing GE’s RCM product. On the EHR side, they use Allscripts.

Venture capital firm OpenView Partners makes a minority investment in Prognosis Health Information Systems. Prognosis CEO Ramsey Evans says that OpenView’s investment will allow the company to “move forward and take our business to the next level.”

North York General Hospital in Toronto goes live with 300 order sets, using tools from Zynx Health’s ZynxOrder and integrating them into Cerner EHR.

CMS says the error rate for Medicare fee-for-service claims in 2010 dropped to 10.5%, or $34.3 billion in estimated improper claims payment. That’s down from 2009’s $35.4 billion in payment errors. I guess we should all be thrilled that CMS is getting better, but I am stuck thinking about all the better ways that $34.3 billion could have been spent.

The Stone Center of New Jersey IPA signs a 15-month contract with iMedicor to connect its 120 urologists into iMedicor’s National Health Communications Network.

Central Maine Healthcare eliminates 20 jobs as a result of outsourcing its medical transcription to Precyse Solutions. Precsyse offered positions to all 20 employees, though only 10 accepted. The move to outsourced transcription is part of a $11 million cost-cutting initiative.

Health management company Continuum Health Alliance contracts with Ignis Systems to provide integrated lab orders management for its EMR application services.

The Indian Health Service (IHS) commits to a $3.3 million contract with Orchestrate Healthcare and Vangent to plan, implement, and support the national deployment of the IHS HIE, enterprise MPI, and NHIN capability. Vangent’s HIEOS open source software will be used to establish connectivity between IHS facilities and the NHIN.

Miami-Dade County Commissions tell Jackson Health System to cut ties with the company handling its international marketing after a recent report details excess spending for such things as flowers and birthday cakes ($7,000), local meals ($37,000), and limo rides ($12,000).  An additional $6,000 was spent on a Royal Caribbean cruise for five of the marketing firm’s senior executives and their families. Foundation Health Services was the organization handling the health system’s international marketing efforts. It’s a not-for-profit, so I guess the execs had to get their perks from somewhere.

Teleradiology service provider Century Digitec Services goes live on eRAD’s hosted teleradiology software platform.

A study of 15 IDNs leads the Government Accountability Office to declare that EHRs can improve the quality of healthcare, making patient information more readily available and improving communication and coordination between providers. Providers still face challenges in terms of maximizing their use of EHRs, including limitations on sharing patient records outside their health system.

New on HIStalk Practice this week: 15 HIT vendor execs share what their company is doing to help physicians qualify for Meaningful Use. Evan Steele of SRSsoft provides commentary on the Meaningful Use challenges for specialists. Fun details on the eClinicalWorks national user conference, including a party pic with a uniquely attired CEO Garish Navani. And, the EHRevent patient safety reporting system. There’s a bunch of other good stuff as well, none of which you will find on HIStalk. Make sure you remain smarter than your co-workers and take a read.

"But Inga,” you say. “I’m too busy, just give me the highlights.” For grins and because I believe it’s important stuff, here’s a short summary of what the HIT vendor execs had to say about helping providers reach Meaningful Use:

• Several are incorporating dashboard tools or similar reports to help providers assess EHR usage based on Meaningful Use requirements.
• Most are offering webinars; many are setting up regional meetings to educate users on what needs to be done; most have online tools available; and, most mention the option for personal assistance, either on-site or remotely.
• Only a couple mentioned working with regional extension centers to share expertise and help beef up local infrastructures.
• Allscripts and athenahealth remind users that they offer Meaningful Use guarantees.
• Not surprisingly, some of the vendors have nicely packaged answers, which to me suggests (a) the vendor has established a clear-cut plan,  or, (b) the vendor has a great marketing department, or (c) both.
• A couple are short on specifics and don’t say much more than vendors needs to help physicians in the process.
• Jonathan Bush of athenahealth wins the prize for the most entertaining answer.
• Evan Steele of SRSsoft  has the most unusual reply, saying the company has spent considerable time reviewing the requirements and are helping its clients make an informed decision as to whether participation is right for the individual practice.

Sponsor Updates

• Encore Health Resources had a contest to see who could do something creative with 100 Legos in celebrating the hiring of the company’s 100th employee. Above is one of the submissions by employee Paul Murphy, who went with a multimedia strategy with an Ivo bobble head approach. I was thinking that I could have cheated and added extra Legos and come up with something spectacular.
• Nuance Communications introduces Nuance Transcription Services, which combines the eScription speech recognition platform with medical transcription and editing services from two of Nuance’s newly acquired companies, Outsource Solutions and Encompass Medical Transcription.
• MEDecision earns NCQA HEDIS software certification for its Alineo Clinical Intelligence Rules 2.4.0 and 2.5.0 programs.
• CareTech Solutions launches CareWorks 4.0, which includes enhancements in audit reporting, directory utilities, and several mobile modules.
• Fast-growing EnovateIT will move its headquarters from Ferndale, MI to Canton. The company’s mobile and wall-mounted computer workstations are used a third of the hospitals in he US, with last years $19 million in sales expected to reach $35 million this year.
• dbMotion appoints Prematics president and CEO Keving Hutchinson to its board of directors.
• 3M Health Information Systems and IQMax partner to offer 3M’s coding and documentation tools using IQMax’s mobile healthcare platform.
• Hayes Management Consulting will provide its Legacy Application IT Help Desk services to Moses Cone Health System as they transition from GE Centricity Enterprise to Epic.
• South Australia’s Public Health System names Allscripts its vendor of choice to provide EHR to its 80 hospitals. The agreement to purchase Sunrise Enterprise 5.5 is subject to contract negotiations, with final approval expected during the first half of 2011.
• Sage is named a group purchasing EHR vendor by PA REACH, which will offer Sage Intergy Meaningful Use edition to providers at a discount.
• A new KLAS report on ED solutions names Epic and Wellsoft as tying for the top spot.

E-mail Inga.

HIStalk Interviews Jonathan Phillips

Jon Phillips is founder and managing director of Healthcare Growth Partners.

Explain what you do. I don’t really understand it except I figure it’s lucrative.

We are an investment bank focused on healthcare technology and services. What we do is analogous to being a real estate agent for companies where we help companies sell themselves, or we help companies buy other companies.

So a good bellwether of how busy that market is would be how often your phone rings. Are you finding that it’s a lot busier now than it was?

What’s interesting is that it is a lot busier now, although the best bellwether is still the number of deals that actually get done. One thing that’s just a fact of life in the mergers and acquisitions business is that when you start a process, you don’t always finish it.

What you see are a lot of situations where companies decide to sell themselves and they don’t get a buyer for reason A, B, or C. It could be that the price that the market thinks that they’re worth isn’t what they think they’re worth and so they decide to wait. Or, it could be that they just don’t get interest at all. Or, it could be that they decide they’d rather do something different — that maybe they’d rather raise money instead of selling themselves, go buy something.

The key challenge in terms of this business is getting things to the finish line. What you’re seeing in the market as a whole is a significant uptick in terms of the number of transactions getting done as compared to a year ago or two years ago, both in terms of the number of deals and the value of those deals.

Where we sit right now is that there are more deals trying to get done than deals that have gotten done, and so you have a lot of folks who haven’t been able to get things done and there’s some interesting dynamics that go along with that.

Do you think it’s because companies that are trying to sell are seeing a top in the market and figure, “Hey, now’s my chance, although I’ll keep going if it doesn’t work out” or do you think they’re desperate, like, “I’ve got to do it now or it’s never going to happen?”

Early in the year, a lot of those were driven by the fact that healthcare mergers and acquisitions activity emerged faster than other sectors. What you saw was a lot of individual shareholders or private equity firms or venture firms looking to sell companies because healthcare was a hot area. Healthcare IT in particular was especially hot, and so you saw a lot of books come out early in the year. Early in the year was driven by, “Hey, the market is hot, and it’s getting hotter. Let’s go out and get a good value for our business.”

Later on in the year, what you started seeing is a little bit of a different trend, where you have some folks who are pulling the trigger on an exit because of tax-related concerns. There are absolutely companies out there that have decided to sell because their sense is that capital gains tax rates are going to go up next year.

Even if capital gains tax rates don’t go up next year — if there’s some type of an extension of the tax breaks — capital gains rates will go up at some point down the road. That does have some impact on decision-making, because even just a five percentage point increase in the tax rate, if you’re doing a $100 million deal, that’s potentially $5 million of more money that you’re paying to the government on January 1 as compared to December 31. That’s been another driver.

The other thing that you’re starting to see — and I still think it’s an early phase of this — but you’re starting to see this phenomenon that I thought we would see a while ago. Companies that are somewhat weaker, that aren’t growing as quickly or aren’t growing at all, or don’t have as strong of a product set and product capability — some of those companies are finally saying. “You know what? Either this market is moving, it’s not moving fast enough, or we’re not moving fast enough in terms of our internal growth to really dig our way out of our current predicament, so we’re going to sell because it’s probably not going to get any better.”

That’s something I think we’re going to see more of, because the way that I characterize the M&A market right now is it’s really kind of a world of haves and have-nots, if you will. Normally what you see in terms of valuation multiples — the multiple of revenue or the multiple of earnings for which a company sells — normally you’ll have a normal distribution of that. If the median multiple is 10 times EBITDA, then you’ll have a bunch of deals happening close to 10 times EBITDA, you’ll have a few deals happening at 15 times EBITDA, and a few deals happening at five times EBITDA.

Where the market is right now is much more in kind of a bimodal distribution. You have a some deals happening at very high multiples, and you have a bunch of deals happening at much lower multiples. You don’t have a lot going on in the middle. I think as this M&A market continues to mature and as the cycle continues, I think you’ll see more activity in the middle. You’ll see more kind of eight to 10 times EBITDA deals happening, but right now, it’s really at the extremes.

I would assume that the number of deals on the high end probably has always been the same. Does that mean more people are unloading for less than they expected or less than historically has been the case?

There are certainly a few more deals on the high end than over the last couple of years at least, but it does mean that more people are unloading at the low end.

Some of that comes back to putting yourself in an investor’s shoes, where you’re an investor in a company that is $3 million in revenue, and you put money in it maybe five years ago, maybe seven years ago. Just to use hospitals as an example, although it would apply to the physician software, it would apply to payer software in 2008, when the hospital spending really froze because of the capital markets early in the year in terms of the auction rate securities and the lack of liquidity for hospitals, later in the year as the market downturn occurred when hospital spending slowed, then the growth source for a lot of these companies slowed down.

But coming into 2009, you had this grand stimulus package that was going to drive all this growth in healthcare IT. Well now it’s a year and a half later, and a lot of those companies that were doing $3 million in 2008 did $3 million or maybe $3.1 or $3.2 million in 2009, and did maybe a little bit more than that or are going to do a little bit more than that in 2010. But from an investor perspective, they’re saying, “How long am I going to have to wait for this market?”

While there are certain subsets that are seeing tremendous growth, my opinion just from talking to a lot of different companies out there, a lot of companies are having a tough time just getting decent growth because resources are geared toward making sure that you can get your Meaningful Use dollars. Resources that aren’t geared toward Meaningful Use dollars are severely restrained, and they’re going to be focused on those things that are going to drive the highest ROI for the hospital.

It’s very competitive for those capital dollars. As a result, demand is soft, and investors say, “Well, do I want to count on demand improving in 2011? I’m going to have to invest more. I’m going to have to wait a few more years.” Or maybe it’s not throwing up the white flag, but it’s certainly, effectively surrendering and saying, “All right, I didn’t do well on this one. I’m going to move on to the next one.”

If you look at the effect of federal money on the potential for company profitability, when do you see that peaking?

I think you’re going to see it peaking in 2012 or 2013.

Really? So you don’t think it’s here yet, so there’s still a lot of opportunity for companies to improve their bottom lines in the next couple of years?

I think there are a lot of opportunities to do that, but the problem is you have to be really disciplined leading up to that point.

Part of the challenge that you see with folks who are selling at less than optimal values is that they’ve found themselves between a rock and a hard place. They see the potential a couple years down the road, that whether they would be direct beneficiaries of the stimulus dollars or not. As those dollars flow into the system, it will create a much more favorable capital spending environment for hospitals. Maybe not much more, but at least a more favorable capital spending environment for hospitals, but you’ve got to get there.

Candidly, I’m still of the view that if you really dig into the performance of the large majority of companies out there — whether they’re selling to hospitals or physicians — I think that the reality of sales momentum is far short of the story that’s been told. Not story as in a negative thing, but kind of the potential that’s out there. I just think this market, it moves slowly. You’ve been around the market long enough.

It’s like nothing happens fast here, and while the HITECH dollars would drive all the spending, effectively what they did is they froze things for a very long time. Consultants got a ton of business over that timeframe as people tried to figure out what to do.

But now as the middle-of-the-market folks are actually implementing their plans, it still is just going to take time. In that time, you have to be really disciplined. You’ve got to figure out a way that you’re not going to be reliant on outside money to come in to fund you. You have to make sure that you can figure out a way to cash flow yourself rather than being dependent on an investor to do it because investors very likely will get impatient with your performance if you can’t show that very immediate path to profitability.

Given how slow this market, is you’ve got to be able to hunker down and make it through. Down the road, there’s a ton of money to be made here, but it’s going to take time.

Companies will need to ride the wave up now and then down again when the surge of money runs out. Do you think that’s a concern, where companies look good now but will be terrible later?

I think there’s definitely some of that. That’s one of the things that as folks are looking at investment opportunities or are looking at companies you want to line up with. You do have to be careful about that.

It comes back to if you look at what happened to the professional services space in healthcare IT leading up to Y2K and then what happened after that. You look at it and you go, “Wow. All these companies were growing like crazy, and then business fell off really quickly.”

It wasn’t all just Y2K-driven, but what it came back to was you had the combination of the outside threat went away, you had a recession that came along, and then hospitals cut back on the professional services spending. You had this very quick retrenchment that a lot of those organizations had to do. For some of the bigger ones, it was really hard to dig out of that at all because it’s one thing to grow, it’s hard to cut. I think that’s the risk that you see.

And once again, not until 2015 or beyond, but the risk that you will see is that there will be all this money flowing through the system and folks will invest on the assumption that that will be there forever. It won’t. You’ll certainly see some businesses that will really struggle at that point.

Who are the potential buyers out there, and what is it they’re looking for?

In terms of the buyers, my fundamental belief is that this is still more of a buyer’s market than a seller’s market, if you want to have kind of a general view of the market. Now in certain subsectors of the market, it’s definitely a seller’s market. You can’t just say it’s a buyer’s market across the board, but in more places than not, it’s a buyer’s market.

Before getting to who the specific buyers are, generally what buyers are going to be looking for are businesses that can grow and that are growing, and businesses that either are or can show that they can be immediately profitable. Folks really aren’t interested in spending much money on businesses that are declining in revenue or going sideways on revenue and are either just making a tiny bit of money or losing money. Those are tough things to get to the finish line, and the value that you’re likely to see in situations like that will tend to be that you’re not going to get great valuation multiples.

