Readers Write 10/23/08

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Personal Health Records are Durable Medical Equipment
By Manfred Sternberg, J.D.
Presiding Officer, Board of Directors, Texas Health Services Authority

There is little debate that knowledge and information have always been among a physician’s best clinical tools. Consistent with this fact, information technology (IT) should be viewed by the healthcare industry as a medical device. With the advent of evidence-based medicine coupled with advances of IT, we are in many ways on the brink of a golden age of medicine.

In the relatively near future, information supporting evidence based medicine will translate from bench to bedside at speeds never before witnessed. We will have more accurate information to treat health issues more appropriately, based on the data, than ever before.

Admittedly, IT is in many ways a crude medical device, but that is today. Many of the now traditional medical devices that were introduced into the healthcare market throughout history started off as crude devices; think about surgical tools.

Like other medical devices, this device is certain to evolve with use, experience, and continued development and innovation. Many predict that the use of this IT device by healthcare professionals will become the standard of practice, like scrubbing in before surgery. The legitimate debate generally centers on how and when.

As with other changes in medicine, the adoption of this new tool will be an evolution. It will not happen by just flipping a switch at the end of any given year, it will evolve. Consumers and their physicians must participate in this evolution for it to ultimately be successful. The consumer’s best platform to effectively and economically engage with the industry is a standardized personal heath record (PHR).

What is a PHR?

A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information.

The Benefits of using a PHR

There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective healthcare. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and consumers and doctors can share that information to make the best decisions concerning their healthcare. Better data (e.g. timely, personalized clinical and billing data) provides better results whether in the hands of a physician, patient, health coach, or measurement program Additionally, care coordination from a process management perspective is critical to improved results

Consumer Empowerment

Consumers have great interest in the subject of healthcare. It is the most searched subject on the Internet, yet the long predicted wave of consumer empowerment in healthcare has yet to arrive.

Consumers, as well as the business community, are generally unaware of the healthcare cost and quality issues and interoperability issues. Nor do they recognize that they have a new, long anticipated, role as purchasers seeking value in the healthcare delivery system. They tolerate the existence of numerous inefficiencies and cost in the healthcare sector far more than in any other market, because of and in spite of its relative importance and their inability to judge value.

Today, the consumer is unable to identify value without information on cost and quality. Quality cannot be identified without measurement and it cannot be compared without standardization.

Since the mass adoption of the Internet, the benefits of IT have embedded themselves into society as one of the most powerful tools that consumers have ever had. Endless information is now available in everyone’s home. Society has embraced this new found consumer tool, but comprehensive personal clinical information has not digitally made its way into the consumer’s hands. To some degree it is not readily recommended or available, yet.

How does a consumer get educated about their new role in their own health and their interaction with the healthcare delivery system? Who do they trust to guide them? Consumers trust their physicians far more than any other group in the Healthcare system. They certainly value their doctor’s advice, even if they don’t follow it all of the time.

Today, the consumer is effectively, unwittingly waiting on their physicians to recommend this new medical device for their health. Therefore, engagement of the physician is the key to fostering consumer empowerment.

What is Durable Medical Equipment (DME)?

There is no single authority, such as a federal agency that confers the official status of DME on any device or product. A fairly comprehensive definition of Durable Medical Equipment as contained in a Texas Group Policy is as follows:

Durable Medical Equipment is defined as being equipment that:

• can withstand repeated use; and
• is primarily and customarily used to serve a medical purpose; and
• is generally not useful to a person who is not sick or injured, or used by other family members; and
• is appropriate for home use; and
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition; and
• is prescribed by a physician.

A consumer’s PHR fits the definition as follows:

Durable Medical Equipment means

equipment : Noun. An instrumentality needed for an undertaking or to perform a service.

that:

• can withstand repeated use. A PHR easily withstands repeated use.
• is primarily and customarily used to serve a medical purpose. A PHR contains a consumer’s relevant medical information so many medical decisions can be made based on the contents of the record.
• is generally not useful to a person who is not sick or injured, or used by other family members. A PHR is not useful to anyone in the consumer’s family but the consumer and only the consumer can use it to track and support her health or coordinate her care when she is ill
• is appropriate for home use. A PHR is appropriate for home use or anyplace a consumer has a connection to the Internet.
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition. According to the trade association that represents insurance plans and the executives of most plans, there is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

and is prescribed by a Physician; Can physicians professionally make this recommendation to their patients? It depends on whether they can professionally agree with the statement that “a PHR is a medical device that in certain cases can benefit their patient’s ongoing health or illness.”

If physicians prescribe a PHR for their patients, and the Payers collectively agree to pay the costs, the standard of practice in a community will change. Physicians will create a new business model in order to pay for their EMR system, and the power of a new medical device can be leveraged for the benefit of the consumer.

The PHR information must be stored in a secure way with patient privacy a cornerstone of the repository. Physicians must play a role in the central repository of this clinical information in terms of governance and oversight with appropriate financial compensation for their participation.

If every physician in Harris County, Texas prescribes a PHR for every patient that could benefit from such a device, it will be a catalyst for the creation of a clinical information database that would be owned and controlled by doctors and their patients.

The opportunity for today’s leaders is to take steps to enable our community to appropriately leverage the power and value of the data. To be sure, this is not as much a technology problem as it is a sociology issue. The first step is for the Industry is to acknowledge IT for what it is, a medical device.

News 10/22/08

From Elsie EHR: "Re: two I’ve not heard of. While reviewing the new 2008 CCHIT-certified EHRs, I saw two products I hadn’t heard of before … MedLink and SmartClinic. The web site of the latter looks a tad (how to put this delicately?) like it was created by someone whose full time job is not in the field of web design (I like the fact that the title of their home page is ‘home’). Oddly, despite being one of only ten 2008 CCHIT-certified EHRs, SmartClinic’s website doesn’t mention the certification." MedLink is here and VIP Medicine (the SmartClinic people) is here. I’ll refrain from snarky commentary on the latter except to say that you have to see it to believe it. I guarantee I could get an ultra-slick version done for a few hundred dollars (including graphics that are attractive and legible), so it seems like a poor investment to leave it hanging out there like it is.

From Ken Malansky: "Re: the former chairman of that fraudulent vendor you mentioned. He is GUILTY! I spent seven weeks of my life on that jury. The one holdout was star struck by his lawyer’s impersonation of Johnny Cochran." I thought they were going to retry him, but that was probably just prosecutorial chest-puffing after the hung jury in 2006. His attorney also represented Scooter Libby (where he parked his aging mother in her wheelchair where the jury could see him fawning over her), Eliot Spitzer, Exxon, Merck, and Philip Morris.

From Dave Dravecky: "Re: rumor. Heard at MGMA that GE is buying Greenway; can’t verify. Supposedly the VC guys want their money, the market is no good for going public, and GE needs a more up-to-date product."

From Salesgal: "Re: Sage. [name removed] got the axe." Unconfirmed. The person named was sales VP for the northeast, but I didn’t feel right about putting his name up here. If he’s gone (which I assume is the case) it’s embarrassing to him, and if he’s not, it’s embarrassing to me. Those who care will know who it is from the position (and whether it’s true or not).

From TalkoftheTown: "Re: Allscripts. I’m surprised you discount what McConnell says about the Allscripts/Misys headquarters situation. The guy has gotten more then 1.2 billion from the two companies for parts of what is left and it’s now valued at about 600 million. Which raises another issue on my mind – what was Allscripts worth when Tullman took over 11 years ago?" I don’t get the feeling that John is involved at all with the new Allscripts, so while his assessment about Raleigh may be interesting, I don’t know if he’s got any insider information now. I could be wrong. Most of the company is in Raleigh,I think I read somewhere.

From GirlGeek: "Re: Epic. Altru Health Systems, Grand Forks, ND, is switching from QuadraMed’s Affinity software to Epic. Altru is one of QM’s oldest clients dating back to the 1980s (or earlier?). Word is that Altru had to beg Epic to take them on since they don’t meet their bed count criteria."

From Al Borges, MD: "Re: Magellan EMR. Anyone know what has happened to them? Their website is dead. A physician who is still using the Magellan Writer can’t get in touch with them." I snooped around starting with the old domain name, registered by John Curtis of College Station, TX under the company name of BTQnet, a Texas corporation (custom software) with an Austin apartment address (the corporation is not in good standing with the state). He appears to have been at Quotient Integrated Solutions afterward (owned by BTQnet, I suspect) but their PBX doesn’t list him (this writeup says he ways still there in July). He’s on LinkedIn. Magellan was going crazy giving away tablet PCs back in 2005 and that’s all I ever heard of them. OK, can someone take it from there?

Just in: Cerner beats Q3 estimates: revenue up 13%, EPS $0.54 vs. $0.37. The company says it will exceed that in Q4. Well done.

A woman who waited 19 hours in Parkland Hospital’s ED and finally left without having her broken leg treated receives a bill for $162. They probably shouldn’t have let Parkland’s revenue VP go on record because he made it an even worse PR nightmare: "She’s not paying for waiting. She’s paying for the assessment she received." No she’s not, the woman says, who has no insurance and says she will not be sending Parkland a check for having a nurse take her blood pressure and tell her to wait.

McKesson will sell its specialty pharmacy business to Walgreen.

Listening: new AC/DC. It’s no Back in Black, but it’s good, straight ahead rock. I saw them live in the Bon Scott years — the guy in schoolboy knickers (guitarist Angus Young) doesn’t look any older even though he’s now 53.

RAND Corporation is all for NHIN and a unique patient identifier, but then again they’re not the ones who have to pay the hundreds of billions of dollars those would cost. The predict great cost savings and patient safety improvements, but they said the same thing about those EMRS that few doctors are using for various reasons unrelated to the quality of the doctors or the EMRs (poor adoption of which make NHIN and the identifier worthless since they add little value to paper charts).

Kaiser says HealthConnect is now live in 12 Southern California hospitals, bragging that its total of 22 hospitals serving 4.8 million members is the US civilian record.

Dr. Wes says it’s not an "electronic medical record," it’s "a sea of electronic medical servers," observing that every system at his hospital requires its own logon. Sounds like they need a physician portal at NorthShore to run Epic and those other applications mentioned.

Talyst announces its medication system (ordering, pharmacy, automated dispensing) for correctional facilities.

CareTech Solutions migrates the 80-server data center of Port Huron Hospital (MI) to its own Troy, MI headquarters in 36 hours as part of its outsourcing contract. The company has 1,000 employees and is bringing on many more. "Pretty much anything that has an electron running through it we are probably working on it," says Jim Giordano, president and CEO.

Arthur Clark is named VP/CIO of Haven Hospital (FL), coming over from John Sealy Hospital (TX).

A survey reinforces what everybody knows already: order sets improve processes and patient safety. The best time hospitals can spend in a clinical systems implementation or improvement is to develop an effective order set review process, starting with automatic inclusion and working toward evidence-based consensus.

Winchester District Memorial Hospital of Ontario, Canada signs for QuadraMed QCPR, document imaging, and enterprise scheduling.

ClearCount Medical Solutions, a Pittsburgh vendor of RFID surgical sponge counting technology, raises $4.1 million in Series A financing.

Daniel A. Krause, formerly of SciHealth, is named head of US business development for Satyam Healthcare.

Millin Associates announces a new practice management billing system for certain clinic types.

A new project named Wareed will electronically  link all hospitals in United Arab Emirates. Cerner is a participant.

A mob with iron rods storms and vandalizes a hospital in India, claiming that a patient’s lab tests were sent to an outside organization because the hospital’s doctors get a cut of the cost. The hospital says techs work only normal office hours and after hours work is always referred.

A man registering his pregnant wife online at Mary Washington Hospital (VA) finds that he can see the files of 803 patients on the site. The hospital said it was "an anomaly." The man got an invalid security certificate warning, then tried to delete some of the URL, which then took him to other pages that showed him the records of every patient who had registered online since December 2007.

Jack McCloskey joins Magruder Hospital (OH) as IT director, leaving a similar role at Floyd Memorial Hospital (IN).

NextGen Healthcare is named as one of the best places to work in the Philadelphia area.

Jobs: Epic Consultant, SIS Project Manager, Cerner PharmNet Consultant.

About 88% of American adults can’t make good health care decisions given the right information, an AHRQ study reports.

HLTH and WebMD cancel their $2.31 billion merger. I can never figure out that corporate mess where one owns most of the other and Marty Wygod is chairman of both companies. Conveniently, I have zero interest in both.

E-mail me.

Inga Live from MGMA

From Nasty Parts: "Re: political correctness. Did not realize the whole Obama thing was a done deal!” A couple of weeks ago I made one remark about Sarah Palin’s bangs and suddenly started getting hate mail from folks who treated that as a political endorsement. Yesterday I quoted someone else who mentioned “a possible role in an Obama administration” and suddenly I have written off McCain. I think everyone needs to take a deep breath and settle down. It will all be over in two weeks.