Where you’re going to see the really big valuation multiples are going to be in situations where the business is growing, they’re making money, there’s significant growth left for them to go after, and then you’ll see some of these well-capitalized strategic buyers stepping in and making a play. The case examples on that really come back to you look at the deals that Ingenix has done over the last few months, and obviously varying multiples in terms of what they paid for things. But they’ve certainly been willing to pay more aggressively for businesses that they feel they can use their existing infrastructure — their existing customer reach — to generate substantial incremental value. Ingenix absolutely is going to continue to be a significant buyer. Emdeon is going to be a significant buyer.

You look at the McKesson / US Oncology deal. Very interesting in terms of how that changes the axis of that company a little bit beyond where they’ve ever sat before. In organizations like that, you’re going to see substantial increased acquisition activity because they can afford to look at a lot of different things and they’ll be able to pick and choose those deals that make the most sense for them.

I think, realistically, all of the large — whether it’s a diversified healthcare entity like a McKesson, or a specific healthcare IT company like an Allscripts — I think you’re just going to see a lot of acquisition activity on an ongoing basis because there are a lot of companies that want to sell and I’m not going to say there’s a very short list of buyers, but it’s not a huge list of buyers. The pure healthcare IT- and healthcare-focused companies are going to be able to pick and choose and pick those things that are going to drive the most value for them.

I think you’re going to see more folks coming into healthcare from outside of the space. Traditional software players are absolutely going to continue to increase their presence in healthcare. You’ll see traditional services players increasing their presence in healthcare.

Then, alongside all those groups, you’re going to see the private equity universe, whether bio guys or growth equity investors. You’re going to see them looking at healthcare technology and services as well because at the end of the day, it’s a market that healthcare as a whole is going to be growing in  2-3-times GDP over the foreseeable future. Healthcare technology and services will be growing faster than that. So if you get a business that is just growing at the market rate, it’s a nice business. If you get a business that can grow faster than that market rate, it could be a great business.

I think there’s a pretty broad universe of buyers right now. The problem is that buyers are picky because they’re getting to see a lot of different things, so they can afford to be picky.

In the past, the big money came from outsiders who didn’t know the market very well and got taken to the cleaners by buying something that industry folks would have thought was puzzling. Would you agree that if there’s big money to be made, it’s probably going to be somebody who just wants to buy a foothold in healthcare and doesn’t really understand the positioning of a specific company?

I think that’s one of the ways. The “stupid money” coming in is something that has been around healthcare forever. I don’t think that goes away. I actually think the folks who can stand to make the most money and make the best returns, in my opinion, are ones where you can make a very simple case. Some of this comes back to the case that can be made for somebody coming into healthcare from outside of healthcare.

But if you think about healthcare IT at its most basic level; you have, just round numbers, 6,000 hospitals. You have anywhere between 600,000 and 800,000 physicians and thousands of other care providers in this space. Just think about the provider universe and think about how fragmented that provider universe is and how hard it is to have a footprint that touches more than a fraction of that provider universe.

In my opinion, where folks will get the best exit multiple — where they’ll get paid the highest multiple for their business — and where the acquirers will make the most money on that are situations where you have an acquirer who has really broad reach and you have a seller — a target — who has a great product that is getting traction on its own, but will get a lot more traction if it can just access that acquirer’s distribution network.

Those are the situations where, honestly, if you look at the financial models, acquirers can afford to pay a lot. They can afford to pay what may seem to be irrational prices because the return that they get is incredible.

You go back to my favorite case study on that is the McKesson acquisition of ALI way back when. They hit the market just right. They bought a great company with a great product. They paid a huge number for it, but it really worked out for them and they made a mint on it because they could increase the price. They rolled it out to their customer base and it’s been a great outcome for them.

I think you look at some of the other deals that have happened over the last 10-15 years in the space and those are generally the deals that are the best outcome for everybody — that you have something where it’s a great product, a great capability, a great solution that gets acquired by someone who has a customer base that’s already interested in that solution. You put the two together and they get to take the market by storm. The sellers made a lot of money when they sold, and the buyers make a lot of money on being able to sell that product to their customers.

Sounds like it’s time for Oracle to buy Cerner. What do you think?

I don’t know about that.

You know Oracle wants in. They’ve got to buy something. They have so much cash that surely they want to be in healthcare.

They definitely want to be in healthcare, and I think you certainly can make a case that they’d buy Cerner. I actually think if they were trying to really mix it up, the angle that somebody would take — and once again, I know Epic’s not for sale and Meditech’s not for sale and eClinicalWorks isn’t for sale — but the concept of a big outsider coming in and picking up one of those folks would be the really big game-changer. They’d have to pay a huge number and maybe there’s not a number that’s big enough, but that could be a huge game changer.

But you’re right. From Oracle’s perspective, they did pick up Phase Forward, which makes them not the 800-pound gorilla, but the 2,000-pound gorilla in the clinical trial software space. But they certainly can’t sit here and look at the hospital market and the physician market and say, “Well, we’re not going to touch that.” I mean, there’s too much potential spend there for them to overlook it. The question is whether Oracle and folks like them, whether they decide to take a big jump or a little jump.

Interestingly, if you look at what historically works the best for folks entering the space, generally the big jumps have been tough. You think about McKesson/HBO. You think about Siemens/SMS, GE/IDX. You run down the really big deals and they haven’t worked out that well as compared to some of the ones where there have been much, much smaller plays. They’ve generally worked out a lot better.

If you had Larry Ellison’s wallet, how much would you be willing to spend on Epic?

That’s a great question. I would be willing to spend if I had his wallet — and I don’t have his balance sheet in front of me — but if I had his wallet, I’d be willing to pay a huge number for Epic because I think that in doing that, you’re effectively locking up a lot of the market for a long time to come. You go in and you say, “Well, what are the biggest hospitals in the United States worth from an IT spending perspective over the next 10 years?” You’re not talking about a two-year horizon or a five-year horizon. You’re talking about a really long-term horizon just given the decision cycles on these systems, and it’s a really big number.

You didn’t give me a number, so let me give you mine and you tell me if it’s too high or too low. I was thinking between $5 and $10 billion.

I actually would have said, without knowing exactly where Epic’s numbers are, $5 to $7 billion.

Of course that means you’ve got to have a seller.

Now honestly, I think that Judy and her team would still probably say no. I’d be surprised if somebody hasn’t come to Epic and offered them an absolutely tremendous number. But from Epic’s perspective — and I think this is part of the issue you’d see with a lot of folks out there — that’s not why they’re doing it. It’s not to just throw a bunch of cash in the bank.

I think if they felt that doing something like that would allow them to do a significantly better job of serving their customers, I think they’d do it and I think maybe they’d even do it for a much more reasonable price. I think that’s the take with Epic. That’s not the reason that they’re in the game.

Give me a handful of companies that most people haven’t heard of that you like.

As I look at the market, I think that there are a couple things that are going to be really, really important. The most interesting area for me really, circles around cost containment and quality management. What it gets back to is the fundamental challenge that we have as a healthcare system is that we have no control over cost and we’ve got, effectively, a fee-for-service model. We have a piecework model.

As we roll forward in healthcare broadly, we’re going to run into situations where those new approaches to care delivery and to care management and case management. Those companies are going to have a chance to build a tremendous amount of value.

There are a number of companies that are focused on — some people call it physician analytics, and some people call it the quality infrastructure. Some of these guys are thinking about it as local HIEs, but technology platforms that allow for capturing information from disparate sources and analyzing that information and deriving useful, actionable outputs from that information. That for me is a huge opportunity. The challenge that you see is that a lot of companies that play in that space are coming at it from very different angles.

I haven’t come across a company that I’d say wow, they’ve really got it. Some folks are coming at it from the HIE angle, some people are coming at it from the payer angle, some folks are coming at it from a clinical trials angle, but you haven’t had somebody who comes out and says well, here’s an infrastructure that it’s truly going to support  — whether it’s called an ACO or whatever the buzzword of the day is that’s used to describe that — but here’s an infrastructure that’s going to allow for integrating disparate data sets. In flagging issues with patients getting the right intervention and then monitoring the results, those types of things are going to be huge.

One of the other areas that I get really excited about is the home monitoring space. Home monitoring has been just a backwater in healthcare for such a long time because the reimbursement models haven’t been there to support it. Now what you’re seeing is the beginning of a trend toward coming up with new ways to go about monitoring patients when they’re in a home environment.

Honestly, once again it’s reimbursement-driven because people are fast-forwarding to when they’re not going to get paid for the 30-day readmits and saying, “All right, how are we going to keep these people out of the hospital?” Well, there are these tools that are out there that have been well proven that if you’re doing the right types of monitoring at home, you can keep people out of the hospital. Well, that’s getting pretty exciting.

Area one, it’s not interoperability, it’s really interoperable analytics. Area two is home monitoring.

I still get intrigued by the fact that I think there are a lot of opportunities in just niche-y areas that the big guys don’t necessarily focus on. Even in areas where the big guys do focus, you have the opportunity to build real expertise and just own a sub-segment.

You look at folks like Curaspan out there, in terms of the discharge management, and you look at TeleTracking in terms of the patient flow solutions. Folks like that that just pick what they’re going to do and they do it really well and just stick to their knitting and build up. Those are pretty exciting. I think most folks have probably heard of those guys, but that’s really exciting.

I know a lot of people disagree with me on this one, but I still come back to I think there’s still opportunity for — whether you call them best-of-breed or departmental solutions — I still think there are opportunities within hospitals for non-enterprise vendors. Now, do I think there’s an opportunity in a hospital for a non-enterprise vendor that has one function that’s a very narrow function? Probably not. If you just have a software product that handles valet parking at the hospital, yeah, you’re probably at risk for somebody taking you out.

But if you have a suite around access management that you could go in and you’re better than the access management capabilities of the hospital’s enterprise vendor and you have enough functionality that you’re not just a one-trick pony, there’s real opportunity for that.

I think you will see a consolidation in terms of the number of vendors because you don’t want to have 200 vendors out there. You want to have a manageable amount. The key is if you want to play in the hospital market and you’re not an enterprise guy, you’ve just got to figure out how to get big enough and add enough capability that you’re one of the surviving vendors. That’s pretty exciting to me. I think it’s an area where there haven’t been a lot of folks focusing on it, and I think some companies can really take some interesting steps there.

Last question. You get one-sentence answers.Give me three predictions on anything related to healthcare IT.

Prediction #1 is that the M&A market in healthcare IT will be very strong in late 2010 and through 2011, and then will fall off significantly in 2012.

Prediction #2 is that by the end of 2011, there will be multiple deals north of a billion dollars in the space, which would be a big disconnect from history that generally, there’s one of those deals every couple years. But before the end of 2011, there will be multiple large deals.

The third prediction would be that the actual payout for stimulus funds will be a fraction of the total potential amount.

CompuGROUP To Buy HealthPort’s Systems Business

Germany-based medical software vendor CompuGROUP Medical AG announced today that it will buy HealthPort LLC of Columbia, SC, the solutions business of HealthPort, for $24.3 million in cash.

The Alpharetta, GA HealthPort will apparently keep its other business lines, including Release of Information and auditing services, as they were not mentioned in the CompuGROUP announcement. The company was named as the top-selected RAC vendor in a recent KLAS report.

Rumor reporter Iggy told HIStalk readers in August that HealthPort was preparing to sell its non-ROI business, possibly in preparation for an Initial Public Offering like the $100 million one it cancelled last November, citing poor market conditions. Another rumor reporter Staff Infection specifically mentioned on August 11 that CompuGROUP was in talks with HealthPort.

CompuGROUP also announced its Q3 earnings today, reporting revenues of $102 million and operating profit of $24 million. The company has 3,000 employees and a market cap of $720 million.

CompuGROUP acquired Cleveland-based ambulatory systems vendor Noteworthy Medical Systems in February 2009. In September, CompuGROUP acquired the US-based Visionary Healthcare Group for up to $65 million, noting that gaining the PM/EMR vendor’s 10,000-physician customer base was a commitment to CompuGROUP’s plans to make the US a key market. CompuGROUP also announced this week that it had completed the acquisition of Swedish hospital EMR vendor Profdoc Care.

News 11/17/10

From HIPAA Police: “Re: spelling. You would think a group sending a mass e-mail pitching its market research services would spell HIPAA correctly.” You would indeed.

From Limber Lob: “Re: getting physicians to standardize processes. Princeton economist Uwe Reinhardt says that trying to get physicians to work together is like trying to get eagles to fly in formation.” I like that analogy a lot.

From Capone’s Vault: “Re: Motion Computing Mobile Clinical Assistant C5V. This is slick. The pressure will be on the iPad to match the healthcare-friendly features of this.” It’s a full tablet with a docking station, optional barcode scanner, camera, Gorilla glass breakage resistance, and hot-swap batteries. It weighs three pounds, can be disinfected, and can withstand drops (big thumbs down to the iPad in that regard). Sounds great, just a little bit expensive at the mid-$2,000 range, but IT-friendly. Motion was bad about not getting enough nurse input on their previous models, so I’ll withhold judgment until I heard from nurses who have used a C5V at the bedside.

From Randy: “Re: Connected for Health review. I am enrolled in a Health Systems Management class at Morehead State University. This book is required reading.” I’m glad to hear that – I bet its great for that. Another reader is using it in an informatics course for public health students they’re teaching. For those who don’t know, Morehead State is in eastern Kentucky. I went to a seminar at St. Claire Regional Medical Center once, which is how I knew. Thanks for the report.

From Duke Nukem: “Re: NEJM article saying doctors should beat hospitals to the punch in forming their own ACOs to protect their own interests. Harrumph – you mean the same way they protect themselves by walling off nurse practitioners and claiming medical expertise is required to deliver acupuncture? A hundred years ago, they were barely better trained than barbers and butchers.”

Microsoft says its genomic sequencing project with Seattle Children’s Hospital consumed $18,000 worth of cloud-based supercomputing resources compared to the $3 million it would have cost using traditional local hardware. It used the Windows Azure cloud computing platform.
 
Wake Forest University Baptist Medical Center is going Epic, I’m told.

Nuesoft’s IT and product groups throw down a pretty good Lady Gaga video spoof. It sounds a lot like her and many other singers today, i.e. heavy on the Auto-Tune, which I really dislike — think Cher’s Believe from 1998, which sounds kind of Peter Framptony like somebody’s singing into a keyboard (meaning you don’t really have to be able to carry a tune to be a “singer” with computer-perfect pitch – it just came a few years too late for Milli Vanilli, but in plenty of time for the cast of Glee). But I digress – it’s a pretty good video. 

A former Fallon Clinic (MA) doctor brags on the clinic’s EMR, but complains that his access to it was terminated when he left to join another clinic. His point: he can’t treat patients as effectively who have chosen to move with him since “their” information is being held captive by Fallon Clinic, who says they’ll mail him a CD in a few weeks. I think it’s a bit presumptuous to assume that his former employer will continue to let him use their systems and I assume the CD they’re sending will have the information about his patients in some standard format he can review. Beyond that, that’s why there are HIEs (other than to get federal money).