From Inga Wannabe: “Hi Inga. I am at MGMA and for some reason, several friends insist that I am Inga. I finally gave up and let them call me Inga. And, I actually decided it might be fun to be you.” Yea! We had a fake Inga at MGMA after all! By the way, it is pretty fun to be me. You are welcome to be Tina Fey to my Sarah Palin anytime (note to the crazy politicos: the previous sentence was not meant to be political).

From oneHITwonder: “Re: annoying texting. Man, I am so bummed out that I did not identify Inga in the relatively small CCHIT crowd. I will have to keep looking … hope she was not the annoying lady who was texting behind me during the entire session.” Likely not me since I sat up pretty close and (just like in third grade) would have been embarrassed if the speaker caught me not paying attention. As for the texting people, you have to remember that there are a lot of busy people in this world who believe the world may fall to pieces if they were unavailable to their underlings for an hour.

I got my first LinkedIn recommendation! “Not only does she give us great information, she also gives us humor, fun, and something to look forward to reading every day.” Thank you, Christianne for making my day. Mr. H and I, by the way, love to accept all LinkedIn requests.

It’s Tuesday afternoon in lovely San Diego. There is a reception tonight, but I don’t think my feet can handle any more standing or walking. I think I’ll go for dinner, a glass of wine, and an early night before I head for home in the morning.

Last night was a not an early night. I scored an invite to the Allscripts party, which was in a beautiful outside patio on top of the Hard Rock Café. It was pretty packed. Everyone seemed to be upbeat about the Allscripts/Misys thing, though it’s easier to be happy when you’re being provided all the free drinks you want. The only thing I heard anyone complaining about was the lack of food. Perhaps Allscripts decided to eliminate consumption synergies.

In a session yesterday, the speaker asked who had a hospital-provided EMR. Only about 10% of the hands went up, which surprised me a bit. I wish he had also asked if anyone’s practice had been offered the financial assistance from the hospital but turned it down. That’s the question I want answered.

I touched on this yesterday, but my impression is that the top concern for attendees is improving the bottom line. Hence, vendors are promoting many tools for increasing revenues and/or cutting costs. Even solutions like EMR are being discussed in terms of how it will help with pay-for-performance objectives. When I thought more about it, I remembered that the administrator is the one charged with taking care of the bottom line, so it shouldn’t really surprise me that they are less concerned with finding tools to make life better for physicians, etc.

A cool tool I checked out was from a company named Phytel. As I understand it, their Proactive Patient Outreach program works with any PM/EMR. It scrubs the offices’ data and finds all the patients meeting a particular set of criteria, such as all diabetic patients who have not had an office visit in over a year. Then it will call those patients, thus increasing revenue. Really simple concept, the technology works, and it produces results.

A couple of companies were promoting standalone products that calculate the patient-responsible monies at checkout and then place a hold on the patient’s card for that amount. Thus the patient has no surprises about the costs, does not have to worry about later paying a bill, and the practice is paid faster. Preferred Health Technology and mPay Gateway were the two I saw offering slightly different flavors of this concept. Both claim the PM vendors are lining up to partner with them.

One of the most entertaining moments of my day was a meeting with athenahealth’s Jonathan Bush, who gets excited about everything. He was clearly still pumped by a dawn surfboarding expedition. He’s about 100 IQ points higher than the rest of us, reflecting on recent industry consolidations and Marxist capitalism (consolidation is a predictable result of capitalism). We quickly jumped to his theory on software licensing versus software as a service, which is where he obviously believes the industry is heading. Finally, JB was gracious enough to say that HIStalk is about the only industry publication he reads (the always skeptical Mr. H says he probably says that to all the journalists).

A few other quick tidbits:

• I tried a couple of times to ask someone at the busy NextGen booth to explain more about their recent RCM acquisition. I never got a chance to talk to anyone in the know, but I did get a free t-shirt and a cool little flashlight.
• I spent a bit of time in Greenway’s booth and got the scoop on their new PrimeResearch product (they are excited about it) and quickly met EHRA chair Justin Barnes.
• Tried to check out PatientKeeper a few times, but every time I walked over there were busy, busy, busy.
• I met Sage VP Sharon Howard, who commented they were happy to be done with the turmoil a few months ago when her comments about some layoffs were misinterpreted. She thinks they did the right thing trying to be as forthright with the press as possible.
• I asked several attendees if they had an EMR and if they were on their first one, second, etc. Almost all claimed to still be on the first. Several vendors claimed they had replaced one competitor or another, but admitted that most buyers are on their first install.

Enough on my impressions! My wine is waiting. If you were at MGMA, please send us your thoughts!

E-mail Inga.

Inga Live from MGMA 10/20/08

Greetings from San Diego! It’s been years since I’ve been here and I had forgotten how absolutely perfect the weather is. Although, aside from the short walk from my hotel to the convention center, I haven’t had much fresh air!

I spent Sunday afternoon checking out the exhibit hall. Apparently there are over 350 vendors here to promote their wares to the 2,800 attendees. The traffic seemed pretty slow to me, and actually several vendors agreed. It’s Sunday as I write this, though, so it will pick up Monday.

None of the booths were over the top like you see at HIMSS. Cerner, McKesson, Sage, and Allscripts had some of the bigger booths, but there were plenty of small booths throughout. I also noticed what appeared to be 2-3 vendor no-shows.

One of my first visits was to Med3000/InteGreat, which was handing out cute little teddy bears. It probably would have been Mr. H’s favorite booth because two booth babes in black boots and white shorts were flagging those attendees who didn’t find the teddy bear to be an adequate draw.

Another memorable booth was Health Business Navigators. Everyone was wearing these silly white sailor hats, but they were being good sports about it and people were stopping. Plus if you sat through a five-minute overview of their ad hoc reporting tools, they gave you your own hat plus a $5 Starbucks gift card.

It’s been a few years since I had been to an MGMA meeting, but I seem to recall EMR being the buzz at that time. This year EMR is still hot, but revenue cycle billing services seem to be this year’s "it" product. Sage, for example, had a presentation by RCM expert Pam Moore, who is editorial director for Physician Advisor. I sat through her spiel, which was pleasantly generic and not a straight pitch for Sage. They also had really comfy chairs to sit in, and if you participated, you got your name in the hat for a $500 cash drawing (which, sadly, I didn’t win).

And speaking of comfy chairs, the Panasonic folks had this awesome massage chair. Full body massage. I want to marry the massage chair.

Anyway, my favorite booth pitch was Gateway EDI. If you gave them your card to swipe, they would donate $5 to Susan G. Komen for the Cure. Good stuff.

According to the exhibit information, Misys and Allscripts were each scheduled to have a booth. However, they used the original Allscripts space for all the demos (complete with the new orange, new logos, etc.) and turned the other into private meeting rooms. It’s actually pretty impressive that they had all the new branding in place a mere one week after the merger closed. I am sure the marketing guys were breathing a sigh of relief that there were no more delays in the merger.

Towards the end of my booth trekking, I stepped into the Workforce.com/OnBase booth. Tiki torches, thatch huts, and an open bar made it seem like a good stop (I actually did hang out at one of their tables for a bit, but drank only water). Unlike every other booth I popped into, no one really chatted with me for some reason. I kind of wanted to hear their story, but everyone seemed to be busy putting collateral up or conversing among themselves.

After a short break in my hotel room, I went over to the opening reception. Lots of folks there were using up their free drink tickets (I used mine up, too). They had an assortment of entertainment in place (my favorite was the lady making ice sculptures with a chain saw). I had fun chatting with a few administrators who were trading EMR implementation horror stories. I actually slipped out early lest I be tempted to find some after-party!

On Monday, I sat in on a CCHIT session. Not surprisingly, most of the attendees were looking for EMRs. Besides learning more about the certification process, there was some discussion on what other criteria CCHIT should consider. The audience recommended CCHIT consider adding more more portability requirements to make it easier to move from one EMR to another (when you dump the first vendor). Another couple of suggestions that I am sure would make vendors quiver: coming up with a certification process for physician PM systems and making EMRs more seamlessly integrate with PMs at a nominal cost. 

One session I missed: The Office: Manners Matter and Courtesy Counts.

I also  had a chance to hear Glen Tullman speak this a.m. The conversation was brief, but I heard enough to leave me convinced he really is passionate about this whole connecting healthcare thing. I’m sure he has shared his "connecting the community" vision hundreds of times, but  he still managed to sound genuinely fresh and passionate about advancing interoperability (between Allscripts products as well as other products). Someone asked him if he was making any plans for a possible role in an Obama administration or possibly as a senator. He stressed that he had signed a three-year agreement and wouldn’t have done that if he hadn’t thought long and hard about those options. He also said he has been vocal in his opinion that the HHS leader should be a physician and since he lacked that credential, it sort of hurt his chances. Of course, if that phone does ring, I imagine he’ll at least take Obama’s call. However, my impression is that he believes he has a chance to make a bigger impact in HIT staying in his current role.

I’m sitting in a session but I can’t absorb another fact about the benefits of interoperability. So, a few more notes:

• If you sit through a Navicure demo, you can get into a drawing for an Audi convertible. I am hoping to drive home.
• Magician fans could get their fill at the Greenway and McKesson booths.
• If advertising in the restrooms is appealing to you, you’d best stick to HIMSS. At least the ladies’ rooms were signage-free.
• Even though Medinotes is now part of Eclipsys, you’d hardly know it. Not only did they have separate booths, there was very little signage promoting the marriage.
• I prefer suits over those homogenous golf shirts. Don’t know if it is a trend, but a good number of the vendors wore "real" clothes and not those shirts that never fit the women well and in colors that real men would never wear. 

An HIT Moment With … Justen Deal

An HIT Moment with ... is a quick interview with someone we find interesting. Justen Deal was the Kaiser Permanente employee made famous when his November 2006 internal e-mail criticizing the organization’s HealthConnect EMR project was leaked out to the press. The CIO left, the CEO was publicly and somewhat arrogantly defensive, and HIStalk’s readers voted Justen Deal Industry Figure of the Year in the HISsies that year.

What has your post-Kaiser Permanente life been like?

In one word, interesting. Challenging at times, as well. It helps to have the perspective afforded by two years, though. Challenging in that the first few days, weeks, and months took a lot of patience, quite a bit of deliberation, a fair amount of persistence, and a ton of coffee.

Interesting in that I came to see healthcare information technology from a different angle. I saw the provider side, the needs, the costs. I saw the vendor side, the challenges, the risks. If you got past the headlines, I always defended Kaiser Permanente and the importance of the HealthConnect project, and on more than one occasion, I pointed out the strengths and advantages of Epic.

I eventually began working on Vieue, which has given me the opportunity to put some of that perspective to use. I know that no one company or person can solve every healthcare information technology problem, but there are a few we’re working on.

What good and bad effects resulted from your famous e-mail?

We’re just shy of about two years out, so, as I said, the time allows a bit more perspective.

The negative was that I ended up leaving Kaiser Permanente, which is an organization I believed in and still very much care about.

On the positive side, speaking about healthcare in general, I think there has been a small, but real shift in how electronic health record projects are assessed, in terms of their costs and successes. I think there still is a lack of thorough, public, critical analysis of the efficiency and effectiveness of electronic health record projects, but it has definitely improved, and I hope my e-mail played some small part in that.

HealthConnect is getting good press about improving patient outcomes. Are you buying it?

I think we all agree that smart, interconnected electronic health record systems can have an enormously positive impact on patient outcomes. The recent report that Kaiser Permanente is leading the nation in terms of breast cancer screening rates is great news, and it comes after more than a decade of work at KP specifically geared towards increasing detection. For 2005, the Southern California region achieved a mammography screening rate of 84%, which, as you’ve mentioned, has reached 87% according to the most recent data. By comparison, the current national average is 72%. 

Other regions have seen success, as well. In 1996, the Georgia region had a screening rate of 74%. In 1997, they implemented their Breast Health and Cancer Detection Program, and by 1999, they had significantly increased their rate to over 84%. The combination of building smart reminders into healthcare information systems and relevant patient workflows can obviously go a long way to improving patient outcomes.

Broadening your question just a little bit, I think the question for healthcare has to be whether we’re actually taking meaningful steps towards taking breast cancer screening rates up nationally, towards catching the hundreds of thousands of deaths every year caused by preventable medical errors, towards tracking and ensuring better compliance and follow-up on chronic conditions. I just don’t think we’re seeing the sizable shift we should be seeing there across the country, and I think that’s because the software isn’t as "smart" as it needs to be to catch, track, and prevent.

The other issue, I think, is cost. Across healthcare, we’re spending tens of billions of dollars on healthcare information technology, and the return on investment just isn’t there yet, until we are indeed meaningfully and quantifiably improving outcomes and reducing the cost of care. I worry about whether we’re wearing out our welcome with providers and insurers alike when we over promise, under deliver, over budget.

Lots of folks said you were highly analytical and well spoken in your HIStalk interview, but said they would never hire you because of the risk of a similar situation down the road. Has that been the case?

I decided fairly early on that I wanted to focus on Vieue, so I was thankfully spared any awkward interview moments. For any companies that might care about my particular perspective, though, I will say that I think it is critical to have a thorough, sincere, and independent compliance process, which can go a long way towards catching and addressing concerns proactively. I think it is a mistake to view compliance as a public relations apparatus, but the reality is a competent compliance process can often help prevent internal problems from becoming public problems, not through suppression but through correction.

Kaiser chairman George Halvorson is speaking at the HIMSS conference in Chicago next year.  If you were in the audience, what questions would you ask him?

I honestly can’t think of a single question.

Monday Morning Update 10/20/08

From Hoyce: "Re: inkjets. I wonder what these cartridges will cost?" Link. HP licenses its inkjet fluid technology to Home Dialysis Plus for mixing of dialysate and water for in-home treatment of kidney failure, saving the patients trips to the dialysis center. HP had already licensed the technology for administration of vaccines.

From The Blogfather: "Re: Cerner. Never let it be said that Neal Patterson makes idle threats. After bringing up the famous e-mail at the company meeting, he followed through and cut Cerner’s healthcare benefits in the middle of open enrollment. Cerner’s only contribution is $400 to an HRA account, leaving associates to fund the remainder of their care through old school FSA accounts." Unverified.

From The PACS Designer: "Re: Virtual Desktop Infrastructure. With the increased focus on virtualization, a term invented by VMware in 2006 is starting to gain some traction. Virtual Desktop Infrastructure (VDI) will be seen in the news more often now due to the virtualization efforts of VMware, Amazon, and now Microsoft with its soon to be introduced virtual desktop that runs in cache memory as a thin client. As more organizations look to reduce operating costs and simplify desktop application management, you will see more movement toward this thin client concept. The possibility of thin client PACS running on a virtual server that downloads the application to your cache memory could be a new trend in the years to come and would be a good cost saving application for smaller providers." Link.

From Fourth Hansen Brother: "Re: non-competes. They just got killed in California. Are people getting out of those that Epic writes?" Link. The California Supreme Court rules that employers can’t stop former employees from starting businesses or working for a competitor. Let’s face it: no court will stop you from making a living just because your former employer made you sign some questionably binding document as a condition of employment. Your problem isn’t the courts, though – it’s the new employer who doesn’t need the legal headache (or to make Epic mad if they depend on them). They’ll just hire someone else. If a former employee had the time and money to fight the non-compete, they would probably win and potentially set a precedent for everyone. I haven’t heard of Epic’s in particular, but I’ve heard that some Wisconsin attorneys were taking cases awhile back.  

From Lucy Ewing: "Re: physician contracts. Will doctors sign anything someone puts in front of them? A friend mentioned that a practice was getting terrible service from their billing service and planned to change. The billing service’s CEO freaked out and threatened to sue, pointing out that the contract they signed legally obligates them to send all billing through that company." I know doctors hate lawyers, but so does everyone else … until you need one. Like when signing a contract. 

The Raleigh paper just can’t accept the fact that Allscripts has moved the former Misys Healthcare’s headquarters to Chicago. The reporter pestered Glen to the point he finally said, "I wouldn’t rule out the fact that the headquarters may be here at some point in the future," surely just to get the reporter off his back. For some reason, the reporter then checked with John McConnell, who’s not part of the deal, and he fanned the dying HQ embers by saying Glen works for Misys and they’ve always liked Raleigh. My opinion: the important products going forward are Enterprise, Professional, Payerpath, and Connect. Everything else in Raleigh other than product maintenance (sales, administration, non-HealthMatics R&D) is way overstaffed under the new model. As tough as it is to hear, Misys brought little to the table except lots of indifferent customers, so it’s certainly not going to business as usual in Raleigh since Allscripts really needs to put up good numbers right away. I hate that "trim a tree to make it grow" stuff too, but that’s reality.

PatientKeeper’s Suzanne Cogan will speak Monday and Tuesday at MGMA (at Sage’s Booth 615) on "The Physician on the Go: Improving Revenue and Practice Operations with Mobile Applications."

I never heard of company Conceptual Mindworks of San Antonio, TX or its EHR product Sevocity (I must not pay enough attention to CCHIT certification since it earned Ambulatory 2007 in May). The name’s a stretch ("a combination of two words: seven, which signifies good luck or prosperity and velocity, which means speed or journey") but it looks of cool and is cheap ($800 startup per provider, then around $500 a month for EHR; another $200 for PM) with 24×7 support. They seem to have made their money from Air Force contracts.

Here’s a bit of McKesson history that I hadn’t heard. In 1938, its predecessor, drug wholesaler McKesson & Robbins Inc., faced bankruptcy after it was discovered that the CEO had cooked the books (he was actually an ex-con and swindler who used a fake name and medical background to buy the company). At an emergency company board meeting, word got back that the CEO had committed suicide. Said a Goldman Sachs partner who sat on the company’s board: "Let’s fire him for his sins anyway." The same thing happened with the HBOC acquisition, announced October 26, 1998 (maybe McKesson will be providing cake and punch for the tenth anniversary) except that McKesson’s executives didn’t kill themselves (only their careers – they were all canned after the fact) and the numbers were a lot bigger ($14.5 billion). The happy union was frenetically consummated on January 13, 1999 and the cooked books were discovered only three months later, sending $9 billion of McKesson market value up in smoke in a single day, leading to an entirely new meaning for Pathways Accounting. Everyone I knew saw it coming, so either I had smart friends or McKesson had dumb executives. Believe it or not, the adjusted share price still hasn’t recovered from that self-inflicted disaster: shares were around $82 in the fall of 1998 and are a little more than half that now. Cerner shares have tripled since then.

Jim Riley, formerly of Payerpath, joins MedAvant as sales VP, reconnecting with his former Misys boss Andrew Lawson, now MedAvant president.

Picis will be at CHIME’s Fall CIO Forum next week in Lost Wages, so if you’re going, drop by and tell them you appreciate their support of HIStalk.

While I’m on that particular soapbox, show a little sponsor love all around when you get the chance: click their ads to see what’s up with them and tell their executives that you saw the company mentioned on HIStalk. I’m a foot soldier working a hospital job by day, so I need some allies in proving the sponsorship value here. Thanks.

Sisters of St. Francis Health System threatens to cancel its WellPoint contracts because the Indianapolis insurance company isn’t paying on time. The insurance company blames its BlueCard claims payment software. WellPoint has been sued by investors who claim the company knew about the problem but didn’t disclose it. A representative of the company’s Anthem subsidiary says the problems won’t be fixed until February. WellPoint’s former CEO walked away with $23.9 million last year and the current one is getting $9 million a year. Why deliver actual care when pushing the paper it generates pays so much better? Adding value is so 1970s.

Gartner places Sentillion in its Challengers quadrant for Enterprise Single Sign-On.

Alberta, Canada (always reminds me of "Prince Albert in a can") will make health information available online to its residents.

Healthcare IT consulting firm Global Works Systems opens its new corporate office in Colchester, VT, which it points out is near its partners Allscripts and GE Healthcare.

I hadn’t snooped around MEDITECH’s site lately, so here’s your info tidbit: the cafe lunch in Westwood Monday will be grilled steak tips with sweet potatoes and Brussels sprouts. I bring that up because I’m one of the approximately five Americans who will eat Brussels sprouts (as long as they’re fresh and not frozen). I see they’ve posted all new (to me, anyway) color photos of the executives and they look like the kind of people I like (few ties, some are kind of nerdy looking, and everybody looks happy, maybe because they’re wealthy). It’s the most successful company in the history of the industry (which it happened to create – look it up) so I like to pay appropriate homage. The only blot on their otherwise perfect HIStalk record is that I can’t convince Neil Pappalardo to let me interview him even though he’s a rock star to me, but Howard Messing did an inarguably fine interview back in the early days of HIStalk that I really enjoyed.

A huge federal raid in the Cleveland area involves MetroHealth Medical Center. Several companies were searched, among them a local division of Siemens, which got contracts for both public housing and hospital work. FBI agents told the Siemens employees to clear out while they hauled out boxes. "He is an employee at Siemens, which handled a $33 million energy conservation contract with CMHA that Phillips helped shepherd through. McMichael is named in a federal subpoena involving Carroll and Greco. The subpoena indicates that agents are looking into whether contractors, including Siemens, had any financial relationship with the hospital administrators or whether any contractor did work at the men’s homes." Bribery (several billions of dollars’ worth) appears to have been woven into the corporate culture, according to former executives. Somehow they’re still in business.

The preview looks wickedly funny: Children’s Hospital, an Web series on the WB. Doctor in clown makeup: "I’m challenging you to a healing-power-of-laughter-off."

Vendor Deals and Announcements

• InteGreat and Nuance extend their partnership, giving InteGreat the ability to provide its clients with Dragon Medical 10.
• eHealth Global Technologies announces the release of the Image Exchange Service for RHIOs and HIEs. The product facilitates the exchange of medical images utilizing a DICOM-compliant viewer.
• Ingenix acquires business intelligence company Bull Services/Integris. Bull Services also offers consulting services, systems integration solutions, and outsourcing.
• QuadraMed’s former VP of strategic services Vicki Wheatley is now VP of consulting services for HIT consulting firm Just Associates.
• North Hawaii Community Hospital contracts with Phoenix Health Systems to provide IT management and infrastructure services.
• Physician-owned MSO Premiere Medical Resources (Ohio) selects Noteworthy’s NetPracticePM and NetPracticeEHR for its 92 members.
• iMedica signs a sales and marketing agreement with CySolutions, a provider of community health center solutions.
• Munson Healthcare (MI) selects Lawson Human Resource Management Suite and Lawson Business Intelligence to consolidate its administrative processes and support its HR and payroll functions.
• MedAssets announces the release of its Medicare Recovery Audit Contract solution that helps healthcare providers throughout the recovery audit process.

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News 10/17/08

From Jaitar: "Re: McCain. What’s with McCain repeatedly saying he wants to put medical records ‘online?’ Maybe he should also say he wants to put our financial histories online. He should get this straight – I’m not sure he is doing us any favors given the privacy hawks out there who leverage any public sentiment to slow down information exchange."

From HISWatcher: "Re: NextGen. Their buy on Practice Management Partners today and HSI a while back means they want to take athenahealth on in the RCM space. Should be interesting …" Agreed. PMP was doing great covering just a tiny part of the country, so they get a prime time slot with NextGen.

From Monsieur de Groot: "Re: hospital of the future. Here is a story about the "Hospital Room of the Future" that features Cerner products. Some of the entries in the ‘Comments’ page are  interesting." Link. It’s interesting (and scary) to see what’s inside the minds of average Americans when it comes to healthcare. 

From MC Hammersmith: "Re: CAROL. My colleague forwarded me the link. They give price and care information (with online scheduling) for procedures or care bundles. So far it looks like only a few providers have signed on, but I like the interface. I believe that the prices are still fiction, since they can charge whatever they want but will get what insurance pays, but, still looks pretty good for version 1.0." Link. I think I gave it a look and mention right after it launched. Looks pretty good. Actually, it looks very good once you dig into individual provider pages. I would use it.

Greenway launches PrimeResearch, a research solution that connects PrimeSuite EHR to clinical studies, quality and safety initiatives, and analytics. Researchers list their active studies on PrimeResearch, physicians choose those to participate in, and PrimeSuite runs a list of patients (de-identified using PHI scrubbing rules) that meet the study criteria. Now I’m not a practicing doc, but someone who is told me once that the biggest overlooked source of physician revenue is providing electronic information to companies doing drug or other clinical research. This guy, who was a really smart futurist and an MD/PhD, said that those organizations are happy to pay because they need quickly selectable data from big patient populations in electronic form, so it’s still cheaper for them than doing traditional paper studies. Finding patients out in the field, especially those with unusual conditions or demographics for niche drug studies, is nearly impossible otherwise, plus it does patients a favor by getting new treatments to market faster. I think it’s a great idea, one of the big benefits of having electronic data instead of manila folders. Expect that to really mushroom once genetic data is in there and more linkages between genes and disease (and drug responsiveness) are uncovered.

A medical helicopter crashes in the Chicago area while heading to Children’s Memorial Hospital from Valley West Hospital, killing three crew members and a 13-month-old baby. The helicopter, owned by the Air Angels emergency medical transport service in Bolingbrook, clipped an antenna guide wire and crashed in a field, killing the pilot, nurse, paramedic, and patient. The crash is the third involving Air Angels and the ninth in the past 12 months nationally involving medical helicopters. The pilot, Dell Waugh, was a two-tour Vietnam vet with two purple hearts who started a company after he retired from the Army, writing software for hospitals and creating instructional videos for drug companies. Condolences all around.

Mrs. HIStalk was having some impressive coughing fits but couldn’t get an appointment for several days at the practice we use, so I suggested she try the local back-of-the-drugstore retail clinic (because I was tired of hearing the hacking, but it probably sounded caring the smooth way I said it). The diagnosis: her first case of bronchitis, which we already knew since we’re medical types. Total time spent for visit and prescription pickup: 15 minutes. Visit cost: $60, but they took our insurance too, so it was $30 or something. Her grade for the experience: A+. She was the only patient there, the NP was experienced and efficient, and she was treated like an actual human being. She’s happy about it, but maybe that’s the Tessalon Perles talking. She’s cute as a button when she takes the cough syrup and makes that Robitussin face.