The OncoEMR oncology EMR by Altos Solutions becomes the first oncology-specific EMR to receive ONC-ATCB certification as a complete EHR, the company says.

Patient Privacy Rights releases an informed consent white paper and the results of a new patient privacy poll. The rags are picking up the poll result as big news since it finds that 90% of Americans want to be able to decide who can see and use their health information, but I should add a cautionary counterpoint that the questions were loaded with what the ever-witty Inga always calls bias of the “Do you like babies and puppies?” variety. For example: it asked lay people whether providers should be able to “share or sell your sensitive health information without your consent” and “Who should make the decision on whether corporations and researchers can see and use the information in your health records without your permission?” I don’t know how far that skewed the percentages that ended up in the 90s, but I’d say quite a bit. Still, I don’t doubt the conclusions, just the methodology. I’d also guess that quite a lot of Americans would divulge just about anything for cash (like those Brits and their passwords a couple of years ago), so maybe that’s the backup plan for those profiting from their data – just buy it from them and mark it up.

Stanford Hospital runs a pilot project in which cath and angiography patients are given iPads preloaded with movies, books, games, and Internet access to entertain themselves before and after their procedures. The hospital likes the idea because TV installation was going to be a pain.

Inga did her usual bang-up job with the latest installment in her ongoing Vendor Executive Series on HIStalk Practice. She asked 14 top executives to comment on a recent survey that found that about half of physicians in private practice expect their EMR vendor to help them qualify for Meaningful Use money. It’s always fun to compare and contrast their answers.

McKesson CEO John Hammergren comes in at #10 in the list of the highest-paid CEOs of publicly traded companies, bringing home $24.5 million in total compensation for the year ending September 30. The company declined to comment.

Vocera acquires two Tennessee hospital communications companies: Clinical Health Communications and Integrated Voice Solutions. Guille Cruze, founder of White Stone Group that spun off Clinical Health Communications, will run both organizations as a Vocera VP in charge of handoff communications products like the ones offered by those two vendors. I interviewed him back in January 2008. The companies have 30 employees and 150 hospital customers between them.

Bill Gates says robots will be the next big technology. Maybe he’s right: check out the Actroid-F from Japan, which the developing company will market to provide social services such as those delivered by hospitals. I creeped myself out when I realized that I was thinking that she’s pretty cute. I bet I’m not the first.

Healthcare is the #3 enterprise user of iPads, trailing only financial services and the tech sector.

Maybe the iPad will rank higher in healthcare in Australia, where Victorian Premier John Brumby promises that every state hospital doctor will be given an iPad if his party is re-elected. He says $12 million will cover it, but he seems vague about exactly what’s going to be running on those devices that will give doctors “easy access to time-critical clinical information,” not to mention who’s going to support them. 

In the UK, Portsmouth Hospitals NHS Trust wins a patient safety award for co-developing a PDA vital signs capture application.

Odd lawsuit: a prisoner serving 10 years for running over and killing a teenager on a bicycle while going 83 in a 45 mph zone is suing the dead teen’s parents, who he claims were negligent in allowing the dead teen to ride his bike without a helmet. He wants compensation for his “great mental and emotional pain and suffering.”

E-mail me.

HERtalk by Inga

UPMC says it will add 815 new full-time jobs, including up to 80 in IT. This announcement came following the release of UPMC’s first quarter financials, in which operating revenues grew by $77 million to $2.1 billion and profit increased $28 million to $93 million from July through October. The health system is on track to spend about $500 million on capital improvements this year, including about $100 million on its EMR implementation.

Former Sentillion and Microsoft executive Rick Dean moves to Humedica as VP of provider sales.

KLAS introduces an RSNA Resource Center that features several radiology-focused KLAS reports, including the Medical Imaging Buyers Guide. It’s free for providers and thousands of dollars for the rest of us.

Florida Hospital DeLand, which is part of Adventist Health System, goes live on Cerner CPOE.

Memorial Hospital (IL) selects Summit Healthcare as its integration partner as it migrates to Meditech 6.0.

Saint Luke’s Health System (MO) will implement the SeeMyRadiology.com platform to share medical images across the enterprise.

I’m guessing that Mr. H is the new BFF of Louise L. Liang. MD. In case you missed it, Mr. H wrote a terrific review of her book, Connected for Health, recommending that that basically anyone with an even remote interest in IT and healthcare read the book. The masses took the message to heart and from about 8:00 this morning until 3:15 this afternoon, the book has climbed from #2,223 on Amazon’s bestseller list to #218. It also moved from #90 to #8 on the Medicine bestseller list and from #4 to #1 in the Public Health category. Heck, Dr. Liang should buy Mr. H a Christmas ham. Speaking of Christmas, I’m putting the book on my list.

Preliminary data from HIMSS Analytics suggests that 22% of hospitals are capable of achieving 10 or more of the required core measurements for Stage 1 Meaningful Use; 40% have the capability to meet five or more of the menu items. HIMSS Analytics says it will provide quarterly updates on hospitals’ progress beginning January 2011.

Apple’s AppsStore rankings for the Top 10 EMR and Operational apps can be found here. Bedside by IMS MAXIMS tops the EMR and Operational apps list and ranks 150th in the overall medical category.

A spokesperson for Advocate Health Care says patients experienced little or no interruption in care despite an 11-hour computer crash that affected 10 Chicago-area hospitals. The health system’s Cerner system went down about 5:00 a.m. Saturday, requiring employees to take patient orders on papers and access records using backup computer systems.

Sponsor Updates

• Chandler Regional Medical Center (AZ) will implement the GetWellNetwork interactive patient care solution and integrate it with its Meditech 6.0 system.
• API Healthcare names Lisa LaBau COO. She was previously with Cerner and Dynamic Healthcare Technology.
• Precyse Solutions appoints William F. Bria II, MD, CMIO for Shriners Hospital for Children in Tampa, to its advisory council.
• Allscripts wins the 2010 Excellence Award as the fastest growing company by the North Carolina Technology Association.
• Baptist Health Care (FL/AL) executes an agreement with NextGen to deploy its EHR and PM solutions  for its employed physicians. Baptist will also offer system access for community physicians who choose to purchase the solution.
• CareTech Solutions added three new healthcare clients to its Web products and services division last month, including San Juan Regional Medical Center (NM), Southern New Hampshire Medical Center (NH), and  Wheaton Franciscan Healthcare (WI). The company also announces Version 4.0 of its CareWorks content management system for hospitals.
• CapSite will present at the 22nd Annual Piper Jaffray Health Care Conference, to be held November 30 – December 30 in New York.
• ICA earns a spot of The Nashville Post’s Fast 50 Award for being one of Middle Tennessee’s fastest growing companies.
• At its annual user conference last week, Nuance recognized 25 healthcare organizations for saving one million dollars or more on medical transcription costs as a result of implementing Nuance’s eScription platform. Eight other organizations were also recognized for their gains in medical transcriptionist productivity.
• McKesson partners with the Emergency Nurses Association to offer the ED Benchmarks Collaborative, a Web-based subscription service that helps EDs identify trends and compare their performance with that of other facilities.
• Ingenix CTO Art Glasgow will speak Thursday at a congressional luncheon on the state of HIE initiatives at the Institute for eHealth Policy in Washington, DC. It will be broadcast online for those who can’t make it to DC.

E-mail Inga.

Book Review: Connected for Health

I’m rarely a fan of healthcare IT books. My criticisms generally fall along these lines:

• The author isn’t original, authoritative, or knowledgeable.
• The book tells me nothing that wasn’t obvious or that I don’t already know
• Its content isn’t really “meaty” enough to get excited about.
• It uses too much material already available elsewhere, with lots of citations and excerpts that make it look like an imitative journal article.
• Whatever knowledge the author possesses isn’t generalizable to everybody else.
• The book is a chore to read because it’s written pedantically or without skill.
• It doesn’t deliver an end result that makes me happy to have spent the time and money to earn it.

Connected for Health: Using Electronic Health Records to Transform Care Delivery raises none of these criticisms. I found it to be fascinating and informative. It is easily the best work I’ve read on healthcare IT’s role in changing how healthcare is delivered.

I’ll try to keep my review short, but there’s literally something on every page that’s highly useful even to someone like me who’s been in the industry forever and thought they’d figured it all out by now. I’m pretty sure I’ll read it at least five times over the next few weeks since there’s a lot to absorb.

(By the way, if you teach any kind of healthcare or healthcare IT class, this would be a great course resource).

In the interest of disclosure, here’s all I have to share. A book PR company asked if they could send me a free copy in case I wanted to review it. I said OK, but didn’t commit to anything since I don’t like reviewing books (I almost always have lots of criticisms, but then I feel guilty for laying them out even though someone asked me to review their book honestly). I don’t have any connection to Kaiser, I don’t know any of the authors, and I didn’t even try to sneak one of those commission-paying Amazon links above just in case you click on over to buy a copy.

Now I’m not about to sell out my integrity for the price of a book, so rest assured that it’s the same old cynical, dismissive Mr. H talking. Keep that in mind because I’m about to turn into an uncharacteristic cheerleader for Connected for Health. I’m hoping this doesn’t taint my curmudgeonly image (or encourage other authors to send me books to review that I’ll probably not like).

Every hospital that’s using or planning to use clinical information systems should buy copies for every board member and executive. It’s that good. It sets the vision and perspective needed to embark on big-budget projects involving CPOE, nursing documentation, ancillary systems, and data warehousing. It doesn’t tell you what you should do, but it tells you what KP did. And a lot of what KP did and is doing is what everybody else should aspire to.

I think you’d have a tough time arguing why KP’s methods wouldn’t work in some form for other hospitals. Instead of having one of those dopey CPOE kickoff meetings where the winner of the “name our clinical system” contest is announced and everybody pretends they are committed to something they don’t even understand, pass out copies of Connected for Health (even better, do it well before any important decisions are made, like choosing a vendor or developing the project plan).

The book covers in perfect detail Kaiser Permanente’s HealthConnect project, the largest non-governmental HIT project in the world. You might think, “What does that huge organization and its $4 billion project budget have to do with my hospital?” Plenty, as it turns out. Most everything in the book is relevant to the EMR-type projects of even modest-sized organizations. Only the scale differs. The issues are pretty much the same everywhere.

Maybe the most important takeaway is that you’re wasting your money on software if you can’t back it up with the pieces that go with it. Hospitals where I’ve worked shot their wads buying an arguably overpriced clinical system, then ensured mediocrity by trying to run it as an on-the-cheap IT project. We didn’t have enough dedicated resources, we weren’t willing to pay community-based doctors for their time to help out, and we went cheap on end user devices and support resources. Maybe Kaiser did a lot more than a typical hospital could afford, but their results have been proportionately more impressive. They spent a ton of money, effort, and planning to go live, but then as the book says, “Welcome to the starting line.”

If you ask me, the foreword by Don Berwick (then of the Institute of Healthcare Improvement, now of the Center for Medicare and Medicaid Services) is worth more than the cost of the book. Don’s a quality and outcomes guy, not some IT geek doctor with four smart phones on his belt. He focuses on patients, not vendors and deals and Gantt charts. I could have worn out a highlighter marking the parts that had my head nodding.

Here’s a snip that struck home as I thought of all the failed, expensive implementations that are wasting the budgets and energies of hospitals looking for an electronic magic bullet to will absolve them of the responsibility to change themselves and instead just convince themselves that swapping out their data plumbing is the Holy Grail:

Without clear incorporation into the actual processes of care, and without the re-engineering of those processes, and without the changes in norms, capabilities, and culture to allow those new systems to take root, KP HealthConnect would become what far too many other health care organizations had already discovered in their own modernization journeys: the computerization of a defective status quo. Kaiser Permanente was not after a modern information system; they were after a modern health care system. Halvorson called building KP HealthConnect “laying tracks”, but he and I both knew that, in the end, it would be the trains, not the tracks, that mattered more.

Kaiser’s former SVP of quality, Louise Liang, MD, ran the HealthConnect project and edited the book (quite nicely, I should add, since I’m highly critical of editing in general). Its chapters were written by local Kaiser experts on everything to system selection to redesigning primary care. Every one of them is a gem, coming from slightly different perspectives, but with a lot of useful information from an organization that has actually done what all hospitals wish they could do.

Now a cynic (like me) might assume that some of the accomplishments might have been glorified a bit by the home team authors, and maybe they were (certainly anyone who has attended a “look what we did” presentation at HIMSS knows that reality and PowerPoints sometimes don’t intersect). KP probably struggled more than was detailed here, and most likely made some stupid implementation mistakes not listed and let politics and let executive egos drive expensively bad decisions that are regretted to this day but not brought up in polite company (like everybody else does, in other words).

I didn’t find that possibility at all concerning since the material has high value even if that’s true. If you’re a skeptic, just consider the book a picture of a desirable future state that Kaiser may or may not have achieved.

Besides, there are some KP warts in there. They had a terrible time getting regions to standardize (I loved this saying: No one is either so high in Kaiser Permanente that they can make a decision, or so low that they cannot veto a decision.) They wasted a lot of money on failed EMR projects. They had to fight human nature. They overspent. They first decided to expand the use of a homegrown system that one of its regions had developed, but then reconsidered when it fell short on its ability to turn KP into an enterprise-wide electronic backbone going beyond just automating clinic offices. They had to sell the vision to the board with the frank admission that KP was “betting the farm” that KP’s form of medicine was where the country was going and their existing systems couldn’t support the transition.

I found this tidbit interesting. They could find only two commercial vendors able to handle everything from medical offices to hospitals. Epic was named, but KP thought they were shaky because their hospital experience was limited back in 2003. The other vendor wasn’t named, but I assume it had to be Cerner, and whoever it was got axed because of inadequate ambulatory experience. Everybody always wants to know why the Epic wins big hospital deals – the book makes it clear from the customer’s perspective that it’s partly because of the company’s vision and leadership, but maybe mostly because their competitors aren’t very good, especially when it comes to connecting the multiple venues of care offered by larger health systems.

KP did a lot of upfront thinking about HealthConnect, which hospitals unfortunately rarely do beyond choosing their vendor. They brought in a wide variety of people to set the vision, not just for the Epic system, but for how care should be delivered. The items that group came up with in 2003 are pretty much dead on with what’s happening today. Their themes were: (a) Home as the Hub; (b) Integration and Leveraging; (c) Secure and Seamless Transition; and (d) Customization.

The book has a wealth of information about project structure, implementation, budgeting, and leadership. Maybe you don’t buy the vision thing (which probably means you shouldn’t be in charge of anything involving patient-centered IT) but these project details will make your time spent reading worthwhile.