If you want to buy a "top of the line hospital information system" from India, this guy is selling one.

Listening: Montrose, hard-driving early 1970s rock with Ronnie Montrose and Sammy Hagar.

MacPractice, the Mac-based practice management system, has a new release and an iPhone interface. I would have told you how it looks since I tried to check out their demo, but of course the wiley marketers make sure you can’t actually see it without first completing a truly massive online form so they can pester you later (do they really need to ask what time zone you’re in when you have to give them your whole address?) You want people to watch your demo. You trust them to follow up if they like what they see. What’s so hard about that? I bet they sit around and moan that more people should be watching their demo.

HIMSS sent out its ballots today. My first rule of thumb: I never vote for anyone who isn’t FHIMSS. If they can’t take the time to qualify for HIMSS Fellow, what are they doing running for HIMSS national office?

Healthcare Growth Partners releases its Q3 HCIT Transaction Report. Download here (warning: PDF).

Rush-Copley Medical Center (IL) will implement McKesson’s closed loop solutions (Meds Manager, PACMED, Robot-RX, MedCarousel, Admin-RX). Notably omitted from the list: Horizon Expert Orders, since I believe the hospital went with Eclipsys SunriseXA instead, leading to some confusion about which loop they closed and what they closed it with.

Someone sent a rumor that Medsphere just laid off 15 people after moving to Carlsbad supposedly because of rapid headcount expansion. Inga asked the company about it and was told they don’t discuss rumor or personnel matters. I have my guess what that means and you’re entitled to your own. I don’t like to see anyone lose a job.

Bravo to the Project On Government Oversight (POGO), which tabulates information to remind government agencies which big contractors and companies have been guilty of major misconduct (hint: drugs, oil, and consultants). #1 by far is Merck ($5.8 billion) and GlaxoSmithKline ($4.2 billion). Surprisingly, McKesson is the fifth biggest offender at $996 million (thanks, HBOC). IBM is way up the list, as is Cardinal Health, Health Net, and the the usual contractors like Boeing, Lockheed Martin, and Northrop Grumman. Somehow BearingPoint came in way down the list with just $54.2 million (heck, CoreFLS was nearly ten times that amount of utterly wasted taxpayer dollars).

Nashville-based onFocus Healthcare, which sells enterprise performance software, completes a round of private equity financing. Here’s what impresses me: the chairman has a Carnegie Mellon doctorate (damn).

Grand Bahama Healthcare System will go live on its first Centricity Pharmacy install in a couple of weeks. You know the GE implementers are fighting to go there this winter.

CSC, new owner of Covansys and FCG, will hire 2,000 IT professionals in the next six months, all of them in India.

Taiwanese hardware vendor Unitech launches a healthcare PDA made from antimicrobial materials and offering both RFID and barcode readers.

State of Ohio CIO Steve Edmonson, formerly of Cardinal Health, will leave his position this week.

Rumor: GE Healthcare Financial Services has cut 30 salespeople, with more to come. And speaking of GE and its sudden problems related to its financial and healthcare units, the credit squeeze will hit GE and Siemens hard, the New York Times says, as hospitals finally have to adjust their capital-heavy ways in a down economy and with shrinking investment portfolios.

UVA goes with AtStaff ClairVia for staff and demand management.

Nuance says users are pumping 1.4 billion lines of medical transcription per year through eScription’s computer aided medical transcription system, with 17 new customers this year. John Halamka says it has saved BIDMC $5 million in transcription cost, while Orlando Health says turnaround time on clinical reports is down two hours just eight weeks after go-live.

Odd lawsuit: a man is beaten in the head with a yard-long log at a party in 2002, mistaken for the guy his assailant really meant to clobber. He is taken to the hospital, waits 90 minutes, and is later transferred to another hospital for emergency neurosurgery. He is paralyzed and  settles with the first hospital and its doctors and nurses for $8.5 million US, coincidentally the precise amount of the hospital’s malpractice coverage. And in Greenwich, Connecticut, eight women are suing the hospital and seeking class action status for allowing a drug-addicted plastic surgeon to perform breast reconstruction surgeries. The doctor turned in his medical license after being accused of injecting a patient’s painkiller into himself and later died of a heroin overdose.

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HERtalk by Inga

From Southern Rocker: “Re: Glen Tullman interview. Congrats on the interview with Allscripts. Seems like quite a coup to have a company of that stature select HIStalk as the forum of choice to communicate directly with the market.” Mr. H was pretty darned excited that Allscripts suggested it. So what if McCain and Obama won’t answer our e-mails? We got Glen. If anybody has suggestions about the format, time of day, etc. let us know so we can decide about future chats.

The X PRIZE Foundation and insurance giant WellPoint team up to develop a $10 million contest to improve health care quality and reduce costs. The finalists will have their proposals tested in state markets. Not to sound like Mr. H or anything, but don’t you just know the winner is going to have a solution that’s pretty health insurance company-friendly?

CTG Healthcare Solutions announces (warning: PDF) it will be providing implementation for a number of Epic Systems implementations. Interestingly, the press release provides such details such as it is providing “services to a major children’s hospital with a large pediatric research program” for $1.7 million, but, doesn’t name of the hospital. Another project is for “one of the nation’s largest faith-based integrated delivery systems… which operates hospitals, physician practices, outpatient clinics, health plans, and related health and human services in seven states.” I bet we have readers that could name those hospitals off the top of their heads.

Dan Nigrin, MD, MS, CIO of Children’s Hospital Boston, is mentioned in this article that revisits the question of which is better: CIOs who come up through the IT organization or those with a more diverse business background? Dr. Nigrin is not only CIO, but also an endocrinologist who went back to school for a master’s degree in informatics from Harvard Medical School and MIT. Obviously those are some pretty strong credentials. I also hear he owns a recording label and is an HIStalk fan. Doesn’t get much better than that.

An Employee Benefit Research study (warning: PDF) finds that 60% of us believe that centrally maintained EMRs shareable by authorized health care providers are extremely or very important. However, 62% indicate they are either not too or not at all confident that such records would remain confidential.

Mediware is expanding its stock re-purchase plan. In addition to the $4 million earmarked earlier this year, the board has authorized an additional $3.3 million. Stock is currently trading around $4/share, down from $7.25 less than a year ago.

QuadraMed is also repurchasing shares, though they are buying from a single shareholder. QuadraMed is buying 620,614 shares at $5.50 for $3.4 million. Though the stock closed at $5.85 Tuesday. It was close to $10/share when the company was listed on Nasdaq in July. The purchase represents approximately 7% of the common shares outstanding.

Teleradiology is the latest service being outsourced to India because of a US shortage of radiologists, particularly those willing and able to work night shifts. Other likely services soon to be offshored include telecardiology, telepathology, teledermatology, telephathology and robotic telesurgery.

Rick Norling, president and CEO of the national healthcare alliance Premier, announces his retirement as of June 30, 2009. The company earned the 2006 Malcolm Baldrige National Quality award under his leadership. His replacement has not yet been named.

According to a blog sponsored by the local paper, Lawrence Memorial Hospital (KS) has approved a five-year contract for Cerner to provide technical hosting services for the hospital’s clinical information systems. The transfer, scheduled to take place in April 2009, is predicted to save the hospital $1.5 million over five years.

Officials from a California elementary school claim HIPAA privacy rules prevented them from informing parents of a teacher’s sexual "reassignment." The music teacher, previously a woman, returned to school this fall asking to be addressed as Mister.

Last call for survey participants! If you are either a physician or a CIO/IS director and are willing to give me 10 minutes of your time, let me know. As a participant, you’ll get to hear about some of our latest scheming and have an opportunity to influence the future of HIStalk. Come on, you know you want to hear more!

E-mail Inga.

NextGen to Acquire Practice Management Partners

NextGen Healthcare Information Systems, a wholly owned subsidiary of Quality Systems, Inc., announced this morning that it will acquire revenue cycle management company Practice Management Partners of Baltimore, MD. Terms of the agreement were not disclosed.

PMP, which was founded in 2001, has 200 employees, handles 16 million transactions per year, and has annual revenue of $16 million from its service area of MD, DC, PA, and VA. Perry Snyder is the company’s founder and chair while Don Good, formerly of HCIA, is president and CEO.

Patrick Cline, President of NextGen Healthcare said "We have been very pleased with the demand we have seen for our revenue cycle management services, and while we remain committed to organic growth in all areas of our business, PMP will help to build out our RCM capability both geographically and with regard to capacity and talent. This acquisition also continues to build our base of recurring, visible revenue. Like HSI, PMP presents a number of strategic synergies." 

CIO Unplugged – 10/15/08

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

CIO reDefined. CIO 2.0 Ubiquitous Influence
By Ed Marx

I had the privilege of being a part of the CHIME faculty for a forum entitled CIO 2.0. Gartner representatives offered research and helped define the meaning of CIO 2.0. Faculty gave tangible examples from their unique experiences. In preparation, I had to do some introspection and analysis so I could succinctly convey my thoughts on the term and how someone could evolve from the traditional CIO to the technology leader needed for today and beyond.

I shared that CIO 2.0 presented the external manifestation of an internal transformation. It’s not about doing a couple of things differently in the workplace or changing the rhetoric or updating the eye glasses. Rather, it is a different way of interacting with life holistically, juxtaposed from traditional thought and action. It came down to five things I wanted to share with the forum. In an August post, I focused on one of these, Disruptive Leadership. This post will discuss Ubiquitous Influence.

People make too big of a deal out of which bigwig a CIO reports to. The prevailing belief foists upon us the idea that if you do not report to the CEO you have limited influence in your organization. Heaven forbid you fall into the legacy camp of reporting to a CFO!

In contrast, CIO 2.0 loses little sleep with regards to the reporting structure. They realize their influence is not confined to a specific reporting relationship vertical; it is instead ubiquitous, breaking out of silos and infiltrating the entire organization. While at University Hospitals (Cleveland), I reported to the CFO and arguably had greater influence on this prestigious academic health system than many of my peers who reported to CEO’s. It doubtless helped that I worked for a very progressive organization and one of the nation’s foremost healthcare CFO’s (Kevin Roberts, now with BJC). Choosing not to limit my influence to my silo, I reached across all aisles to gain bipartisan support for major strategic initiatives, which helped propel our organization from doldrums to national acclaim.

With my current employer, I report to one of two COO’s. Again, I do not allow the formal organizational structure to cap my influence. The CIO 2.0 masters talents that enable him or her to reach across all organizational verticals to bring about change, innovation, and strategic imperatives. If you find your impact limited, resist blaming the organizational structure and start learning/applying the skills and talents necessary to lead your organization to the next level.

Sometimes an org chart can paint a thousand words.

CIO 1.0

CIO 2.0

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

Readers Write 10/16/08

Thanks to all who participated in the live chat with Glen Tullman of Allscripts on Wednesday evening. It’s pretty cool that a CEO went on live with a blog and its readers (recall, too, that Glen was typing his own responses in real time!) Glen passed along a message to everyone that he was happy with the chance to connect. If you missed it, you can scroll through the transcript here.

From the Floor of the American Academy of Pediatrics Convention
By Willis Jackson

I’m tired and burned out, but here is the news from the floor of the AAP show from a veteran booth slut.

The traffic was not bad, as attendance was up this year. The Hynes Convention center is a bit awkward (multiple floors, each floor is "split" in the middle), but most vendors we spoke to thought it went well. The last few years, the AAP floor has not been strong.

The sharks are in the water. About 15-20 EHR/PM vendors who haven’t set foot near a pediatric show in the last five years are suddenly in the house. Some claim pediatric customization, but that just means growth charts and some templates they got from a practice. Why now? We all think that it’s the CCHIT money … the Feds, et al, have thrown the chum over the back of the boat and the sharks are circling. Meanwhile, the AAP’s COCIT committee can’t must enough $$ to get a decent program and none of these companies can be bothered to help underwrite them.

The Allscripts booth did not have a corrective sticker slapped over the logo on Monday morning. They also didn’t have many people stopping by, either. Misys, I believe, may be the only mainline EHR/PM vendor who WASN’T at this show.

Word on the street, and I heard this from more than a dozen folks, is that Office Practicum is "the only pediatric EHR to consider" right now. Personally, I have to concur. They have leapfrogged everyone, including (and especially) eCW, NextGen, etc. Every person spoke to who attended the EHR showdown said that OP crushed it, though one person gave a half nod to iMedica, if I remember correctly.

The GE booth was big, quite sparse, and usually empty as well. The sales people were on their phones rather than attending to customers. We presume they were checking the Dow.

A small group of well-known pediatricians is focusing on creating a centralized, Web-services driven clinical data repository for things like pediatric dosing, immunization algorithms, etc. Ultimately, it looks like the goal would be to pass the ownership of this desperately needed material to the AAP. If you don’t get it, imagine a quarterly HL7 download from the AAP against which all of your pediatric norms, etc., could be compared. Right now, it’s a mess. I’m hoping it works.

The nagging flies throughout the conference were the folks from Phreesia (phreesia.com – like "Frees Ya!" – get it? – they say it has to do with a flower, I don’t buy it). It’s the "Patient Check-In Company." They have a Tang-orange tablet (with a mag strip reader) that walks patients through the standard questionnaire process on the tablet. Your standard patient kiosk concept, except that it prints the report and the entire thing is ad-supported. Client after client, potential and otherwise, stopped by and said, "You have to go work with those guys. That thing is so cool!" So, we stopped by. And, no, they don’t interface with any EHRs or PMs yet. It prints the report. From their FAQ: "Q: How does Phreesia work with EMRs?  A: Phreesia is compatible with EMRs." By this standard, so are paper charts. And the mag strip – which would be really really cool for collecting co-pays and reading insurance cards – doesn’t work yet either. Yet again, a vendor has chosen to take the pharma+ money up front  rather than build a good product to interface with others. Wasn’t that the PCN model, almost 20 years ago?

Clinical Software Review -  Microsoft CUI – Introduction
By The PACS Designer

The Microsoft Common User Interface has been released for review and user input based on Microsoft’s Silverlight platform. This Microsoft CUI introduction requires you to download and install Silverlight 2 Beta 2 on your system. Once you download it,  reboot your system and launch the application to see how the Microsoft CUI works in daily practice. Here us the download link.

After logging off and relaunching your system, open the Microsoft CUI by clicking this link.

We are going to launch the "Patient Journey Demonstrator".  Once you are on the Patient Journey Demonstrator page, you are going to be navigating the "Explore UI" section first, so click the "Launch Button" under "Administration". Follow the steps below to learn the best method for navigating:

1. You will notice four physicians have their day’s schedule posted. The "Red Bullet" before Dr. Cox’s name indicates he is busy. Click the bullet to see the contacting options that are available to reach him.
2. Next, move your cursor over Dr. Cox’s box and drag it to the right and place it over Dr. Yu’s box. You’ll notice that the two doctors with green bullets are now first and second in the order of physicians. The "Green Bullet" means they can accept new patients in their daily schedule.
3. Dr. Cox has called to say he can’t see Hao Chen at 8:10, so drag Hao Chen to Dr. Gibbons at 8:10 so he can see the same doctor as his father, John Chen.
4. Click the "Clear Box" in the upper right hand section for Dr. Gibbons to see his entire schedule for the day. Also note that the other three doctors are on the right and can be clicked to see their daily schedules.
5. As the last step for this lesson, navigate by clicking the "Clear Box" of the other boxes so you can see the information they contain.

This ends the first lesson, come back to HIStalk to get the next lesson when it is posted. TPD will be doing a review of "Find a patient" next.

Rumor has it that Cerner’s Neal Patterson is trotting out his old "shot heard ’round the world" e-mail. You know, the pizza-and-parking lot one that sarcastically referred to EMPLOYEES instead of the HR-friendly “associates” because everybody was goofing off (I always write it as ASSociates because it sounds exactly what you’d expect dopey HR types to sit around dreaming up from their happy little floating HR cloud).

Somebody sent his internal-only e-mail to the press back in 2001, while the stench of dot-com smoke was still hanging heavy. Investors were spooked. Shares dropped fast and hard. Neal lost millions overnight while everybody was enjoying a good laugh at his "ready, fire, aim" approach.

Neal got the last laugh. Cerner headcount, profits, and his bankroll are immeasurably larger than they were back in 2001. And in a “goes around, comes around” kind of nostalgia, he’s supposedly proudly brandishing the famous e-mail to employees again, a shot across the bow as a reminder that he wasn’t kidding then and he isn’t now.

Here are some often overlooked facts about the original e-mail. Neal was griping about employees who were working less than 40 hours a week, which is an entirely reasonable bone to pick. He scolded his managers, not the slackers themselves, following the chain of command. It was a raw message intended for (and sent only to) the management team.

This is about as direct as you can get: "I think this parental type action SUCKS … what you are doing, as managers … makes me SICK … the majority of the KC based associates are hard working, committed to Cerner success and committed to transforming health care … this is a management problem, not an EMPLOYEE problem."

It wasn’t personal. It wasn’t even unreasonable (although the 60+ workweeks described are a bit much).

Neal isn’t some emotionless Wall Street hack brought in to push paper. He’s the founder, the owner, and the undisputed boss. When Cerner got too big for him to impose his will directly, he followed the chain of command in telling management to fix the problems he was seeing. Management by nastygram. That’s his right.

Everybody had great fun complaining and commiserating. Some EMPLOYEES left. Those with less backbone or fewer career options just kept whining safely out of Neal’s earshot while turning in fictitious timesheets.

Maybe one benefit of today’s economic meltdown is Depression-era common sense. Nobody promises lifetime employment. Nobody said work is always fun and fulfilling. Nobody promised that the boss might not occasionally behave like a horse’s ass in expressing disappointment in individual or group performance.

Employees with guts or valued skills don’t stick around to whine – they just move on. That’s how you hurt an unjust company (if there is such a thing) or an insufferable boss: you leave them, forcing them to forge on with a workforce of scared and compliant underperformers who have nowhere else to go. If the company thrives, you were wrong. If the company tanks, you were right.

Whether Neal is indeed rattling his e-mail saber again is irrelevant. The feel-good era of "associates" is over, if it was ever anything more than an illusion to start with. When jobs are hard to find, lots of people would love to have yours. Those would-be EMPLOYEES might even work harder, cheaper, or with less complaining. People tend to do that when they’re broke. That’s not to say that any particular company will start treating employees badly, but those who do will find it easier to keep them.

In that regard, Neal’s e-mail wasn’t the ranting of a tyrannical CEO. He was, as he often is, simply ahead of his time.

Live Chat with Allscripts CEO Glen Tullman – Wednesday, 10/15, 7:00 PM ET

News 10/15/08

Reminder: Allscripts CEO Glen Tullman will be live here in an online chat at 7:00 ET Wednesday evening. Several folks have left comments on his article or weighed in on the merger, so why not let Glen answer your questions directly? I’ll be posting the chat thing right here on HIStalk like any other article. You can set up a reminder for yourself right in the chat thing (I don’t know what else to call it, but it will make sense when you see it – picture above). I’ve practiced a little with it and I promise it’s fun and easy to use. Watch for the link or just go to www.histalk.com and you’ll see it.

From AHIMA IS DEAD: "Re: News from AHIMA – Seattle. One word – DEAD. Needs to be merged into HIMSS. No decision makers, no excitement, no pulse, no attendees." I know QuadraMed is there with some of those more modern technologies you’re interested in (HIM and identity management), so drop by their booth, tell them you’re probably the only HIStalk reader in attendance, and ask to be informed and entertained (no promises, but it never hurts to ask, unless you’re a competitor anyway).

From Duffy Dyer: "Re: Medsphere. The company put out a press release that implied that the VueCentric GUI was open source and part of its product, then had to retract it on Hardhats, saying they intended only to say that VueCentric was used in the Indian Health Service facility that just won the Davies." I’d call that press release a total disaster since it was nearly impossible to comprehend even without the gaffe. It must have been a slip because the others are OK and Schwartz PR is among the best that I’ve seen.

From Wilma Flintstone: "Re: Allscripts. Misys was supposed to be the acquirer, but all the top management is from Allscripts, the Allscripts name replaced the tainted Misys one, and it looks like from the site that the old Misys products like Tiger, Vision, Misys EMR, and even MyWay may be available only from resellers. The orange color might be what you get when you mix purple and red and the logo kind of looks like an M and an A (with the M in the shadows), but otherwise it looks like 90% Allscripts."

From Lula: "Re: Ingenix. You might be interested to know (if you don’t already), that Paul Sinclair, ex-senior VP of Cerner, resigned a few weeks ago and is now the COO of Ingenix Consulting. You can validate this via his Linkedin profile." You are correct. I didn’t know that. He had run Cerner’s professional services business for 12 years.

From Fourth Hansen Brother: "Re: shooting victims taken to closed hospital." I couldn’t find the online story to link to, but the text FHB copied says people took shooting victims to a closed Milwaukee hospital twice in a single night. Two men in their 20s were shot in unrelated incidents and in both cases, friends and family drove them to St. Michael Hospital, which has been closed for two years. Police advised everyone to call 911 instead of driving victims to a hospital.

I was Googling former IDXer Jim Crook to see what he’s up to, having forgotten that he’s now on the board of Vitalize Consulting Solutions. If you’re been around awhile (their employees average 12 years with their particular product) you might want to peruse their job listings, of which they have some juicy ones.

A new article by MEDSEEK president Peter Kuhn brings up an interesting statistic: scheduling a patient appointment by telephone takes six minutes (three each for the patient and the scheduler), while doing the same thing via a patient portal takes one minute (just the patient). That’s the same reason I buy online (and schedule appointments online) whenever I can.

This legal mumbo-jumbo, as best I can tell, is some kind of preliminary argument about definitions in McKesson’s lawsuit against Epic that claims MyChart infringes on McKesson patients. In this round, McKesson was the clear winner, it appears.

Online doctor rating service MDX Medical/Vitals.com gets $4 million in VC funding. Inquiries are free, so I looked up John Halamka. The information is basic (specialty, hospital affiliation, medical school, publications) and the results screen includes ads (one for billing software, one a silly game advertising a drug). Why would regular people checking their doctor’s credentials be hot prospects for buying physician billing systems or prescribing Lunesta? The site has all the cute bubble graphics and the Arial Rounded font that embodies 2.0 anything (and that will be as dated as a ’76 Vega in a couple of years), but I’m not seeing $4 million worth of potential with all the similar sites out there.

Hospira acquires the EndoTool blood glucose monitoring system from MD Scientific.

Iron Mountain, apparently tired of making a ridiculously profitable living hauling truckloads of medical records to its old limestone mine for long-term storage, wants to "shift toward a more consultative approach in the healthcare space" by telling hospitals how to handle paper records. The obligatory President Bush/EMR/2014 boilerplate is inserted as a reference to how poorly hospitals are doing with EMRs. I bet they had a big presence at AHIMA.

TeraMedica wins an imaging informatics value award for delivering ROI to its customers, specifically for consolidating disparate PACS through partnerships and in-house engineering.

Carilion’s struggles to convert from a hospital to a clinic are detailed in the local paper. One nugget: they’ve put aside $66 million for a statewide medical information system.

A new Pennsylvania law bans mandatory nurse overtime. It’s too bad a law had to be passed preventing employers from making people work when they don’t want to (or who aren’t at 100%, increasing the chance of error).

HealthBridge, the Cincinnati HIE company, is considering expanding to other cities. It just extended its relationship with Axolotl.

I’m fairly knowledgeable about the use of barcodes, so I found this entry in Loftware’s blog interesting: how about a color-enhanced barcode that can store 1.2 gigabytes of content? As it points out, that could be interesting for easy, cheap storage of medical records, medical images, or even media. If you ask me, healthcare is just beginning to realize the potential of barcodes.

Now you know why subscriptions are free. Modern Healthcare launches its fancily titled "leadership forum," which it says will offer "unparalleled access to highly qualified healthcare decision-makers." Pieces of meat … uhh, provider attendees … can be happy that "educational sessions will not compete with exhibiting, providing maximum sales exposure and sales opportunities for exhibiting companies." Don’t hospital executives have problems to solve at home without attending the equivalent of a timeshare sales pitch? I’m a little hostile, but only because I thought Modern Healthcare was above that level of overt pimping.

The Raleigh paper moans about losing its Misys Healthcare headquarters to Chicago, also claiming without further reference that 44 jobs will be lost as a result. 

Hillcrest Medical Center (OK) will deploy the CareView bedside TV and workflow application. Looks like it includes patient monitoring cameras and recording, online patient viewing for family, Internet access, basic telemedicine, and movies. Tommy Thompson is on the company’s board.

Jobs: Production Control Manager (MA), Regional Sales Director NE (NY), Customer Support Analyst – EMR (PA), Application Manager, Epic Ambulatory (CA).

Dossia joins the Continua Health Alliance (Wal-Mart PHR meets home device monitoring). I thought Continua was going to be hot when it started, but I haven’t heard much.

Microsoft says it will stick with SpeechMagic for Amalga even though Philips sold that division to Nuance.

If you’ve ever been to a seminar talking about the drug supply chain, this is familiar. A former Cardinal employee pocketed $350,000 in kickbacks from a felon in buying drugs of dubious quality on behalf of Cardinal. Cardinal already settled for trading in the so-called secondary drug market. The article cites a case I knew about: a cancer patient died because someone swapped her Procrit labels to sell the lower concentration drug at full price. That drug came from the same guy the Cardinal employee was buying from, who also made $42 million (!) selling phony Lipitor. The program I attended was shocking: totes full of fake Valium coming through the Miami post office, Mexican dealers who buy the same expensive labeling equipment the drug companies use (even holographic label printers) for making convincing fakes, and thieves who had already cracked RFID just in case FDA requires tracking products. Forget Tony Montana’s crack dealing: the real money is in fake drugs for fake Canadian pharmacies and innocent hospitals who don’t know what they’re getting or where it’s been.