The idea of a Collaborative Build was key, where HealthConnect would be built at a national level, but with some customizability allowed by each Kaiser region. The key point was: first standardize, then diverge. They knew that it would be much easier to force standardization and then relax it later as needed, rather than trying to tighten up after the fact (that’s a Management 101 principal that I’ve always embraced – start out as a tough guy, then loosen up later, because the opposite never works).

There is much detail on how KP identified and involved physicians of different capabilities (operational leaders, opinion leaders, and technically adept). They helped choose the system, develop the clinical content, and sell the idea to their peers (clinicians won’t necessarily be faster, but they should be better, they said).

I’m happy to see that a whole chapter was devoted to nursing leadership and impact. It talks about standardizing terminology, involving nurses in system decisions, and looking at specific goals for barcode medication administration and medication administration.

There’s a really nice chapter called Making It Matter that looks at value and quality.The best part was the description of how the goals of HealthConnect were aligned with KP’s commitment to members, something I have pretty much never seen by hospitals anxious to whip out their checkbook and get their CPOE implementation underway before everybody loses interest. KP knew exactly what it wanted to do in a big picture way: make clinical information available around the clock, deliver superior outcomes, become national leaders in patient safety, use patient preferences to make decisions, and several other very specific organizational goals. HealthConnect was the technology enabler, not the project itself.

An idea I really liked was called SmartBooks for Value Realization and Optimization, which was an extremely well developed list of 250 opportunities that each Kaiser organization (region, department, etc.) could use to improve performance by using HealthConnect. The book also has a lot of information about quality data, outcomes measures, and a full chapter on population health (nearly always ignored by four-walls-centric hospitals and health systems). When you see the scope of HealthConnect, suddenly it’s clear where the $4 billion went — most of it not into Epic’s pocket.

Kaiser took a creative approach to designing primary care services. They decided to design processes to meet the needs of their populations even if capacity seemed insufficient, expecting that they could increase capacity virtually by offering more services by telephone, group visits, and e-visits. They had to have a lot of confidence to go that route.

Everybody’s heard of Epic’s MyChart, which Kaiser calls My Health Manager. The book makes an interesting argument about personal health records: surveys that show low PHR use by consumers are asking the wrong question. Consumers will use them if their services are useful and of high quality, and KP’s patients are big users of patient-to-doctor e-mails, checking online lab results, ordering prescription refills, reviewing office visit summaries, and self-scheduling their appointments.

The book has a very nice summary called Refocusing on Systems Versus Individuals that lays out a hierarch of controls for reducing risk. It says that the most effective changes are, in order: simplifying and standardizing, removing opportunities for error, making it hard to do the wrong thing, making it easy to do the right thing, providing intrusive alarms and warnings, and using reminders and non-intrusive decision support. What doesn’t work as well: policies, procedures, and training. Surprised?

Just about every group involved with clinical systems that I can think of would get an immense amount of highly useful information from the book: clinical leaders, physicians, informatics people, and executives. Every group, that is, except one: the average CIO. Kaiser intentionally ran HealthConnect without much direct IT strategic involvement, correctly identifying it as a huge change project, not an IT project. IT’s job was to handle the infrastructure and technology components, not to convince the doctors to use order sets or demand that nurses scan meds before administration. That’s nearly always true of successful big-hospital clinical IT projects. People on the IT dark side don’t usually have a lot of credibility with clinicians, no different than a Mac-using surgeon who thinks he can educate the CIO on how to run a networking team.

If you’re a CIO who thinks you need to be in charge of anything that plugs into a network jack, you will probably be licking your wounds that it’s not Kaiser’s CIO or IT people bragging about their key involvement in the book. Those willing to look at the big picture and share project responsibility without feeling threatened will find it refreshing and enlightening. It isn’t that the CIO’s role was marginalized, it’s that KP let the operational and clinical leadership lead the changes, with IT providing the technical support to enable them. The CEO set the vision, paved the way with resources, and set up the means to collaborate across several regions. CIOs will still look darned smart among their executive, medical, and technical peers for having read this book.

I would consider Connected for Health essential reading for leaders of any hospital that has an interest in quality, data, clinical transformation, and yes, technology (and I would hope that every hospital falls into that category, or at least any that I’d want to be admitted to). The $40 cost of the paperback (the hardcover isn’t out yet) is just ridiculous. At five times that price, you would be getting a steal considering the ideas it has for projects costing dozens or hundreds of millions of dollars. If they packaged up a tenth of what the book covers into a two-day seminar, you would happily pay 50 times the price of a copy. If you are an enterprising consultant, you could probably make a handsome living for many years by just traveling around the country like a honeybee spreading pollen to grateful plants, sharing your purloined wisdom about strategic vision and IT’s role in quality and cost that’s all right there for the taking.

Like I said, I don’t generally like HIT books. I hit the HIMSS bookstore with enthusiasm, but I’ve been burned too many times. I recommend Connected for Health without reservation. It did for me what no book, presentation, or article has done recently: it got me excited all over again at the potential of IT to change healthcare in a way that actually benefits patients.

CIO Unplugged 11/15/10

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

How Opaque is your Transparency?

All humans desire relationship. Solitary confinement is the greatest torture. A psychologist would tell you that no person can mentally survive being alone for long periods.

Even the entertainment industry knows this. One reason for the long-term success of the television hit Cheers is that the producers and writers tapped into our human need. Their theme dwells in the show’s chorus.

Be glad there’s one place in the world,
Where everybody knows your name,
And they’re always glad you came.
You wanna go where people know,
People are all the same,
You wanna go where everybody knows your name.

Leaders talk of transparency and its many forms — from quality outcomes to business performance to personal. Many opinions on the level of transparency arise, especially when it comes down to personal revelations. How open should you be with your manager, peers, and staff? Does familiarity really breed contempt? How much is too much information? Should there be a wall between professional and personal?

As I began my career, I wondered what it was like to be a manager or director, vice president, CEO, etc. I wondered how they prioritized, how they managed their time, and how they dealt with challenges. This was always a great mystery, and I wanted to know more. I longed to observe, learn, and understand the essentials and what it took to get there. Therefore, as my career journey unfolded, I elected to be as transparent as I hoped my management would be.

I recall the advice Captain Davies gave to us impressionable 2nd Lieutenants on this topic at our army engineer school. “I am all for hanging out with troops after hours. But once the conversation gets into work matters, I take leave.” I believe personal transparency carries more benefits that costs. I acknowledge the risks and am careful not to violate necessary confidences. And, like Captain Davies, I avoid discussing work matters.

One benefit of personal transparency is a friendlier work environment. When people see that you’re a genuine person and that you want to get to know them, you’re breaking down the walls between management and staff. Once people see your heart and understand your motives, they’ll be more compelled to follow.

Your authenticity will expand your level of influence. Over time, your proactive interest in others will increase their level of engagement. The fact that your manager knows you and cares about you can speak louder than an annual raise. People also enjoy the recognition that comes with the investment and gift of your time.

Another benefit is the opportunity to model appropriate behavior. Many emerging leaders have not seen management up close and may not know the protocol for social and business contexts. This can help remove the fear of interfacing with executives and understanding etiquette. 

I employ the following to ensure a level of personal transparency:

• Host annual wine, cheese, and chocolate parties for emerging leaders and significant others (my wife also helps spouses see the genuine human side of an executive).
• Host annual Christmas parties at my home with leaders and their significant others.
• Host in-home parties for teams to celebrate accomplishments.
• Attend almost every event I’m invited to, including parties, weddings, and my favorite — RockBand jam sessions.
• Attend funerals of an employee or his/her spouse.
• Yammer (micro-blog) daily on my agenda and other items of interest, and sometimes offer an impromptu lunch.
• Accept Facebook invites and Twitter followers from co-workers.
• Participate in all work events, such as fundraisers, contests, and celebrations (dancing, sumo wrestling, etc).
• Organize and participate in sport events.
• Volunteer my home and time for work-related fundraisers.
• Send handwritten notes saying “thank you” or “good job”.

This open approach has greatly accelerated the development of relationships with my leaders and staff. Something magical happens when you put aside the pretenses and trappings of the formal work environment, let your guard down, and be who you truly are. Create a place where everyone knows your name and you also know theirs.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Monday Morning Update 11/15/10

From Simon Stiles: “Re: Georgia HIT Leadership Summit. It was a huge success in that it united the leaders and vendors to begin talking ‘collaboration’ to benefit the growth of both large and small companies that are part of the health IT cluster that has developed in Georgia. The organizers are focused on attracting and creating more HIT vendors in Atlanta and Georgia that will provide high-quality, high-paying HIT jobs, not to sell products. Success was measured by the number of participating companies (110), the number of speakers and panelists who agreed to future collaboration (100%), and the number of companies that are interested in ongoing events that bring Georgia’s HIT companies together (100%).”

From Jenny from Venice: “Re: you and Inga. Let’s hook up at HIMSS. I love everything you both do, I really do. Lurve you!” Thanks, but I ran your proposal up the Mrs. HIStalk flagpole and she didn’t salute. I can’t speak for Inga. I had to look up “lurve” since I wasn’t exactly sure what it means, so that’s probably a good indication that we wouldn’t have hit it off anyway.

From MarketWatcher: “Re: Merge and Fletcher Flora. That was a very quiet acquisition and and odd one at that. Insight?” Coming soon, quite possibly – I’ll be interviewing a top exec there shortly, provided I can figure out a time after work to connect (darned day job).

From Tony: “Re: HIMSS reception. Has the signup page gone up yet?” Not yet. Look for it in January.

Inga mentioned that Henry Ford Health System is working on rolling out a new version of its CarePlus Next Generation EHR. A reader tells me that the Web-based SOA system was developed by RelWare, which offers its commercial version of it under the EXR nameplate.

AMIA says it doesn’t like “hold harmless” clauses in vendor software contracts. At a reader’s suggestion, I e-mailed CEO Ed Shortliffe to ask if AMIA will put some teeth behind its proclamation by turning down the sponsorship of vendors who won’t go on record as saying they don’t use those. He hasn’t responded, but I’ll let you know if he does.

It’s close to an even split whether recent election results will reduce or delay HITECH payments. New poll to your right: have you personally seen a “hold harmless” clause in a HIT vendor’s software contract? They’re supposed to be everywhere, but nobody every provides an example. I know I’ve seen them in some old copies of contracts that I discarded a few years ago.

San Juan Regional Medical Center (NM) sends four tons of old computer hardware to a Canada-based company that takes electronic waste for free, pays a third party to process it, and donates the profit to Feed the Children.

A Tampa publication mentions the cost of implementing clinical systems at a couple of local hospitals: BayCare ($200 million) and Tampa General ($120 million).

How to be a HIStalk Meaningful User: (a) put your e-mail address in the Subscribe to Updates box to your right to join 6,419 fellow HIStalkers in receiving the latest news first; (b) use the Search box just below it at your leisure to find companies or people mentioned in HIStalk, HIStalk Practice, and HIStalk Mobile, up to 7.5 years ago in the started-in-2003 HIStalk; (c) peruse the ads of those brave companies that sponsor HIStalk, supporting an anonymous, cynical loose cannon who doesn’t always say nice things about this business we call show; (d) share your wisdom by posting your best comments or writing a guest article (provider people especially encouraged); and (e) tell your friends and least-hated enemies about HIStalk, allowing them to join the high-level HIStalk readership, of which a shocking 82% say reading HIStalk helps them do their job better. Thanks for reading.

Four small, closely-located Texas hospitals (the largest has 45 beds) join to create a RHIO around the Prognosis ChartAccess EMR.

Cloud-based population data analytics vendor Explorys, co-founded last year by Cleveland Clinic, hires Anil Jain, MD of the Cleveland Clinic IT department as its part-time chief medical officer.  

The health authority of Norway signs a $120 million deal with IBM to provide a variety of services and to implement a custom logistics solution built around SAP.

Healthrageous, which offers consumer health solutions based on technologies developed by the Center for Connected Health at Partners HealthCare, is chosen as one of the 50 most promising tech startups. It collects health data from patient biometric devices, analyzes it, then sends out recommendations to the patient. I like the name.

Laboratory middleware vendor Data Innovations is sold to Battery Ventures. Old news from last month, but I missed it first time around.

The government of Hong Kong invites proposals to develop a territory-wide platform for sharing electronic health records. More information on the project is available from the eHealth Record Office.

Newborn twins die of a IV-related medication error at a scandal-ridden UK hospital that is already under public inquiry for the unnecessary deaths of 400 to 1,200 patients.

The CEO of National Health Insurance Board of Turks and Caicos Islands has a financial interest in the vendor chosen to process medical claims there, critics claim. The CEO disclosed his “minority interest” in Mitan, but the company’s Web site lists him as founder, director, president, and CEO since 1999.

Odd lawsuit: the transplant center of Georgetown University Hospital calls a cirrhosis patient who’s on the liver transplant list to tell her that a matching donor liver is available for immediate transplantation. They didn’t call any of the emergency numbers she had given, instead leaving a message on her home answering machine. The woman, as it turned out, had a good excuse for not being home – she was an inpatient at the same hospital at that time. When her family found the message and returned the call, they were told that the liver had been given to the next patient in line. The woman died, her family is suing.

Sponsor Updates

• MedPlus announces collaborations with several regional extension centers that involve the company and its Web-based Care360 EHR .

E-mail me.

mHealth Reaction
By Deja Vu All Over Again

For anyone who attended Web or Internet conferences in the mid-90s, your description of the market is a flashback. mHealth as a separate model does not make a lot of sense, which is why they are having a hard time trying to figure it out.

Like in the late 90s for eHealth, all those new mHealth corporate groups will be integrated back into the main lines of business. Mobility is just a different (and exciting) way to deliver much more interactive and innovative value for core health care processes. The dot-com bubble experience will keep the fervor in check this time around.

Having said that, mHealth will have profound changes in US health care over the next five years for the following reasons:

1. Our 5-10 year industry technology lag sets up a great deal of potential disruption for mobile components as the current brittle systems start to move towards loosely coupled modular application platforms like in other industries. Many large HIT vendors are about to enter the SAP enterprise model death spiral.
2. Historically institutions and "back channel" processes have been the focus, not mobile savvy consumer / patients who are rapidly becoming financially forced to be more engaged in their health.
3. Care delivery transformation from payment reform and skill shortages will require fluid care approaches that require mobility, and
4. Most care is now done in the home, but will move from routine to chronic disease management due to aging and the obesity explosion.

Note to bright-eyed entrepreneurs who have not been in the health care industry a long time: the existing HIT vendor mafia has always been much more effective in squashing innovation from disruptive outsiders to maintain the status quo than competitively innovating against each other. If you fashion yourself as David vs. Goliath, make darn sure that God is on your side before you start hurling rocks.

Therefore, there will be a great deal of opportunity for those niche companies that focus on meeting the needs above by complimenting the old guard entrenched HIT vendor systems, but with an eye towards explosive disruption when they are embedded, delivering value, and the market timing is right.