Philips misses Q3 estimates, blaming slow US healthcare business.

MedAssurant, a healthcare data analysis company, moves to Bowie, MD. One of the Roche family just invested $175 million in the company, so it must be hot stuff (and has 2,000 employees besides).

A Thai software company called International Medical Software has developed a large-hospital system in J2EE that’s being used in 12 hospitals. An ISP "pay per use" feature is coming.

Oracle CEO Larry Ellison says he’s on the prowl for acquisitions cheapened by the stock sell-off, expecting to continue the company’s one-per-month average.

Odd hospital lawsuit: an overweight 46-year-old woman arrives at the ED complaining of abdominal pain. The nurses and doctors start her workup, but she asks to use the restroom. Staff later find her 6-pound newborn daughter in the toilet. She’s suing the hospital (actually the newborn is suing) for lifelong care of the baby, claiming the medical staff missed obvious labor signs even though the woman herself didn’t know she was pregnant. She had cocaine in her bloodstream. An outside psychiatric expert summarized, "Chutzpah. This is America. You’ve got to love this country. This woman doesn’t know she is pregnant, but somebody else should."

E-mail me.

HERtalk by Inga

From Janeen: “Re: MGMA. Inga, I had to smile when I learned you were going to MGMA. Your friends from RelayHealth will be there. Should we have an Inga lookalike in our booth again?” For those who attended HIMSS earlier this year, RelayHealth did have a lovely Inga stand-in. Too bad Mr. H and I didn’t get our act together in time to provide our unique brand of Fake Ingas, celebrity galas, and giveaways for MGMA, but it was a last minute decision. Anyway, one reason Mr. H is sending me on this field trip is to brush up on the latest in the ambulatory space. We’d like to be better versed in that area to appeal to our readers from that world. Janeen also reminded me that RelayHealth has a PHR offering, with their model connecting to the consumer via their provider. I do plan to stop by to see their plans for working with HealthVault.

I’ve stopped opening my 401K statements recently because all those down arrows make me depressed. On the other hand, I bought gas for $2.69 a gallon this week, so go figure out what it all means. Last week, before the close of the Allscripts-Misys deal, Dr. Borges asked why I thought Allscripts stock was falling if the merger was suppose to be such a great thing. I asked an expert (and HIStalk fan) Sean Wieland, Piper Jaffray analyst and industry mover and shaker, for his impressions since I clearly don’t have the economy figured out. To paraphrase Sean’s comments, this isn’t the time to rationally explain the movement of any stocks because all stocks are trading independent of their fundamentals right now. However, one factor possibly affecting shares of Allscripts was the trade x-dividend. Shareholders through October 10th are scheduled to receive a dividend. The tax treatment of dividends can be a little messy, so some stockholders may have elected to sell their shares in advance to avoid the tax implications. On Monday, Allscripts opened at $4.40 and closed at $5.47; Tuesday it closed at $5.40.

Ingenix announces the winners of its 5th Annual Top 200 coding hospitals. The award recognizes facilities based on the completeness and accuracy of their medical coding practices to bill Medicare for inpatient medical services.

The Health Resources and Services Administration announces plans to hand out $18.9 million to 25 community health organizations for EHR implementation. It seems like a lot until you remember it’s just a drop in the bucket compared to the billions our government is shelling out to our banks and automobile makers. This latest EMR incentive is in addition to the $290,000 per practice that the CMS promised last week to primary care groups with 20 or fewer physicians.

Alegent Health selects LYNX Medical Systems, a Picis company, to provide outpatient facility coding services to its five Omaha metropolitan area hospitals.

I don’t watch a lot of TV, but I do remember that old commercial (for Vicks-44, I think) where the good-looking guy says, “I’m not a doctor, but I play one on TV.” Maybe advertisers will resurrect it from this statistic: 26% of Americans say they get a big part of the health information from TV, particularly TV dramas (not PBS, not even TLC).

Eclipsys announces that the University of Michigan Health System recently deployed Sunrise Acute Care across its 913-bed system and has seen a 29% decrease in medical errors. Additionally, the health system claims a 40% reduction in the time to administer urgent medical orders.

Healthgrades’ 11th Annual Hospital Quality Study concludes that patients have a 70% better survival rate when treated at one of the nation’s top-rated hospitals compared to the lowest-rated ones. Across the board death rates are declining at the 5,000 hospitals studied, but the drop is faster at the top performing hospitals.

E-mail Inga.

Emageon To Be Acquired by Health Systems Solutions, Inc.

 Health Systems Solutions, Inc. of New York, NY announced Monday evening that it will acquire medical imaging vendor Emageon of Birmingham, AL for $2.85 per share or $62 million in cash, a 37% premium to its share price at Monday’s close.

HSS, traded on the OTC bulletin board, has a market cap of $20 million. Chairman and CEO Stanley Vashovsky was quoted as saying, "This transaction will offer us the ability to leverage Emageon’s best-in-market products as well as broaden and strengthen our management team with some of the industry’s most respected leaders. Our ability to bring together innovators in healthcare technology and unleash their entrepreneurial and creative talents will result in cutting-edge solutions that will improve clinical care and significantly improve customer profitability."

The company announced that it will seek Nasdaq listing following closing of the deal, which is subject to shareholder approval.

Emageon settled its proxy fight with Oliver Press Partners LLC in June, giving the investment manager three seats on its board. It announced evaluation of strategic alternatives at that time, including sale of the company. The company’s share price has dropped by 80% in the past year.

An HIT Moment With … Leah Binder

An HIT Moment with ... is a quick interview with someone we find interesting. Leah Binder is CEO of The Leapfrog Group of Washington DC.

Healthcare IT insiders and clinicians often criticize Leapfrog’s choice of CPOE as a technology that benefits patients, given that most medication errors that cause serious patient harm involve drug preparation or administration, not ordering, as in the recent Corpus Christi example with heparin. What overwhelming evidence makes CPOE so compelling to Leapfrog that those critics aren’t seeing?

Our fidelity is not to CPOE per se, but to any and all evidence-based best practices for reducing medication errors and improving patient safety. It happens that CPOE emerges as a clear winner in the evidence. We offer a bibliography on our website.

Among the studies: a study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55% — from 10.7 to 4.9 per 1000 patient-days. Rates of serious medication errors fell by 88% in a subsequent study by the same group. Another study conducted by LDS Hospital in Salt Lake City by David Classen, MD, demonstrated a 70% reduction in antibiotic-related ADEs after implementation of decision support for those drugs.

Recently there were two small studies suggesting CPOE might not be effective, but our expert panel discounts those studies because they took place in hospitals that deployed CPOE in six days — a ridiculously short time period for implementing any kind of complex system change.

Our experts read the peer-reviewed research. If there are better ways to reduce medication errors we welcome the opportunity to consider it.

Would you say that Leapfrog has had the influence on outcomes and healthcare purchasing that were expected when it was formed in 2000?

Leapfrog’s influence has been nothing short of astonishing in light of its short history. The central tenets of Leapfrog’s mission — transparency, good measures of quality, and rewarding good performance — have literally transformed mainstream health policy in the United States. Leapfrog led the way in innovations and policy priorities, among them:

• Leapfrog was the first to issue a never events policy, in 2006; now CMS has begun issuing regulations that Medicare will no longer pay for certain hospital acquired conditions, and all national health plans, and more than 60% of Leapfrog-reporting hospitals have followed suit with never events policies of their own.
• Leapfrog’s focus on paying for value and performance is now a mainstream philosophy. There are over 200 pay for performance programs in the country, including Leapfrog’s own Hospital Rewards Program, which at least one health plan intends to roll out nationally.
• Leapfrog’s commitment to transparency of quality information was one of its most controversial elements in 2000; today there are a plethora of report cards and other public information purporting to reveal comparative information among hospitals. Nonetheless, Leapfrog’s report on hospital performance remains by far the best and most useful: up to date information, evidence-based, and reported in a way that offers a meaningful comparison among institutions.
• Drawing on members’ experience, Leapfrog has influenced the design of CMS’ value-based purchasing initiative as well as HHS Secretary Mike Leavitt’s Executive Order incorporating four “Cornerstones of Value-Driven Health Care.”
• Leapfrog has significant influence in the National Quality Forum, including most recently approval of Leapfrog-sponsored measures on hospital efficiency.

Leapfrog has also seen progress in hospital quality among hundreds of reporting hospitals and raised the bar on patient safety. A recent peer reviewed study from Harvard School of Public Health, consistent with others that have been published on Leapfrog, concluded that hospitals reporting adequate performance on the Leapfrog Hospital Survey have better outcomes than other hospitals in the United States . 

We have not finished our work by any means. Next steps: support and incentivize providers in achieving higher performance, and engage even more employers. Some of our plans: develop best practices for implementing new IT infrastructure that ties to safety, deploy one nationally standardized pay for performance program based on the Leapfrog Survey, support hospitals more in achieving higher Leapfrog standards, and reach out to consumers and employees in new ways to support them in making decisions about providers. 

We are also going to formalize our partnerships with more of the employers now using Leapfrog (the vast majority are not formally members), issue more detailed guidance on implementation of never events, continue our robust partnership with policymakers and like-minded advocates to advance value-driven purchasing, advance a more streamlined and outcome-oriented set of performance measures, and ultimately, of course, improve the quality and safety of care.

All the evidence to date suggests we are on the right track and that we will be very busy in the years to come.

Where does Leapfrog’s mission fit in tough economic times?

There are many questions about who will be in the White House and what will happen to our economy, but one thing can be predicted with near certainty: the Leapfrog vision for health care reform will be a centerpiece. It has to be. Employers and other purchasers of health care will continue to reduce and in some cases eliminate employee health benefits as their profits erode and health costs escalate. In turn, employees will become more price conscious, and shop for the best value. Shopping for value in health care is what Leapfrog is all about.

With all the groups who want to oversee or audit provider performance, why should hospitals participate in Leapfrog’s programs?

Four reasons to start:

1. Because employers and purchasers of health care want them to. Purchasers pay for more than the care of their employees; they also subsidize the care of other patients when reimbursement for their care is inadequate, such as the uninsured.  Over 4,000 employers and counting participate with and use Leapfrog, and there is no other source of hospital data that employers point to as “their” exclusive survey. The least hospitals can do is devote 40-80 hours of staff time to giving employers the information they ask for, and in the process build trust and good relationships with their regional employers and employees.
2. Because it is useful. There is no survey tool that offers a better compendium of the best practices in patient safety, and some of the survey content is like getting high-priced consulting for free. For instance, our evaluation tool for CPOE is unique in the nation and offers invaluable information about the performance of IT systems.
3. Because it is harmonized with others. The measures in the Leapfrog Survey are consistent with NQF-endorsed measures and safe practices, IHI’s 100,000 Lives Campaign, and the Joint Commission.
4. Because you’re going to see market share and financial reimbursement changes tied to performance on Leapfrog. It is happening now. Many hospitals that perform well on Leapfrog feature that performance on their advertising, particularly in competitive markets. Some employers use Leapfrog scores to determine co-pay levels, and this has a very dramatic impact on patient flow. As changes in our economy and health system are emerging, we see these trends accelerating.

What were the surprises, good and bad, since you took the job?

The biggest “good” surprise is the influence of Leapfrog in Washington health policy circles and among hospitals. I was in Washington for one year about 14 years ago, and the change since then is incredible. 

For instance, at that time, the idea of report cards comparing providers was considered fairly radical and opposed by a wide variety of provider stakeholders. Today, everyone seems to agree it’s a good idea, and they just argue over the format (a very big issue, but still, the progress is substantial). Leapfrog is present at every significant stakeholder forum and regularly consulted by leaders in all branches of government. When Leapfrog summons people for a meeting on an issue, the who’s-who of leaders and experts show up. And among hospitals, where Leapfrog has its share of both passionate supporters and harsh critics, our influence is unquestioned. The visibility enables us to get things done in ways that would be impossible otherwise.

The second biggest “good” surprise: there are thousands more employers involved with Leapfrog than our membership roles would suggest.  That’s also the biggest “bad” surprise — we need them to be counted formally among Leapfrog’s membership, which helps assure we can sustain this remarkable visibility at the national level.

Glen Tullman on the Merger of Allscripts and Misys Healthcare

Allscripts CEO Glen Tullman finished this article early Monday morning to share his Day One thoughts on the newly merged Allscripts and Misys Healthcare with the readers of HIStalk. Completion of the merger was announced this morning. Glen will participate in a live chat on HIStalk Wednesday evening at 7:00 Eastern.

Software Silos – The End of the Beginning
By Glen Tullman, Chief Executive Officer, AllscriptsMisys

This morning we announced that the merger of Allscripts and Misys Healthcare has been finalized, creating a new company with a client base of nearly one out of every three physicians and one of every five hospitals, as well as thousands of post-acute organizations. Clearly, this is a great opportunity for the company and for our shareholders.

However, I look at it in a very different way. I see this merger, not only as an opportunity, but as a responsibility as well. We simply must use our new size/scale, our set of solutions and our reach to radically accelerate the movement to create a truly interconnected healthcare system in order to eliminate errors, improve quality and better manage cost.

But we believe this must be a mandate not just for Allscripts, but for all vendors. While Allscripts and others provide applications that help address the issues I outlined above, the core problem is that healthcare is not connected – functionally, financially or technically. That can’t continue and we collectively have the tools to ensure it doesn’t.

Consider this a call to action to eliminate what I call “software silos.” Now is the time to come together as an industry to create standards, to ensure our systems are actual solutions, and that what we provide is the fix, not the problem.

What do I mean by “software silos?” Simply stated, vendors today often provide stand-alone applications. They are not connected to other systems or to information that is vital to our end users – the equivalent of a computer that’s not connected to the Internet.

Yet connecting to information is the very essence of what we are being asked to do, because healthcare is at its roots an “information business.” Without just the right information at the right place and the right time, providers can’t improve the health of their patients or their bottom line.

Today we have taken a significant step in this direction by bringing together two of the major players in the market. In doing so, we have already spurred additional consolidation. And more is coming.

But it will take more than consolidation. As an industry, we have to begin to move with urgency, because this is not a “problem” we are trying to solve – it’s a crisis. The stakes are too great to wait – 98,000 deaths per year from medical errors, clinical outcomes that are given a “D” on every report card relative to other industrialized nations, and $700 billion wasted every year (ironically, the same amount of the recent Wall Street bailout).

Given what’s at stake, it’s disappointing that there are companies in our market who, when it comes to interoperability, can’t spare the time to help find a solution or lend a word of support to the many efforts that are in motion right now between many of us.  In fact, it’s worse than that. For literally everything that is done, they undermine it, preferring to use a “no, because” approach versus a “yes, if.”  Their attitude shows a fundamental lack of leadership.  Simply stated, walls between systems create chaos for patients and providers. We can’t allow this to continue.

A few years ago, I had an experience that I wouldn’t wish on any parent. While I was running another software company, I was in the operating room with my son Sam. As he was being put under, he looked up at a monitor and said “Hey Dad, isn’t that your company?” When I looked up, I saw an older version of our software and knew that we could do, and had done, better.

At that moment I realized that what flows through our systems is not bits and bytes, but human lives. The lives of our families and of our friends.

When Allscripts partnered with Dell, Microsoft, Google, Fujitsu and a number of other organizations to launch the National ePrescribing Patient Safety Initiative to provide electronic prescribing to every physician in the country for free, everyone thought I was a little bit crazy … including our Board of Directors, who reminded me we were in the business of selling software. But I wasn’t crazy (OK, maybe a little bit) – I was actually still, in a sense, in that operating room with Sam with a promise I made that day, which has turned into an obligation to get life saving technology into the hands of healthcare providers.

And that’s exactly why many of us entered healthcare to begin with and why we wake up every day with the passion to make a difference. But we can only deliver on that promise if we connect our efforts.

I am proud of the work both Allscripts and Misys have done through the years to move beyond software silos. We’ve played an active leadership role in developing standards, demonstrating interoperability in live settings with other Electronic Health Records (IHE Connecthathon, HIMSS Interoperability Showcase, etc.) and connecting patients to a variety of personal health record platforms including Microsoft HealthVault, Google Health and Medem. And, on Day One of our merger, our solutions will connect to others in our portfolio, from Emergency Department physicians who can view a patient’s ambulatory health record to hospital care managers who can share records with home care agencies. We’ll focus on leveraging our footprint to drive connectivity across the care continuum from ambulatory to acute and post-acute.

And just as we’re investing our resources in expanding across all settings and enhancing the interoperability of our solutions, it should be the commitment of every CEO in every healthcare IT company to dedicate the time (not just of their people, but their own personal time) and resources necessary to make their solutions fully interoperable.

We all need to recognize that our industry – and the healthcare providers we serve – is at an inflection point. We’ve succeeded in delivering solutions that help hundreds of thousands of providers deliver safer, more effective and more efficient care. But we’ve also helped to perpetuate the information silos that keep our healthcare system from achieving true connectivity and true health.

To paraphrase Winston Churchill, this is ‘the end of the beginning.’ And now the real fun begins …

We can learn from cell phones and computers, two other technology revolutions that changed our lives, and understand that the basic software and technology are a start, but they are just the first step. The real magic comes when you connect – just as cell phones of different manufacturers and carriers are connected. It seems basic, but it’s exactly what we need to do for healthcare. Not at some point in the future, but right now.

When our industry decides to make interoperability a priority, then we can begin to claim that we are truly delivering on the promise of healthcare information technology. With our solutions connected not only across all care settings but across all vendor platforms, we will deliver higher quality, lower cost patient care through an interoperable system that enables all providers everywhere to Connect to Health. The health of patients, of providers and of healthcare is on the line. The beginning has ended and we all now have a responsibility to deliver.

That’s our goal and that’s why Allscripts and Misys came together. Personally, I can’t imagine a better outcome.

Monday Morning Update 10/13/08

From DeEmailWontGoAway: "Re: Cerner. Neal Patterson had an employee town hall on Thursday. In it, he put the infamous e-mail back up on the screen and discussed why he was right then and why it is still right. He also stated emphatically that Cerner WILL lay off people before the end of the year — believe the exact quote was by the end of the year ‘we will need FAR less EMPLOYEES than we currently have on the payroll.’ Could be the right play, but the dude’s style is poor. While he buys a French villa and takes off the whole summer, he needs to forget about the parking lot and pizza guy." I’m on the fence for the first e-mail: it was obviously blurted out without much thought and sounded cold, but it was mostly management that he was ripping and many folks have told me off the record that he was right. Fact is, the economy has taken away whatever upper hand employees believed they had, so he can say whatever he wants, like always. Shareholders (many of them employees) and customers demand high performance, so you won’t hear them complaining about his whip-cracking. The employees who regularly rip the company (sometimes humorously) on JobVent have the same options as employees everywhere – stay or go, thus proving one of you wrong. Complaining is just wasting time instead of making one of those two decisions and moving on.

From Bobby Orr: "Re: Neal Patterson. Nice job, Neal, providing positive leadership comments in a time of crisis – gloom and doom. He mentioned eliminating insurance companies as they exist today, which is interesting because he is now running an alternative one for his employees that does not save the employees any money vs. a traditional HMO."

From The Alchemist: "Re: Neal Patterson. Folks, I am staunch die-hard metrics man, and although statistics do a great job of lying to support your point of view, I can’t figure out the lie in the World Health Organization’s Report. The United States is the #1 country out of 191 that spends the most money per capita in International Dollars for health expenditures. I can’t figure out where the lie might be in this statistic. The bang U.S. patients are getting for our healthcare bucks ranks the United States in Overall Health System Performance #37 (N + 191) only to redundantly mention that Cuba is Number 39.  The United States is not only ranked #1 for health expenditures, but spends twice as much in International Dollars as Switzerland that ranks #2 for health expenditures and #20 in Overall Health System Performance. If measures applied to our economy in recent days cannot ‘fix’ or ameliorate the situation, then how do we ‘fix’ the United States health system? Throwing money at it doesn’t appear to make things better."

From From Afar: "Re: Misys. Misys and Allscripts have both done layoffs this week. Layoffs at Misys were not mostly management positions. Many positions were project management related positions. There were 11 confirmed casualties from R & D alone, many of which had 10 years or more of service each with the company. There have been announcements about a few executive vice presidents not moving to the new company. Sales did layoffs the week just prior to the big joint sales meeting they had earlier in the week. Management will not release the total number of layoffs."

Listening: brand new Oasis. Melodic Beatles stalkers. I like it. Also: Saviours, angry stoners playing fast guitar.

Yet another business idea I wish I’d thought of: I was buying gas today and saw a pulpy newsletter that featured nothing but local arrest records and mug shots for just $1. The first thing I’d do is raise the price.

HIMSS announces 2008 Davies winners: Eastern Maine Medical Center (a Cerner site), Cardiology Consultants of Philadelphia, Columbia  Basin Health Association, Palm Beach Obstetrics and Gynecology PA (a Greenway site), Oklahoma Arthritis Center, White River Rural Health Center, New York Children’s Health Project, and Community Health Access Network and Member CHCs.

A Louisiana nonprofit isn’t finding many takers for the federal government’s help (financial and otherwise) to implement EMRs. It’s supposed to get 200 volunteer practices, but has only 14 so far.

Sponsor Web cruising: Dewey Howell, MD, PhD of Design Clinicals spoke at a recent medication reconciliation program and the link to his presentation is on the company’s site. 1450 inc. is offering several products of interest to Dragon NaturallySpeaking healthcare users. Healthia Consulting will be at AHIMA and MGMA in the next few days and then AMIA after that, so drop by and thank them for supporting HIStalk. Intellect Resources has a cool newsletter that’s always fun and chatty, so you can read the current and back issues and check out the positions they’re recruiting for. Our consulting friends at Renaissance Resource Associates are looking for some experienced talent in Epic, GE, and other major apps, so have a look. Teramedica, which has several patient-centric software applications, has a couple of job openings and has a signup for its electronic newsletter. The Revere Group will have executives in attendance at Midwest HIMSS later this month, the Blue Cross Blue Shield PMO Summit, and the Jive Software road show on social media. Thanks to all of those companies for sponsoring HIStalk.

Speaking of DNS 10, I’m convinced that voice recognition has finally met those Star Trek expectations. I see it’s available for as low as $70, so I’m thinking about giving it a try.

Norwalk Hospital (CT) honors GE’s Jeff Immelt and heaven’s Paul Newman for giving it money, or so I assume given veiled platitudes referring to "creative, compassionate philanthropy." Newman, for sure. Immelt, I can’t say because I don’t know.

Marvin O’Quinn announces his departure as CEO of Miami’s Jackson Health System, heading out to be COO of Catholic Healthcare West. He mentions Jackson’s Cerner implementation in his short goodbye letter. That’s not why he’s leaving.

Welcome and thanks to new HIStalk Platinum Sponsor Ingenix of Eden Prairie, MN. I usually mention the main offerings of a sponsor company for those who might not be familiar with them, but I’m not sure that’s necessary here since they’re widely known and it’s a long list of products and services they offer to healthcare. Highlights: coding, revenue cycle management, clinical and cost management, demand forecasting, and consulting. White papers and e-newsletter here. Thanks to those folks for helping power the mighty Wurlitzer keyboard that is HIStalk.

You will likely hear much Misys/Allscripts news next week (in fact, you will hear some of it directly and early on Monday morning right here on HIStalk, so look for that). In the meantime, mark this on your calendar: I’ll have Allscripts Chairman and CEO Glen Tullman in a live chat Wednesday, October 15 at 7:00 PM Eastern time (it’s the first time we’re trying this – sample of what it will look like here). Glen will answer questions directly from HIStalk readers. I have to confess: Allscripts was one of those companies that I griped a little about recently because they lumped HIStalk and other blogs as some kind of wacky sub-journalism instead of industry pros who happen to write online, but they’ve done a 180. Anyway, more from them on Monday morning and in the Wednesday chat. If you have questions and won’t be able to join us online, you can e-mail me your questions for Glen.

The special dividend for Allscripts shareholders when the Misys merger is completed will be paid on October 17 for $5.23 per share, with a record date of October 9.

The CoaguTrak Web-based anticoagulation management system ($65 per provider per month) includes native Google Chrome support for its AJAX-powered technology.

One of the two Harvard grad students who just won Siebel Scholar awards is working on disease management software for doctors and patients.

California, that big state whose movie star governor is demanding federal dollars because the state (like the country) can’t live within its means, could have saved money had it not passed a law allowing resigned state employees to get cash for unused vacation and work credits. One prison doctor got four years’ pay when he quit after 10 years, $815,000 for unused vacation and on-call pay, with no records to back it up. Private companies don’t allow accruing that kind of amount, of course, and especially under California’s policy of paying at the most current (usually highest) pay rate. Also mentioned is a minimum security prison nurse who earned over $200,000 in overtime in one year, bringing her one-year pay to $321K.

GE’s Q3 earnings dropped 22%, surprising no one since suckitude of that magnitude had been pre-announced. GE Capital, which the company kept saying was doing great while every other industry player self-destructed, is finally blamed. One funds manager said GE has a lot of good businesses and one underperformer – GE Healthcare, about which even usually cheery Jeff Immelt acknowledged as "a challenging quarter at Healthcare." Time to break GE into far more valuable and nimble individual pieces if you ask me, especially if its other businesses are as hamstrung by corporate bureaucracy as healthcare, which as I always say is the elephant’s graveyard for once-decent products (the first-to-worst KLAS phenomenon that’s unique to GE).

UTMB’s hit from Hurricane Ike: $710 million, of which insurance covers $100 million.

Those little fellows who whip horses for a living now have a PHR. I’m pretty sure they don’t shoot them if they break a leg.

Teleradiology and PACS vendor Medweb sends employees to Pakistan on a humanitarian telemedicine mission as part of the US government’s Digital Freedom technology sharing initiative.