Readers Write 11/12/10

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

On the Largest Medicare Fraud Case in History – $100 Million
By Deborah Peel, MD

Key points:

• This case is “the largest single Medicare fraud case” in history.
• “There were no real medical clinics behind the fraudulent billings, just stolen doctors’ identities," says Janice Fedarcyk, FBI assistant director-in-charge. "There were no colluding patients signing in at clinics for unneeded treatments, just stolen patient identities."
• The organization stole the identities of doctors and filed applications to bill Medicare in their names, often providing a clinic address on the application that was, in fact, the location of a mailbox, according to the indictment. The organization then obtained the stolen identities of thousands of Medicare beneficiaries, including the identities of about 2,900 patients treated at the Orange Regional Medical Center in Orange County, NY.
• Members of the organized crime ring also are charged with operating a multi-million dollar scheme to defraud health insurance companies in the New York area by submitting claims for medically unnecessary treatments.
• In some cases, defendants allegedly staged auto accidents to generate fake patients who would then undergo unnecessary and expensive treatments that would be billed and reimbursed.

What I still do not get is the inability of very smart people in government, healthcare, and HIT to miss the REALLY big picture.

Privacy isn’t about preventing tomorrow’s profits or blocking meaningful use of data. It’s about the fact that if Americans lose ALL control over personal information in healthcare, we will lose all our privacy rights in the Digital Age. Period. All of them. For every kind of information / data about us. Our strongest rights to control personal information are our rights to control health information.

If we lose the war over control of personal information in health, the US will become a total surveillance state and we will have lost the most precious right individuals have in Democracies: the right to be let alone. Do you think that we can remain a Democracy if everyone — government and private corporations — knows everything about us? There is a reason for the saying “information is power.” 

By the way, I am not in the Tea Party or a radical. Standing up for medical ethics, the law, and the right to privacy is a very conservative position!

The big take-away is that as long as patients’ sensitive electronic health information and demographics are so poorly protected, millions of employees of hospitals, clinics, insurers, pharmacies, and health IT vendors will have open access to steal it. We will continue to see an explosion of multi-million dollar healthcare fraud, identity theft, and medical identity theft, unless we radically redesign our health IT systems, protect health data wherever it flows, and restore the right of consent.

The high-profile of this case is supposed to discourage criminals and potential criminals, but when millions of employees in healthcare, government, and health technology corporations have open access to all patient health data, the likelihood of getting away with data theft is high. The innumerable outside hackers and criminals whose business is stealing valuable health data will never stop.

The only solution is to require comprehensive and meaningful privacy and security for all health data, wherever it flows:

1) Restoring patients’ rights to control electronic health information would end open to the nation’s health data by millions of employees of the healthcare system, insurance, government agencies, and technology industry. Requiring informed consent before ANYONE can see our records is simple, cheap, and easy if we require robust electronic patient consent for all data use or exchange.

2) Requiring and enforcing ironclad, state-of-the-art security for all health IT systems and health data wherever it is held online is essential.

If we don’t require and build trusted systems now, before ‘wiring’ all health data systems together, before systems are ‘interoperable’ and before every American is required to have an electronic health record, we will destroy privacy for generations. Once our sensitive data is ‘out’, like Paris Hilton’s sex video, it can never be made private again. And when healthcare systems cannot be trusted, people refuse to get needed treatment, fearing their jobs and futures will be endangered. Creating a healthcare system that people are afraid to use is a national disaster. Trust takes a long time and is very expensive to rebuild.

The implications for Democracy if we lose the right to privacy in healthcare are dire.

Deborah C. Peel, MD is the founder of Patient Privacy Rights.

Before Extending Software Support Contracts, Consider Alternatives
By Tony Paparella

It’s common for a healthcare organization to become unnecessarily tied to an extended support contract when it retires an HIS in favor of a new system. The old system is not an ideal data storage solution. Although patient accounting and clinical data sets still require some functionality and real-time user access, the legacy application is expensive overkill for what is needed.

Support contracts typically run a year or more in length, meaning they’re oftentimes paid for longer than necessary. Furthermore, it may be difficult to negotiate favorable rates and terms with a vendor facing long-term loss of revenue.

Other times, purchasing a contract isn’t an option; the system may be so outdated that the company that owns the software no longer offers support. This places the organization in a precarious position, facing potential loss of vital data. Furthermore, IT staff may become burdened with legacy system upkeep, deflecting efforts away from the new HIS.

“Doing nothing” or opting for an inadequate option invites serious compliance and financial risks. Millions of dollars (and the jobs of CIOs and department directors!) can be lost to: interruption to account billing/cash flow; inability to respond to a payer audit (such as RAC and commercial insurance audits); noncompliance with Federal and State data retention requirements; loss of access to the legal medical record and; increased hardware/software expenditures.

Additionally, fines for non-compliance with Federal employment record, HIPAA and other retention requirements can be significant. Depending on the statute, data retention requirements range from three to 28 years – meaning a short term, one-dimensional solution won’t do.

Fortunately, signing an extended support contract isn’t the only option for organizations that must access and manage legacy data.

Internal warehousing may be considered as an alternative – metaphorically, a home for data, albeit largely unfurnished. Though data access and management is inherently restrictive, this option is typically the most time- and cost-efficient to implement.

In a full detail conversion, all legacy account data is converted into the new system. If precisely executed, compliance and cash flow are maintained. Often, however, the vendor will decline to bring old data into the new HIS. Hence, the risk of cash flow interruption. A high degree of planning and analysis is required before implementation.

Legacy data can also be migrated to a healthcare active archive specifically designed to allow end users to access and update accounts, run reports and, in some cases, post payments and bill accounts. Advance preparation is essential. In some instances, an organization may need to specifically task an IT team member with helping coordinate the migration of data.

Proper planning and preparation will help your organization sidestep a burdensome legacy system support contract. Understand the risks and investigate your options many months in advance.

Tony Paparella is president of MediQuant Inc.

What one hospital charges for a particular procedure varies widely based on a host of factors. Understandably, many providers who are otherwise all for transparency when it comes to patient outcomes are reticent to disclose cost data. There are real reasons for concerns on the globalization of medicine. However, health care is largely a local phenomenon.

What are the compelling reasons for being as transparent with prices as with anything else? For one, increasingly, consumers are armed with price information today that exceeds anything they could have assembled even just a few years back. Also, in the mind of many consumers, price equals quality. Logical or not, this notion has become ingrained as a result of their consumer experience in other industries.

Wine under one label is deemed more expensive than wine under another label, even in the case where the wine has proved to be exactly the same, from the same source, processed and delivered in exactly the same manner.

Reputation Enhances Price

At the supermarket, branded merchandise still sells at a premium compared to store or generic brands that offer the same ingredients, molecule by molecule. Your hospital’s reputation could prove to be the deciding factor in whether or not a patient will plunk down more money to be treated by you over others who, based on all comparison measures, offer exactly the same care and service.

Suppose a consumer does his homework and finds that you and a competitor have entirely equal success rates for particular procedure, and you charge 15% more. Is this a reason to fear price transparency? No, because with all the data available for a consumer to peruse to his heart’s content, the decision to choose one provider over another is multifaceted. Price is one factor, albeit an important one, among several.

Many consumers will go with the lowest price. Many will choose the best value – a blend of price and quality. Short term, there is not much you can do about the prices for some of the procedures you charge. In the long run, everything is up for grabs.

More Business, Lower Prices

The more often a hospital performs a particular procedure, and the more experience its doctors accrue, the better it is able to offer that procedure at a lower price. Even in health care, greater business volumes contribute to economies of scale. In the short run, you can’t do that much about the volume you handle for any particular procedure. In the long run, you could seek dominance in your local or regional area by publicizing your experience in a given procedure. Thus economies of scale could result and price transparency would work to your favor.

At Alegent Health, based in Omaha NE, the prevailing attitude is that consumers have a right and ought to be able to easily know how much a provider charges. Three years ago, Alegent launched My Cost, found at www.alegent.com, a consumer-friendly feature that offers cost estimates for a variety of tests, procedures, appointments, and services.

So, You Want Cost Data

Visitors can simply enter the name of their insurance providers and any co-payment or deductible information. The system then presents a cost estimate that is useful in personal health care decisions.http://www.alegent.com, The visitor is also treated to financial assistance information via links provided, and a phone number in case their anticipated procedure is not listed on the site. Now up and running for nearly three years, more than 50,000 cost estimates have been generated at My Cost.

Alegent’s experience in promoting price transparency has been that consumers appreciate the honesty and openness of the organization. Instead of price transparency scaring away potential business, in this case it has led to stronger provider-patient relationships. Alegent’s CEO says transparency “isn’t necessarily easy, and it does take courage, but in the end it is the right thing to do for consumers and the community.”

Make the Commitment

Commitment to transparency takes guts. Yet, what other choice is there? Fortunately, as we’ll see, there is room for creativity and initiative.

Providing information on the results that your hospital achieves for patients, at the medical condition level, is vital. Your data needs to include patient outcomes with an adjustment for risk based on prior conditions, the overall cost of care, and measurements for both extending through the care cycle.

Transparency also encompasses offering the experience your hospital has in treating specific medical conditions, by volume of patients, coupled with delineation of such treatments based on methods of care offered. Your processes, in the long run, can be improved only by understanding how results are achieved, which methods are most effective, how they might be refined to make critical differences, and what the actual outcome of such refinements have been.

Details Count

Outcomes for a specific medical condition can and should be expressed many ways. For, say, shoulder surgery several validated measures exist such as range of movement, reduction of pain, and ability to function. Still other outcome measures for shoulder surgery include the interval between the initiation of care and return to normal activity such returning to work or playing tennis again.

Data related to the particulars of patients, known as patient attributes, such as gender, age, genetic factors, and prevailing conditions, are vital elements of transparency and are essential for assessing risk. Accurate diagnoses are vital for both the patient and the provider. A transparent provider will publish measures of diagnostic accuracy including cost, timeliness, and completeness.

Outcome measures that only address episodic interventions fall short because they fail to yield results meaningful to the patient. Such short-sighted reporting and consequence scoring can be counterproductive and lead to the publication of misleading data.

Failure is not pretty and human beings instinctively want to avoid reporting their own shortcomings, much like organizations. Still, ineffective treatments – errors in procedure, medication, or treatment – and complications following a procedure need to be identified and scored. As unpleasant as this task may be, it is a step on the path to improved levels of treatment and overall service. You cannot fix a problem that you refuse to acknowledge.

Expand Your Measures

A traditional core measure, “the 30-day readmission rate,” tracked by the government, is of course a potential indicator of poor quality. Who wants too many patients are readmitted within 30 days for the same problem.

You may be able to devise your own kind of data measures by tinkering with traditional data measures. For example, you could align your total quality management efforts, such as your Six Sigma Performance Improvement initiatives, around improving the 30-day readmission rate and devote resources to that. In turn, for each of the core measures which need to be fully transparent, you may wish to devise two, three, four or more strategies to ensure that your scores improve over time. Rest assured, other providers will be doing the same.

Costs Mysteries No More

Unlike most businesses, many hospitals, to this day, don’t know what their actual charges ought to be. They charge for this procedure or that based on tradition, competition, payer contracts, or whatever cost data they can scrape together. A comprehensive understanding of true cost is often lacking. If and when the government mandates that hospitals publish price and quality information, they will need the technical ability to do so.

In almost all cases, some web restructuring proves to be vital. There needs to be a huge consumer section that is highly inviting. Take the bull by the horns and invite the consumer to go patrolling through your data. Just as industrial companies publish annual reports with a profit and loss statement, balance sheet, and cash flow analyses, you might choose to offer a five-year projection as to the life cycle cost of a procedure and its follow up.

Implications for Your Hospital

• Is transparency part of your agenda for your weekly and monthly meetings?
• Has your hospital developed policies and procedures in relation to transparency?
• Within your own office or division, are top officers involved in the transparency discussion?
• Have you attended any conferences and symposiums on transparency?
• Are you monitoring other providers who have already made the conversion to transparency?
• Are you devising plans to capitalize on the inherent opportunities in offering transparent data?

Colin Konschak is the managing partner of DIVURGENT, a management consulting firm. His book on this topic was just released.

News 11/12/10

From The PACS Designer: “Re: CCHIT’s EACH program. TPD is happy to see that the CCHIT organization has realized that many hospitals have custom EHRs, and now through their new EACH program, they will be able to get current hospital EHR configurations certified more quickly than going to an all new EHR product.”

From Mrs. Marine: “Re: Veterans Day. Many thanks for your gracious acknowledgment of our servicemen and women. My husband is a 20-year Marine and I still get a chill when someone goes out of their way to thank him (or me) for his service. I would also like to acknowledge the many companies in healthcare IT that provide opportunities to military spouses like me to achieve in our own careers in spite of the many challenges that a military life presents. I can tell you from my own experience that I am a better employee, wife, and mother because I have had the support of my company in every way. To Mac, Mike, Tom, and Clair — I will be forever grateful. To the industry, thank you for taking care of us…all of us.”

One more military note: congratulations to HIStalk pal Admiral Cindy Dullea, who retired from the Navy after 30 years of service last month. She is a board-certified informatics nurse and was Deputy Commander, Navy Medicine National Capital Area and Deputy Director, Navy Nurse Corps, Reserve Component. She continues as SVP of marketing at SCI Solutions, which has been a sponsor of HIStalk for most of the 7.5 years that I’ve been writing it.

Accelarad announces its Turbo Gateway DICOM image transmission technology, which it says will speed up image delivery to and from cloud-based repositories via the Internet by up to 300% (4.5 CT images and 9 MR images per second).

Wilson Memorial Hospital (OH) names Larry Meyers as CIO. He was previously IT manager with Children’s Medical Center of Dayton.

A study of 250 hospitals by CapSite finds that 25% plan to invest in new Vendor Neutral Archive solutions.

Jobs from the HIStalk Sponsor Job Page: Healthcare Consulting Leader, Channel Account Manager – Cerner, Product Manager – Mobile Point-of-Care Solutions, Senior Manager Segment Marketing. On Healthcare IT Jobs: Implementation Engineer – Eastern Region, Systems Analyst Programmer V, Cerner FirstNet Analyst, Interface Engineer.

PolyRemedy brings on two new executives: Jeffrey Tingle (previously with the Risk Management Foundation of Harvard Medical Institutions) as software development VP and Heath Umbach (from WebMD) as director of product management. The company offers a Personalized Woundcare System that allows clinicians to assess and document using Web-based tools.

Aetna’s incoming CEO says the company will enter the US HIT market to take advantage of healthcare reform. Earlier talk I’d heard pointed to mostly consumer-focused Web tools, but you never know who they might buy.

The Norwegian government will support the Maternal mHealth Initiative with a $1 million donation.

The Institute for Clinical Systems Improvement licenses Nuance’s RadPort radiology ordering solution to support a Minnesota initiative to ensure medically appropriate use of MRI, CT, PET, and nuclear cardiology tests. The state expects to save $28 million per year based on the success of a 4,000 physician, year-long pilot. Docs get the benefit of not having to get pre-approval for the tests as long as they complete the online information needed to generate a clinical appropriateness score using rules derived from the American College of Radiology’s Appropriateness Criteria.

Coro Health receives $2 million in funding from a former Walmart CEO to deliver music “prescriptions” to long-term care patients that can help with cognitive stimulation and socialization, claimed to improve memory, reduce medication needs, and improve mood.

One of the companies showcased to President Obama during his recent visit to India was Teleradiology Solutions, India’s largest teleradiology vendor. The company says its radiologists cover the night shifts of 100 US hospitals from Bangalore. They’ll be at RSNA.

Speaking of RSNA, if you’re going and want to provide updates for HIStalk readers, we’ll take ‘em.

I’ve been really behind after attending the mHealth Summit, trying to catch up at the hospital and at HIStalk Intergalactic Headquarters (an upstairs bedroom that I just painted because Mrs. HIStalk was tired of the crappy builder’s whitewash that we had never changed). I have new sponsors to announce, reception details to hint at coyly, and HISsies to get started shortly. I’m hoping to dig out this weekend in case I’m tardy with something you’re expecting from me. To those folks, thanks for your patience, and to everyone else, thank you for reading and thereby giving me an excuse to do something that at least passes for productive on occasion.

A Harris Interactive study finds that smart phone users don’t care whose brand name is on their apps as long as they are highly recommended and offer a good user experience.

This flies against everything I’ve been taught about medical errors: the systems and procedures at Seattle Children’s were not at fault in three serious medical errors, a state investigation concludes. Everything was in place to protect patient safety, it said, which is then puzzling as to how the errors could have occurred. It also doesn’t explain why the hospital revised its medication policies after killing an 8-month-old with a tenfold overdose of calcium chloride. The investigation now focuses on the individual caregivers, which often means they get all the punishment as rogue operators (which they sometimes are, but not usually).

A Massachusetts county sheriff faults a police dispatcher for the death of a woman who choked to death on a marshmallow. Her husband called 911, but the dispatcher didn’t give him instructions on performing the Heimlich maneuver or CPR during the 12-minute call.

An Associated Press article covers informed consent applications that allow patients to review the risks of their procedures using multimedia, even from their own homes. Mentioned specifically: Chicago-based Emmi Solutions, which sells such a system used by 100 hospitals. Also mentioned: Dialog Medical, which is used by all of the VA’s hospitals.

It’s shocking that Weird News Andy missed this story: a South Carolina man high on hallucinogens is arrested after attacking officers investigating a home burglary, resisting to the point deputies have to use pepper spray, nightsticks, and a Taser on him. He’s taken to the ED, where the doctor notices a computer mouse cable dangling from his nether regions. An X-ray confirms that the rest of the mouse was where you might expect. He doesn’t remember how it got there, which is quite a testament to the power of hallucinogens.

E-mail me.

HERtalk by Inga

From Saxifraga: “Re: Facebook fan. Do I win a prize for being the 1,000th person to like you on Facebook?” I’d send you some fabulous virtual gift if I had one of those goofy Facebook apps set up. Thank you, Saxifraga, and our other 999 fans for your support. Mr. H and I are feeling very connected these days and we’re always happy to friend you on Facebook and connect with you on LinkedIn. You can also join the HIStalk Fan Club on LinkedIn, be a fan of the HIStalk page on Facebook, or follow us on Twitter. Basically, we are trying to be very hip when it comes to social media. It’s satisfying in a pathetic sort of way.

A reader tells us that Saint Alphonsus Regional Medical Center (ID) went live on Cerner October 15th and has reached almost 90% CPOE adoption, also deploying SurgiNet and FirstNet across all its patient and ambulatory areas.

Henry Ford Health System (MI)  announces plans for a $5 million expansion of its Rochester Hills data center, which will create 20 to 30 jobs a year for the next several years. Its technical employees are focused on the rollout of CarePlus Next Generation, the newest version of the health system’s homegrown EMR.

Healthcare providers rely on vendors with which they have an established relationship when selecting a Recovery Audit Contractor (RAC), according to KLAS. The most-considered vendor is Healthport (23% of the time), followed by MediRegs (16%) and 3M (14%.) Of the 98 provider organizations participating, 92% said they already selected a RAC solution; more than half only considered one RAC offering.

VHA selects TeleTracking’s RadarFind and its RTLS network as an option for its 1,400 member hospitals.

Yuma Regional Medical Center (AZ) will use InterSystems Ensemble for the development of interfaces with its Epic EHR application.

The VA contracts with DSS, Inc. for its Mental Health Suite EHR, which it will implement in all 153 of its hospitals.

Accenture wins a 10-year, “indefinite delivery / indefinite quantity" contract with the CDC for information management and IT infrastructure services. The total contract has a ceiling of $4 billion over the life of the contract.

The president of GE Healthcare’s business unit predicts that his division will see 10% profit annual growth, mostly due to an increase in world demand on big medical equipment. John Dineen expects particularly strong growth from China, which could grow 20% a year through 2015.

Halfpenny Technologies names Gai Elhanan, MD, MA as the company’s CMIO. He was most recently chief of healthcare informatics at 3M Health Information Systems.

The American Medical Informatics Association declares that “hold harmless" clauses in contracts between HIT vendors and providers are unethical and that vendors should not be automatically absolved for errors or defects in their software. Instead, vendors and customers should share the responsibility for patient safety and error management. AMIA also states that safe and successful HIT systems require ethics education on the part of vendors and clients. Great recommendations, but I don’t see vendors rushing to ask attorneys rewrite their standard contracts.

CCHIT announces that it will offer a new EHR certification program for hospitals beginning December 15th. The EHR Alternative Certification of Hospitals (EACH) program is an ONC ATCB certification program that is designed for hospitals that have uncertified legacy software, customized commercial products, or self-developed EHRs.

MonteFiore Medical Center (NY) activates DaVincian Technologies’ GUARDIAN to streamline patient registration and scheduling and improve data accuracy.

Sponsor Updates

• The Methodist Hospital System (TX) engages MEDSEEK to create an integrated patient portal based on data from its Eclipsys inpatient system, NextGen outpatient program, and Medicity HIE.
• Informatics Corporation of America (ICA) promotes John Tempesco from VP of client services to chief marketing officer and hires Brian Higdon, formerly of Affinion Group, as vice president of client services. Former TeraMedica Healthcare Technology VP Sandra H. Lillie also joins ICA as VP of sales and business development. In addition, ICA adds three Vanderbilt University Medical Center officials to its board of directors.
• Bridgehead Software partners with Perceptive Software to offer a combined solution that includes Perceptive’s ImageNow enterprise content management application and Bridgehead’s virtualization storage solution.
• Picis hosts an audio conference November 16th featuring several HIE leaders discussing the financial, operational, and clinical considerations of establishing health information exchanges.
• MED3OOO is recognized by Everything Channel’s CRN Magazine as a Top Healthcare VAR.
• Gillette Children’s Specialty Healthcare (MN) chooses Carefx and Indigo Identityware for single sign-on, context management, and clinical workflow.

E-mail Inga.

News 11/11/10

From Icarus: “Re: HIMSS Middle East conference in Dubai. Over 400 attendees are here. Lots of interest from providers in Qatar, Saudi Arabia, Pakistan, and UAE. Vendors include Allscripts, Cerner, First DataBank, Zynx, InterSystems, GE, and Hospira.” Thanks for the photo.

From Matt Yourity: “Re: business models and mHealth. What will work is ‘mHealth Plus,’ apps that are integrated with a person-centric longitudinal health record (with clinical information, claims, patient-entered information, and data from devices). Apps can integrate with each other and with processes in a robust middle layer. The business model is that we’re all paying for the cost of bad behavior, so there’s the incentive. Cute apps built in a silo are not the future.” It struck me at the conference that mHealth is where HIT was 20 years ago – everybody building their own single-purpose app because it’s cool (and because they can) rather than thinking big picture with regard to integration and user convenience. That’s a function of maturity, I think, so hopefully the “cute app” state will go away when investors realize there’s no profit potential and they probably won’t get much patient or clinician uptake anyway. If your solution requires going to a specific product’s Web site, there’s a good chance it won’t fly. The mHealth people need to be put in room with the PHR people since both need some help. The mHealth projects seem to mostly involve people with no enterprise IT experience. They’re doing what spare bedroom programmers always do – building cool stuff that may not be optimal if it ever needs to scale or broaden.

From Hollis Figg: “Re: Dell. Roger Davis, SVP of physician services outsourcing from the former Perot, has left abruptly.” Unverified. His LinkedIn profile is unchanged.

From Scratching my Head: “Re: EHR certification process. Any consultants you’d recommend that can help vendors make sense of it?” I’m sure there are several. The one I know that’s offering that service is Frank Poggio from The Kelzon Group. You’ll notice his text ad running in the right column (which is how I knew he was working with vendors on certification). Others can comment on this post and I’ll waive my usual “no commercial pitches” rule.

From Jesco White: “Re: mHealth. Your report concludes that there is no money to be made, but the opposite appears to have been reckoned by Verizon. They are supporting a big Health IT event in Atlanta.” I should have qualified my assessment by saying that the cellular carriers and phone makers are fully intending to monetize mHealth in some way, perhaps my making it a value added service that either costs extra or results in higher service fees. They were the dominant vendors at the mHealth Summit. It’s the people writing apps that haven’t figured out a business model.

From Digital Bean Counter: “Re: TAG healthcare IT summit in Atlanta. Aside from a decent turkey sandwich, it was a letdown. McKesson took the cake for the most part. I was surprised that the Verizon and Intel reps knew little to nothing about HIT, let along whatever it was they were trying to sell. The summit was mostly around the hype of hiring new people. I was amazed at how many attendees were out of work, between jobs, or in school. Funny thing is, when the floor opened up for questions, panelist balked at the ‘why can’t I get a job when I have experience’ question. At least the eye candy was decent – the industry is still doing a great job at hiring pretty ladies to rep their respective companies.” Maybe that’s what the panelists didn’t want to say – you can’t get a job unless you’re cute.

From Lucky Tech: “Re: weird news candidate. What’s next – pregnancy testing via SMS messaging?” UK researchers are working on a smart phone app that will analyze urine to instantly diagnose sexually transmitted diseases.

From CIODude: “Re: IBM. I’ve had numerous meetings this week with with ex-IBMers. It struck me that the lead healthcare people at most of the major technology companies  are all people who left IBM. Neil de Crescenzo left and is now Oracle’s lead executive. Jamie Coffin leads Dell’s healthcare group and Doug Cusick who led IBM’s global healthcare team is now leading HP. The IBM/Healthlink execs are all at Encore. Who’s left? For the first time in my career, I can’t name a single IBM healthcare executive and I’ve been very active in this industry for many, many years. What’s going on at IBM where they can’t keep people?”

From Happy Valdez: “Re: LSS. At the Meditech CIO conference, rumors were swirling about LSS Data Systems being shut out and Meditech opening a partnership with eClinicalWorks.” Unverified.

I don’t usually post news on Wednesday night, but I’m way behind from being at the mHealth Summit this week, even though Inga skillfully kept things under control. I figure I might as well clean up my inbox now instead of waiting until Thursday evening. It will be back to normal Thursday night.

Listening: We the Kings, Florida-based power pop. They’re young, clean (no explicit lyrics), and cheery. Nice sound.

Google changed its appearance this week in honor of the 115th anniversary of the X-ray, Weird News Andy noted. He also brought up the fact that Google was caught (accidentally) sniffing personal information from WiFi connections, adding, “Just how do people trust their PHR on Google Health? I don’t.”

Thursday is Veterans Day, observed on November 11 as the signing of the armistice ending World War I, which took place on the 11th hour of the 11th day of the 11th month. This is a day set aside to honor all military veterans, living or dead (Memorial Day is for those who died in their service to the country, which I say because people often don’t know the difference). But the main thing you should do tomorrow is to thank those who have served, regardless of whether their orders involved something that you agree with (they don’t get to choose). Which I would like to do right now: thank you.

I’m pleased to welcome Thomson Reuters as a new Platinum Sponsor of both HIStalk and HIStalk Mobile. The company offers the Clinical Xpert solution suite, which delivers real-time data to clinicians via the Web and a variety of smart phones (Windows Mobile, Palm, BlackBerry, and the just-added iPhone/iPad/iPod Touch). Clinical Xpert has been the KLAS Category Leader for Mobile Data Systems for eight years in a row. It gives providers tools to improve quality and reduce cost without changing the underlying IT systems, including the pharmacist dashboard I’ve written about lately, a surveillance tool to prompt clinicians to intervene, the patient information app, a billing system (powered by Ingenious Med), and a handoff tool. Thanks to Thomson Reuters for supporting HIStalk and HIStalk Mobile.

Beryl adds two new regional VPs for its Patient Experience Group: Rick Jacob (formerly of CareTech Solutions) and Nicole Nicoloff (from Community Health Network in Indiana).

Weird News Andy notes that some Romans have put a halt to construction of a planned NHS Lothian primary care clinic in Scotland. They’re not walking a picket line, they’re dead – construction is delayed for at least six months after workers uncovered Roman artifacts from 140 AD, including skeletons and weapons.

Nova Scotia’s health minister denies the request of two large hospitals to change privacy laws to opt-out instead of opt-in, which would have allowed them to market to patients and families using information on file unless those individuals expressly declined. The hospitals said they would make sure not to send promotional materials to parents of deceased children, for example, but the health minister said they should stick to taking care of patients. The hospitals implied their marketing campaigns could have raised $40 million over the next five years.

Virginia Commonwealth University Health System chooses 4medica’s lab and anatomic pathology result viewing and exchange solutions.

Someone who should know tells me that the Kansas City paper had the story wrong in saying that Cerner and Pulse didn’t make the original HITREC cut there, but were added afterward because they are local. Here’s the real story, they say: the Missouri and Kansas RECs had different lists and came together in a complex way to arrive at a single list, but that list was only for negotiating purposes. Missouri’s list was the one in which docs and office staff scored vendor demos and both Cerner and Pulse made that list, which wasn’t intended to be a final preferred vendor list. The whole thing was a little too complex to hold my interest, but basically the paper was correct in saying that there were two lists, but incorrect in assuming that Cerner and Pulse were added to List A to create List B.

Another point of view from someone who knows the HITREC situation there says the news isn’t whether Cerner is or isn’t on the list, but rather that their Tiger Institute investment made it questionable at all considering the whole KC-MO joint process was killed off because of that. This person says Cerner has never said how much it’s spending on the Tiger Institute program since it would then be obvious what benefits they expect to achieve from it, so they just call it “cost neutral” and nobody asks further questions. There’s speculation that since the newly elected governor’s campaign organizer is a Cerner VP that Cerner will somehow take over the state HIE effort, especially since their big campus investment on the Kansas side gives them additional clout.

Someone forwarded an e-mail update from Shareable Ink to Inga that noted two events it mentioned as making “a big splash in the industry news over the past couple of weeks.” One was $4.5 million in new financing. The other was my interview with T-System CEO Sunny Sunyal, who talked quite a bit about the DigitalShare joint project between the companies. That was pretty cool to see.

Interesting: the DoD keeps finding reasons not to use the VA’s VistA system (arrogance seems to be the main one), but the Army is looking for someone to install WorldVistA in a military hospital run by Iraq’s government in Baghdad.

Sponsor Updates

• Blanchard Valley Health System (OH) renews its outsourcing contract with CareTech Solutions.
• An article by Maryland McCarty, IS director at Atlanta Medical Center, in the Atlanta hospital newspaper talks about its implementation of SCI Schedule Maximizer and Order Facilitator. The hospital says they’ll be at the forefront of patient scheduling, which will increase the use of their registration kiosks to reduce wait time. It also mentions that physicians can view availability in real time to make sure their patients get scheduled as promptly as they would like.

E-mail me.

Merge Healthcare Acquires Fletcher-Flora Health Care Systems

One day after reporting strong revenue growth for the third quarter and the appointment of Jeffrey Surges as CEO, Merge Healthcare has acquired Fletcher-Flora Health Care Systems, HIStalk has learned. The Anaheim, CA-based Fletcher-Flora develops and distributes a laboratory information system.

Merge reported $45.2 million in revenue for third quarter, compared to $16.9 million in 2009. Adjusted net income was $.04/share, down from $.06/share last year. Surges, who was previously president of sales for Allscripts, replaces Justin Dearborn, who will take up the newly created role of president and concentrate on Merge’s international operations.

From the mHealth Summit 11/10/10

One thing you can say about the mHealth Summit: they give you your money’s worth in terms of long days with minimal downtime. Today, for example: it was straight through from 9:30 a.m. until 4:30 p.m. with just one five-minute break (even the lunch was all presentations).

They just can’t figure out the whole refreshment thing, though: the one-and-only concession stand that had mile-long lines yesterday was CLOSED today. The only food in the entire building was two levels down at an overwhelmed Starbucks. Man, that was annoying – the food and drink markup is insane, but even then you can’t get anyone to simply show up and sell you the stuff.

I wanted a soda, but of course there are no machines in the building since that would compete with those kiosk people who couldn’t be bothered to actually show up, so I finally worked up the nerve to go outside among the boarded-up buildings and street people to find an incredibly dumpy place willing to part with a dented and off-tasting can of Diet Pepsi for $1.50.

I also noticed that many of the convention center outside doors were locked, the water fountains I tried didn’t work, and some of the bathroom faucets didn’t either, all of which makes me wonder how well maintained the place is. It’s not a bad-looking building and it’s comfortable and well laid out, but the iffy neighborhood on three sides, lack of maintenance, and signs pointing to non-existent food stands left a somewhat negative impression. 

The first speaker came out with his real-time streaming physiologic data displaying on the big screen, collected by a tiny Bluetooth-enabled monitor in his shirt pocket going to a cheap cell phone (blurry, artificially sharpened photo courtesy of the crappy iPod Touch camera). It was pretty cool, but the real-world problem is tougher: who’s going to read that data and react to it? He mentioned that doctors aren’t interested because they don’t have the time to watch data that’s usually meaningless, plus malpractice attorneys would have a field day dragging them to court if they missed something.

That’s the big unanswered challenge: the world is short nearly every kind of healthcare worker, so any mHealth solution would ideally reduce their workload, not increase it.

Ted Turner was an early keynote. I had a snarky comment involving his trying to coerce Hanoi Jane into having three-ways (since he got unwanted PR when she divulged that in her book), but I’ll let that pass. Ted was pretty cool, very low key. I actually thought his answers were all going to be of the yes-no variety until he finally got warmed up and started talking a little. I saw no evidence of the infamous “Mouth of the South” from his younger years (he’s 71 now).

Ted was kind of all over the place, most of it not health-related, but he was still entertaining. He of course gave the UN $1 billion and told a fun story about that. The US was refusing to pay $1 billion in UN dues, so Ted was going to pick up the tab, but the UN wasn’t allowed to take the money directly from him. He said he originally toyed with the idea of buying the debt from them for 80 cents on the dollar, then doing what the UN couldn’t do in suing the US for the unpaid balance, which would have netted him $200 million with minimal work. What he really did was to set up a foundation to support the UN and to do charitable work, some of which involves health (lots of it involves elimination of nuclear weapons and war, which as he cleverly points out, can make all the health gains obsolete if people are killing each other intentionally).

So I didn’t get much healthcare stuff out of Ted, but I loved this story that he used to illustrate the point that conventional wisdom is often wrong. After he started CNN, he also started The Cartoon Network, which everybody told him was stupid since the experts assumed nobody watches cartoons. He said that The Cartoon Network now draws an audience 2.5 times the size of CNN’s, but nobody admits to watching it. As he said, “Bugs Bunny is still funny.”

Carolyn Clancy of AHRQ spoke for a few minutes, but all I wrote down was a couple of not-too-interesting projects at Denver Health and Vanderbilt and this link to a list of innovative projects. She also said the mHealth should be part of Meaningful Use, but didn’t elaborate on that.

Several speakers made these points: the industry needs to move away from single-focus projects that try to beat out a competitor. The way to win is through collaboration. Nearly all of them seemed amazed at the number of attendees since I guess it was a pretty sparse band of research geeks that attended last year’s inaugural conference.

This was a good point made in a morning session. The goal of mHealth in developed countries is to increase the efficiency of care delivery that’s already happening. In developing countries, it’s to provide access to care that doesn’t exist, leapfrogging the phase we’re in here. An example given was SMS appointment reminders that can be cancelled by replying.

One of the best speakers was Patricia Mechael from Columbia, who did a Letterman-like list of things the industry needed to do to hold itself more accountable. As she said in calling for better outcomes research, sending a million text messages doesn’t necessarily change behaviors.

I went to a session in which technologies were shown that send information back to providers. The first was PhiloMetron’s PTMS, the “Patch That Measures Stuff.” This was pretty darned cool, a bandage-like disposable patch (seven-day lifespan) that can track several measures. The most interesting thing they’re working on (gathering the data for FDA review) is auto-sensing of calories take in and calories burned (don’t ask me how they do that – in fact, don’t ask them because they won’t say). They’re planning to use the patch to drive dietician counseling. A variant detects the formation of wounds, like pressure ulcers. The company says the patch can be sold for around $30 at scale, so for $1,500 a year, you are wired 24×7 like an astronaut or something.

A UCLA researcher reviewed his cell phone microscope for cytology, which was cool because to get the size and price down (it’s the size of a quarter, 35 grams, and around $10 to make) it has no lenses. It does some kind of cell-level shadow analysis that allows the cell image to be reconstructed on the back end by software running on a laptop or server. It was nearly perfectly accurate from the pictures shown. I think he said it could be used for water safety and field testing for diseases by experts (not regular citizens, in other words).

Vitality showed its smart pill bottle and the compliance improvements resulting from its use. That’s another of those problems technology alone can’t fix – if patients won’t even take their prescribed meds, then what do you do? At least it has a business model – drug companies make more profit when patients take more pills, so maybe they’ll pay for the gadgetry.

So then it was lunch with Bill Gates, which had people ganging up at the ballroom entrance well in advance. Bill would have felt the pressure to be highly informative and entertaining had he known how bad the lunch was given its $75 ticket price (which I hope went to Bill’s foundation and not the caterer). My table had a spirited debate about whether the hideous drink in the pitcher was iced tea or fruit punch, which was an equal split until I postulated that it tasted like really bad fake lemonade with really bad iced tea from concentrate dumped in.

Bill seemed genuinely humble and introspective, speaking clearly and patiently like a really good teacher. Maybe age does that to you since both Bill and Ted (no Excellent Adventure pun intended) were a lot less animated than in their youth. Bill is amazingly well versed in healthcare and his big thing is reducing mortality of children under 5, which means Bill is a vaccine man big-time. He likes the idea of registering all births so that vaccine reminders can be given.

I found this fascinating: you would think that saving all of those babies would increase world overpopulation, but Bill says no – studies have shown that there is no such thing as a country with good health and a high population growth. For some reason, saving those babies actually reduces the population. He also said that nearly all of the world’s overpopulation is coming from urban slums.

He also likes the idea of digital currency to avoid having the local despots stealing the aid money intended for needy citizens. Apparently it can be handled purely by cell phone.

He brought up again that you can send all the reminders you want and people can pass tests showing they understand what they should be doing, but that doesn’t mean they will actually do it. He proposed for obesity that cell phone sensors should detect a lack of movement, then shake to remind the person to exercise. If they don’t, he said, don’t allow them to make calls until they do five push-ups (pretty funny guy, that Bill). As he put it, it’s been shown that you can take someone who exercises 80% of the time and get them closer to 100%, but for the large majority doing 0%, reminders don’t seem to work.

He also mused that the problem with public health problems is that they take years to develop, which makes people ignore risky behaviors since the time between exposure and suffering is long. He said that it would be better if AIDS killed people instantly because they would have an immediate incentive to avoid risky behaviors (as he said, they would know from the piles of bodies outside bars and brothels not to go inside).

The moderator asked him to name one technology that will be the next big thing after communications tools. He said robots, saying that computers can already see, listen, and move around. He observed that it would be tough to program a robot to help an elderly patient out of bed and to the toilet, for instance, but once the programming was done, the robot would be tireless and consistent.

Bill Gates is the man. I thought so before, but now I’m convinced. Rubber chicken or not, I got my $75 worth.

Aneesh Chopra was next up. The US CTO is a White House position, which was obvious since much of his pep talk involved bragging on the Obama Administration’s healthcare IT accomplishments. He talked up the VA’s telemedicine projects, the Blue Button initiative, and Meaningful Use. He bragged on the wisdom of making EHR certification modular, saying it would allow niche vendors to complete in specific areas of functionality.

He mentioned something about Project SMArt, a universal API into legacy hospital systems that will be available in the spring.  I found its Web page here. Apparently that mention today was its coming out party, according to the page. It was mentioned previously as an iPhone-like front end to legacy systems and there’s a developer contest involved. This could be interesting, so we’ll see where it goes.

I met with Travis Good of HIStalk Mobile after the lunch and then called it a day since I had to meet someone. The conference runs through tomorrow, but like most conferences, I would expect the last day to be less interesting and less well attended.

My summary is this. mHealth is not very well defined. Is it doctors reviewing PACS images by smart phone? Personal health records? Sending SMS text messages to moms-to-be? Using mobile devices to function as remote microscopes and medical devices? Offering face-to-face telehealth consults? Remotely controlling medication dispensing?

This conference focused on global health, primarily patient education and reminders. Most of the rest of what you might logically call mHealth wasn’t really covered since this is a meeting of mostly researchers and public health people. There wasn’t much here for you if your interest is in medical services delivery (hospitals and practices).

If anything, that kind of global health work is probably more noble and impactful than trying to sell EMRs to HITECH-yearning providers who don’t really see reason to change. There isn’t much money in global health. The meetings tend to be academic focused – no motorcycle giveaways or bribes to visit the vendor booths. They also tend to involve countries other than this one, either (a) those that are well ahead of the US in that area or (b) those who can’t provide even basic medical care services to their citizens.

What will be really interesting is to see how next year’s conference shapes up (December 5-7, 2011). Will many of this year’s attendees decide that the content wasn’t relevant to their work, even if seeing Ted Turner and Bill Gates in the ads convinced them to show up this year? Or will word spread and the conference grow to cover more of what could be defined as mHealth? And most of all, will the realization that this kind of global health-focused mHealth is probably never going to be profitable leave it as the domain of grant-funded researchers running endless pilot projects that sound great but don’t impact outcomes?

Beats me. I’m glad I came this time, but I don’t think I’ll be back next year unless I’m somehow improbably more involved in mHealth than I am now. We have our own problems in hospitals and practices and it seems to me that the players, the methods, and the rewards are so vastly different that this group of mHealthers have nearly nothing in common with us HITers, so I found little to learn and little to offer that was relevant. I admire the work they are doing, though.

News 11/10/10

HERtalk by Inga

From Lars Ellison: “Re: ARRA push back dates and repeal. I agree with you 100%. Even with the shift of power in Washington, I do not think that Meaningful Use is going away. On another HIT front, we recently received ‘off the record’ confirmation from the Minnesota pharmacy board that the 2011 e-prescribing initiative would probably (leaning towards very likely) be pushed back to give dentists and doctors more time to comply with the initiative.” Lars is referring to Minnesota’s e-prescribing mandate requiring all providers and dispensers to “establish, maintain, and use” an electronic prescribing program by January 1, 2011.

Customer satisfaction with Siemens Soarian is climbing as customers report improvements in service and product quality, deeper clinical adoption by clinicians, and better interfacing with Siemens’ pharmacy system. Soarian still lags in CPOE adoption, though 23 hospitals are now on CPOE compared to three just two years ago. Soarian sales are still lagging due to lingering negative perceptions.

If this HIStalk thing doesn’t work out, being a social media manager for a hospital might be fun. Reportedly the demand for social media manager or interactive marketing specialists is on the rise as hospitals attempt to increase their social media presence and teach physicians and execs social media basics. The role is so new that it’s hard to pinpoint typical compensation, though one hospital recently offered job-seekers between $60,000-$80,000 a year. Eighty thousand AND you get to post to Facebook all day long.

The Cleveland Clinic plans to lay off nearly 200 employees from a variety of administrative and clinical jobs. The health system says the layoffs are the result of a challenging economy and restructuring.

CPSI announces the formation of its new IT Managed and Professional Services business unit. The division will offer managed IT and professional services for its existing hospital clients.

Emdeon reports net income of $3.73 million for the third quarter, compared to a loss of $7.21 million last year. Revenue was up 4.4% to $245.92 million compared to $235.46 million in 2009.

Several companies have sent notes asking if I’ll be attending RSNA later this month in Chicago. I’m not, though I think I’d like to go one day. I’m amazed that a conference for a single specialty could be so huge (60,000) and attract attendees from all over the world. The enormity of it intrigues me, though there is also the whole “Michigan Avenue shopping opportunity before Christmas” thing that sounds appealing as well.

“

Speaking of huge conventions, HIMSS is just over three months away. I have secured my travel arrangements, which include a hotel half a mile away at $125/night. That’s definitely cheaper than what I paid in Atlanta and Chicago the last couple of years. Thus, I’ll have more spending money for the important things like fashion accessories. And speaking of fashion, Mr. H and I are scheming a few new things for this year’s annual HIStalk reception. Without leaking too many details, the gracious and fun folks from Medicomp are helping us with a red carpet entrance, which will allow all divas, wannabe-divas, and “I want to hang out with divas” to make an appropriate entrance. The “Inga Loves My Shoes” sashes will be once again be awarded to worthy candidates, so don’t leave your hot shoes at home. New this year: we will be encouraging cocktail attire and will award AMAZING prizes to the best dressed guests. We haven’t figured out what those amazing prizes will be, but are happy for any and all suggestions. The party sign-up will be sometime in January, but it is never too early for fashion planning.

CMS is conducting final testing of its system to handle registration, attestation, and payments for providers participating in the Meaningful Use program. Registration opens in early January.

According to the local paper, Banner Boswell and Del E. Webb medical centers have completed their conversion to Epic EMR. An RN with Boswell was quoted as saying the system seemed complicated at first, but was “easy to learn.”

Update: A US District Court judge dismisses a false claims suit filed by whistleblowers against Midwest Orthopaedics at Rush, several of its physicians, and Rush University Medical Center. The lawsuit, originally filed by a hospital executive and a fellow surgeon, stems from accusations that Rush physicians routinely overbooked their schedules and relied on residents to perform surgeries.

University of Utah Health Care installs TeleTracking’s TransferCenter software to speed patient transfers.

Saint Barnabas Health System (NJ) contracts with InSite One’s InDex Vendor Neutral Enterprise Archive to connect its six hospitals into a single, long-term data storage solution.

Sponsor Updates:

• Sage Healthcare announces the addition of six new practices running its PM and EHR applications. The healthcare facilities represent over 150 providers.
• CynergisTek CEO Mac McMillan will be the keynote speaker at next week’s Mississippi Hospital Association HITECH seminar on security.
• Mercy Memorial Hospital (MI) selects several Allscripts clinical products, including Sunrise Enterprise 5.5, EHR and PM for its employed and affiliated physicians, and Allscripts Care Management.
• Community Memorial Health System (CA) purchases PatientKeeper’s product suite, including CPOE, Physician Portal, Mobile Clinical Results, and eSignature
• RelayHealth launches its new Payer Connectivity Services 5010 and Beyond Program at the Workgroup for Electronic Data Interchange 2010 Fall conference this week.
• Frimly Park Hospital (UK) says that within months of going live with Picis solutions, it has improved utilization of its OR suites by 5%.
• Methodist Children’s Hospital (TX) claims its implementation  of T SystemEV has allowed them to save $1.5 million in one year though improved documentation and increased efficiency.
• Children’s Hospital Boston plans to implement iMDsoft’s MetaVision Anesthesia Management System.
• Gillette Children’s Specialty Healthcare (MN) selects Carefx and Indigo Indentityware’s solution for secure identity management and context workflow. In addition, West Hertfordshire Hospitals NHS Trust picks Fusionfx to provide an aggregate view of patient information within a single portal.

E-mail Inga.

From the mHealth Summit 11/8/10

Washington, DC is pretty nice this week given that (a) it was a bit chilly and windy on Sunday but nicer today, and (b) it’s getting dark really early now with the time change (that’s not just Washington’s problem, but since I was here on the day of the time change, I’m blaming them). I like the city, to be honest, even though I loathe the politicians, lobbyists, lawyers, and federal contractors that crawl all over it.

I’m staying in the Grand Hyatt Washington, which hurts a bit less now that I’ve seen it than when I first saw that I would be paying $181 per night out of my pocket. It’s a really nice hotel, two blocks from the White House in Penn Quarter, just down from the main entrance to Chinatown and Verizon Center. It’s also close to lots of funky restaurants, which is a plus. Even the $30 per day self-park fee didn’t seem so bad once I saw what parking cost at the nearby open surface lots. It’s just a couple of blocks from the convention center, an easy walk across a parking lot and up one street.

A friend met me here Sunday, so we took a nice stroll by the White House and down the mall to the Capitol. I took her to Clyde’s of Gallery Place just down the street from the hotel for dinner, which is was what I modestly expected, but with low happy hour prices and a clubby atmosphere that made it quite nice — the $6 empanadas and mussels were good, the $2 PBRs were cold, and the pumpkin bread pudding was pleasantly fall-ish. If you’re looking for someplace cheap and unchallenging near the Convention Center, it’s a safe walk and it feels nicer than the prices would suggest.

About the conference: it’s rather the anti-HIMSS, which I’ll explain as follows. Suppose you really like Las Vegas, with the noise, the glitz, the fakery, the conniving thieves at every turn, and the general sense that lots of people there are expending their pent-up immorality a safe distance from home where nobody knows them. That’s HIMSS.

mHealth Summit has 2,400 attendees (less than a tenth of the HIMSS crowd), most of whom seem to be academics, global health people, federal workers, and people from other countries that are way ahead of us in mHealth (and that’s quite a lot of countries). Vendor presence is minimal. Many of the attendees are young and idealistic, trying to solve big world problems (hunger, infectious disease, etc.) instead of landing their dream job working for a vendor and walking around self-importantly with smart phone in one hand and a mirror in the other. It is, therefore, quite un-HIMSS like – serious people getting serious education mostly working for noble causes underwritten by government money.

Here’s the interesting part: as non-commercial as it is, you might not like it. I felt way out of my comfort zone not seeing the same faces, the neon sprawl of the exhibit hall, and the presenters claiming they had finally reached healthcare Nirvana just by implementing version 26.2 of some vendor’s 1980s clinical system. I recalled that old National Lampoon story about two guys who found an alternate universe version of Las Vegas where the slots paid out freely and the hookers and drunks were absent, but all they could think of was going back to the real, gritty, sleazy Vegas. That’s how I felt today – I kind of missed the debauchery and shallowness.

Logistically, everything was mostly very well done. This was a long day, with the first session starting at 9:30 a.m. and the last one ending at 6:30 p.m. (without those big scheduling blocks that HIMSS leaves open to force you to the exhibit hall – you had to really dig to even tell when the exhibit hall was open). Lunch was scheduled for an hour, but somehow the planners slipped big-time in offering  what was optimistically described as, “Lunch On your Own, concessions stands will be available.” Make that “stand” in the singular: 2,400 attendees were cut loose simultaneously from the one and only keynote, only to find ONE single-line concession stand from which to buy $9 salads and $7 sandwiches. It looked like starving refugees threatening to overwhelm a UN aid truck, to use a global analogy. The line was huge, even at the end of the scheduled hour, and people were still trying to get food well into the next session. The convention center had several signs indicating that food was available elsewhere, but I looked all over the building and there was none. Somebody really goofed. I could have quit my hospital job if I’d had a hot dog cart on the sidewalk just below the window where the line ran.

It was clear from the beginning that this conference was thinking bigger than HIMSS, which fixates on vendors and in-hospital productivity applications to the exclusion of population health. I sketched this on my agenda:

US hospitals < acute care services delivery < US healthcare system < US population health < global population health

HIMSS is mostly in the leftmost category and entirely in the first two (inside the walls of providers almost entirely because that’s the vendors that pay them richly). mHealth Summit is mostly in the rightmost category and entirely in the last two. If you don’t like hearing about charity-funded SMS messaging projects in Kenya and Tanzania presented by volunteers, you should probably stick with HIMSS.

The 2,400 attendees hail from 48 countries. There are 125 exhibitors, a couple of hundred press people, and a ton of poster presentations. The big sessions are in the ballroom, which was nice because it has tables in the round (a place for your laptop, in other words) and free (slow) WiFi.

This site has a lot of information about various mHealth projects. Also mentioned was this site, which will have a cool summer internship program up soon. I jotted down the Web address of this Hopkins-led global health program and this interesting health information project from the Bloomberg School of Public Health at Hopkins.

I liked this quote: “Global is not the opposite of domestic.”

HHS CTO Todd Park was one of the early keynotes. He was pretty good, although he went a little bit too fast for me to be able to follow him. He mentioned that over 100,000 expectant mothers have signed up for the Text4Baby service. He says HHS will be launching similar SMS messaging services for obesity and childhood health. He also said that the HHS-led change in reimbursement will make mHealth a viable business (a feeling not shared by any of the speakers I heard, but I digress).

The next session was a panel, with a couple of speakers standing out. A doc from India said mHealth is important because there’s no way they’ll ever have enough doctors to deliver the care that’s needed. They also don’t have enough broadband penetration, but they do have 675 million cell phones. Allen Hightower from the CDC gave a lot of information, but it sounded to me like they’re doing nothing more than collecting survey information in the field with smart phones. He seemed to bristle a little when the moderator summarized his talk in that way, but that’s what it sounded like to me.

David Gustafson from University of Wisconsin got spontaneous applause a couple of times for saying that mHealth is not ready to scale up because nobody knows what patients and families need and want, the available information is often conflicting and of unverified reliability, and the smart phone form factor has significant limits for many people (small screen and keyboard.) He said research is taking too long and needs to reach the field faster. He expressed his believe that mHealth should be regulated as a medical device (that part didn’t get him any applause – everybody else thinks it’s the Wild West, but will settle down on its own without getting the regulators involved).

Nearly every session addressed the mHealth business model, or rather the lack of one. You get the feeling that maybe it’s not really going to fly given these common speaker opinions that I wrote down:

• Nobody has any idea whether mHealth really affects outcomes because it hasn’t been formally studied.
• There is no business model for mHealth. Companies and programs are almost entirely funded by grant money or by governments that are in the healthcare delivery business.
• Most mHealth applications are interesting and cute, but they don’t fit into the workflow of clinicians or the lifestyle of people. If your app requires going to some dedicated Web site to see or input information, nobody’s going to use it (they didn’t mention PHRs, but all the arguments seemed applicable).
• Doctors either don’t know about mHealth apps or don’t recommend them because they might affect their incomes.
• The only commercially successful mHealth application is Nike Plus, which has two million users who share exercise data via social networking and apparently buy a crapload of Nike stuff.
• One speaker said the conference will be obsolete within three years because broadband will be ubiquitous and SMS messaging apps will be ancient history.

We’ll hear from Bill Gates tomorrow, but one speaker quoted Bill’s take on mHealth, which you might expect to be gung ho since he’s both a technology guy and a world health leader. He’s not fooled into thinking that sending SMS pill reminder messages will change the world, however. “Bathroom scales have been around a long time, but we still have obesity.” In other words, technology doesn’t automatically change behaviors, and it’s behaviors that are often the problem (people don’t take their medicines, don’t stop risky behaviors, and ignore advice). 

I jotted down a couple of interesting items. One researcher said there’s precious little research data on chronic disease management since it takes place in the home. She’s thinking that data sent in via mHealth apps in those homes could be very useful in looking at disease management. Also mentioned was that some countries (not ours, of course) are building a cloud-based PACS image sharing backbone for smart phones to avoid the cost of having each provider buying their own. And a third, which wasn’t surprising: most of the mHealth innovation isn’t happening in the US, but rather in China, India, and Africa (if you’re uncomfortable when anyone suggests that the US is not the world’s admired and envied leader in everything, that’s another reason to not attend this conference – the folks here are a bit more globally objective).

Probably the best speakers were Denis Gilhooly from Digital He@lth Initiative and Joseph Smith of West Wireless Health Institute. They both had short presentations in a panel discussion, but I thought they were objective and authoritative.

I wish the conference used the technology that Inga talked about from MGMA where you texted your questions to the speakers instead of hogging the aisle microphone. The conference allowed long Q&A sessions and as happens every damn time, eager beavers darned near sprinted to the microphones, droning on and on from their written notes, clearly in love with the sound of their voices that were wasting the time of a huge roomful of eye-rolling attendees who wondered if indeed there was a question somewhere in their long monologue (and for a couple, there clearly was not). Starting with the third session, I just started walking out as soon as Q&A was announced, which was for the safety of the microphone droners because I wanted to body-slam them Terry Tate, Office Linebacker-style.

The exhibit hall was low key, mostly non-profits it seemed, with a few vendors. The oddest was a lady in a rather lurid booth selling herbal products, boasting of such medicinal miracles as “Virgin – Again,” herbal Viagra, and “Cleavage Enhancer.” Either she showed up at the wrong event or she has insight into the particular needs of people who attend mHealth events. I can’t quite see strolling up among peers and casually asking for those products, which may have been a shared opinion since people were steering a wide berth around her booth as though there had been a chemo spill. The evening reception was in the exhibit hall, so maybe she’ll get some takers after the drinks have flowed for awhile.

So my takeaway is this: mHealth is not and probably never will be profitable. Insurance companies may pay a little something here and there for some simple apps that might save them a few dollars, but the bottom line is that even if mHealth apps improve health outcomes (which seems debatable), the funding model just isn’t there to turn it into a business. For that reason, it makes sense that the conference attendees are mostly global health people, who I admire (and would admire more if they would do more work in this unhealthy country instead of focusing only on everybody else’s). mHealth, like global health, is a worthy cause that makes a poor business for most of the people in it, who largely self-selected that calling without worrying about cashing in anyway. Kudos to them.

Tomorrow is Ted Turner, Bill Gates, and another long day of sessions. I’m leaving Wednesday morning, so that will be my last report from here.

The ConJoin Group Acquires PHNS for $250 Million

The ConJoin Group, an IT and business services company, acquires HIT services firm PHNS for $250 million. Private equity firm Actis backed the investment.

The new entity will keep the PHNS name.

Monday Morning Update 11/8/10

From Wireless Observer: “Re: Sprint-sponsored article in one of the rags called The Future of Wireless in Healthcare. I find it interesting that it didn’t mention WiFi in hospitals and clinics, but of course the telecom-centric view is that ‘wireless’ only means 3G/4G/broadband. Most wireless data in healthcare is transmitted over WiFi networks. I have been hearing for years (mainly from the telecom side) that WiFi will collapse under its own weight due to capacity limitations, leaving 3G/4G in buildings to step in and save the day. That hasn’t happened and never will, at least if the likes of Cisco has any say. There is no doubt that more data requirements are driven by mobile devices and 3G/4G will be the primary means of transmitting it. But how can you ignore WiFi completely when talking about the future of wireless in healthcare?”

From The PACS Designer: “Re: Microsoft Office 365 Beta. Last month marked the official launch of the beta for Microsoft’s online Office 365 feature set for business enterprises. The Office 365 application is cloud based and focuses on giving users a complete package of business functions to improve office efficiencies for clients through the use of cloud resources.”  

From Chump Change: “Re: Microsoft. CEO Steve Ballmer sold $1.3 billion in stock last week and plans to sell another $700 million in the next few weeks.” I’ll bring that up with Bill Gates when I have lunch with him Tuesday (along with everyone else at the mHealth Summit).

The Missouri HITREC announces its 10 preferred EHR vendors, with Cerner missing the cut. Make that 12 with Cerner among them: the organization reconsiders (probably with encouragement) and adds Cerner and Pulse to the list strictly because they are local vendors. That’s what everybody was worried about with the HITRECs: they can pick whomever they want for whatever reason. Unless those two local companies just happened to be #11 and #12 on their original ranking sheet, that means providers don’t get to hear about higher-scoring systems. I don’t know that being local makes a vendor a better choice. I doubt Neal will drop by on his way to work to make sure everything’s working OK.