It’s HIT’s version of Fisher vs. Spassky: Dolbey is sponsoring The Coding Game at AHIMA, pitting coders against computers. Too bad it’s not in Las Vegas – the bookmakers would be all over it.

MD Anderson, trying to forestall a senator’s demand that it account for its charity care practices in his investigation of hospital tax exemptions, sends Sen. Charles Grassley at least some of what he asked for. He is considering requiring tax-exempt hospitals to provide at least 5% of revenue on charity care (MDA spends 7.6%, but I’m guessing that includes unreimbursed care at ridiculously inflated "list prices" that don’t reflect cost). MDA got fingered in a Wall Street Journal article called "Cash Before Chemo" that detailed a patient’s plight when MD Anderson refused to take her insurance and demanded $105,000 in cash before it would admit her. Everybody wants hospitals to run like a business, except when they want them not to, a situation I ineloquently described in my recent Inside Healthcare Computing guest editorial called Every Time I Say It’s About Patient Care, You Tell Me It’s a Business: Healthcare IT Lessons Learned from North Dallas Forty. I bet Mack Davis never expected anything from his otherwise anemic film career to be used to make a healthcare policy point.

Odd hospital lawsuit: a 77-year-old woman hits the gas instead of the brakes in a hospital parking lot, crashing into the radiation department and killing the hospital’s radiation chief and a secretary. The radiation chief’s widow already sued the driver, who settled without paying anything, but she’s now going after the elderly woman’s doctor, three of his partners, and the practice they work for, claiming they didn’t tell the woman to avoid driving while on medications. Her lawyer says he’s optimistic that he can get more than $10 million.

Also odd: a Yale-graduated surgeon who failed his board exams for five consecutive years and who lost his surgical privileges and medical license after three months of practice at Meadowview Regional Medical Center (KY)  is arrested for the armed robbery of an Austin, TX bank, while wearing a gas mask as a disguise (picture above). Among his medical adventures: leaving a patient under anesthesia for 1.5 hours while arguing with a colleague, clipping the bile duct on two patients, and severing a patient’s carotid artery. Looks like he had filed for bankruptcy as well.

Vendor Deals and Announcements

• The 25-physician Premier Surgical Associates (TN) selects Intergy EHR by Sage for its EMR/PM solution.
• Software provider Cielo MedSolutions and consulting company TransforMED will market one another’s products and services to clinics adopting the “medical home” model.
• Tableau Software will provide its visual data analysis solution for AHIMA’s e-HIM® Virtual Lab program. The Tableau Desktop will be available in the Virtual Lab to help HIM students gain hands-on experience with data visualization, analytics, and business intelligence software.
• The Orthopedic Specialty Clinic selects SRS’s EMR for its providers based at Salt Lake City’s Orthopedic Specialty Hospital.
• The University of Miami Miller School and Medicine and the College of Engineering are partnering with GenerationOne to leverage mobile healthcare technologies and telemedicine to contribute to the care of chronic disease patients.
• Alpha Systems is selected as the vendor of choice for Winthrop-University Hospital. Alpha will provide the 591-bed facility with enterprise EDM software and day-after-discharge document scanning services.
• Consulting firm Physician’s Trust is now an approved eClinicalWorks vendor and will be providing eCW’s EMR/PM solution to physicians affiliated with Hoag Memorial Hospital Presbyterian.
• Zotec Partners announces a couple of new clients for its Electronic Bill Center PM/billing suite. The nine providers at Yakima Valley Radiology (WA) and 32-provider Atlantic Medical Imaging (NJ) are transitioning to the Zotec’s solution.
• The Duke University Health System deploys the Velos eResearch system to automate management of clinical trials.
• Physician services organization Medical Network One (MI) will utilize registry technology from Wellcentive to track patients with chronic conditions.
• Community Health Systems Professional Services Corporation (TN) signs a three-year outsourcing transcription service contract with Spheris for its 118 owned and operated hospitals. As part of the deal, Community has made a minority equity investment in Spheris and will have two seats on its board.
• Texas Children’s Cancer Center announces a new Web-based health history developed with Baylor College of Medicine. The Passport for Care application can be accessed by childhood cancer survivors throughout their lifetime.
• Orthocrat announces that The George Washington University Hospital has purchased TraumaCad, its Web-based pre-op planning and digital templating software solution.
• McKesson is deploying BIO-key International’s WEB-key biometric ID technology to enhance the security and convenience of their medication dispensing cabinets.
• The Christ Hospital (OH) is implementing the eICU Program by VISICU for its 44-bed ICU. eICU combines early warning software and remote monitoring capabilities.
• Park Nicollet Health Services (MN) is implementing Premier healthcare alliances’ SafetySurveillor to prevent healthcare-associated infections.
• A study by Research & Markets finds that the US PACS market is about 90% penetrated.
• Rhea Medical Center (TN) receives $256,500 in funding from the Appalachian Regional Commission (ARC). The money will be used towards the purchase of EMR equipment, training, installation, and licensing for the 25-bed facility.

E-mail me.

News 10/10/08

From The PACS Designer: "Re: Rich Internet Applications (RIA). The next wave of improvements for the web includes RIA. Microsoft Silverlight is a cross-browser, cross-platform, and cross-device plug-in for delivering the next generation of media experiences and rich interactive applications for the Web. Click on the video screen for each of the presented videos to see where RIAs are going to enhance the viewing experience." Link.

From Charles Chipps: "Re: Modern Healthcare’s Best Places to Work. I got a e-mail invitation that looked like a big deal, listing cocktails and dinner and asking for an RSVP. I clicked through and finally got to the RSVP screen and tickets cost $175!" Maybe they should have sent an invoice instead of an RSVP. It’s kind of tacky not to mention in the original e-mail that you’re just being solicited to buy a ticket, not come on over for free.

From Bailey Quarters: "Re: Misys. The Raleigh layoffs have begun, mostly in management." The Raleigh paper quotes a Glen Tullman statement that says an unspecified number of duplicate positions are being eliminated, but that hiring goes on in Raleigh. From Afar report 9 people in R&D were cut loose Wednesday.

From Tucker Garvey: "Re: Misys. Being one of the people that got laid off today due to the merger of Misys/Allscripts, many people were affected, just as John McConnell and others knew they would be. The salespeople were let go prior to their joint sales meeting on Sunday and the others occurred Thursday."

From Skip Battin: "Re: Streamline Health. Heard they’ve had a considerable cut in their workforce, up to 25%." A couple of folks told us that some salespeople who weren’t making their numbers were replaced, but that’s not surprising these days.

From UNoMe: "Re: IBM. As a former IBM’er and a reader of your informative site, I’m curious as to why we don’t see more news about/from them in healthcare IT. Have they become insignificant?" I’ve never followed them, to be honest, so I can’t say that I know what they’re up to. All I could drag up from memory was their big data warehousing project with Geisinger and whatever they’re doing with UPMC.

From Heather McNamara: "Re: CNN. Mr. HIStalk, I forgot to send you this link that was on CNN this weekend. I saw your complaint about CNN and then thought, ‘Shoot, where else could I get a story like this?’ LOL." Link. It’s a story and huge disgusting picture of a guy’s root-like warts that earned him the nickname Treeman. Check these current headlines that CNN’s hard-working journalists have crafted: 7-foot snake found under hood of car, Man paddles giant pumpkin 150 miles, Leaping dolphin lands on boaters, and Brinkley’s ex tells why he slept with teen. Any resemblance to actual news is purely coincidental. Right about the time I think that maybe we can pull ourselves out of our current economic mess, I think about those large numbers of Americans who can’t be bothered to read about it because the paddling pumpkin story has worn out their moving lips.

From MSC: "Re: Medsphere. There’s some confusion regarding the recent VueCentric press release. There is no relationship between the company called VueCentric and Medsphere’s product with the same name — it is simply a case of confused identity." Having the exact same name as another software company’s product that’s #1 in Google PageRank is indeed confusing. I found the press release hard to follow, I admit, like it had been hacked on by committee until the very soul was sucked from it (if I get time, I’ll write it my way for comparison). Still, sounds like a good development for anyone who can figure it out.

Cerner CEO Neal Patterson says that healthcare will need a bailout that will dwarf what the financial industry is getting unless reform is undertaken. "The Wall Street bailout is a one-time number. To bail out health care, it is not a one-time fix. When the bailout comes … it’s going to be a very gloomy day." We’re good on those already, but thanks anyway. He said in a user group speech that the company will allow customers to participate in software development, which one write-up called "open source" but that doesn’t sound exactly like it, even though customers can share stuff they’ve built.

Canadian EMR vendors Healthscreen and Wolf Medical will jointly offer their uninsured services and EMR applications, respectively.

Several readers e-mailed me to say that the Fox Meadows EMR vendor I mentioned is actually just a MediNotes reseller, not an EMR developer. That brought back the creepy, powerless feeling of trying to deal with our local Medical Manager dealer back in the day, an unresponsive, unethical, and incompetent bunch that turned us against Medical Manager even though the product was fine. So, we did the only thing we could: dumped it and bought Medic (now Misys, soon to be Allscripts). That was the first I’d heard of buying software from a dealer since hospitals don’t otherwise do that.

Adena Health System (OH) gets $278K in USDA grants to connect its sites for distance learning and telemedicine.

If you think about it, click on that "E-mail This to a Friend" button at the top right of the page and tell a few folks you like about HIStalk. I don’t advertise, so you’re my only hope.

Jobs: Nursing Informaticist – Meditech, Project Manager – EDIS, Director of Clinical Informatics, User Interface Designer. Gwen will send you a weekly job blast if you sign up.

Prison HIT systems are getting better, even though they’re 10 years behind healthcare, which is 20 years behind everybody else. Howard Salmon of Phase 2 Consulting, who I know from another life, said that. I thought Phase 2 was folded into Rehabcare when John Short took that company over. In fact, I checked and it’s a wholly owned subsidiary. Now I’ve achieved closure.

A family practice group in Minnesota launches a CHF management program after the local hospital shuts theirs down because of budget cuts. Family Practice Medical Center credits its EMR with allowing it to identify and monitor target populations.

SCI Solutions announces a new version of its Schedule Maximizer rules-based enterprise scheduling application. Enhancements are included for large facilities and for the new advance beneficiary notice forms.

A software company’s CIO survey didn’t quite work out as planned, judging from the company’s rather testy announcement of its results. Only 40% of CIOs said that software quality is important (or so the software company claims without showing the actual survey instrument), leading the company to editorialize about "corporate apathy," "disregard," and "high-profile horror stories." As I always say, "Don’t ask a question if you don’t want to know the answer." And, don’t use a press release to slam your respondents/prospects.

Andy sent this odd hospital lawsuit: a man brings his wife to Beebe Medical Center (DE) for indigestion, but ED doctors somberly tell the man an hour later that his wife has died of a heart attack. An hour after that, a nurse notices that the woman is breathing in the morgue, even with an endotracheal tube in place. The woman is healthy enough now to join her husband in suing Beebe. The hospital claims "Lazarus syndrome," a documented condition in which clinically dead patients spontaneously regain heartbeat and breathing, possibly due to delayed delivery of administered epinephrine to the heart or reduction of intrathoracic pressure after ventilation and compressions are stopped. The irony, of course, is that they’re being sued by a live patient for mistaking her for dead, a condition that most of us would be pretty happy about considering the alternative.

Baptist Health System (KY) goes with ADC Telecommunications for an antenna system to improve in-building cellular coverage for McKesson’s Horizon MobileCare Rounding and other applications that run on smartphones and PDAs. Interesting: they bought Nextel phones originally because docs wanted push-to-talk, but passed on Nextel’s repeater because it worked only for Nextel, it was expensive, and the doctors weren’t really using Nextel anyway.

CMS says faxed prescriptions don’t count toward the 2% eRX bonus.

Covisint signs a deal to create an HIE for three big Michigan physician groups.

Cardinal Health will pay $34 million to settle Justice Department charges that it didn’t report suspicious narcotics orders to the DEA.

When questioned by the local paper about who won the Obama-McCain debate, a Florida woman said, "McCain sounded like a socialist on health care with sponsorship of electronic medical records and community health clinics." Seems like kind of an odd thing to say.

UPMC is trimming the management ranks at some of its hospitals.

The former chairman of Staten Island University Hospital’s (NY) pathology and laboratory medicine is charged with tampering with the hospital’s billing system to steal $19,000 in insurance payments.

Healthcare Growth Partners gets a mention for being retained by clinical trials software vendor Datatrak of Mayfield, OH as its advisor.

E-mail me.

HERtalk by Inga

From Sam Matalone: “Re: politician initiative. I have been trying nearly every day contacting the political camps and no traction. The last time I heard the word ‘unavailable’ so much was when I was asking my friends to help me move. Either way, I will keep on keeping on.” Sam is referring to his attempt to get our presidential candidates to provide some specifics on their proposed healthcare IT programs. I have gone through the same exercise a couple of times in last few months and the most I have gotten is daily spam from the Obama campaign (and nothing from McCain’s). Sam also notes that he has been “spammed like you wouldn’t believe” from the Obama camp.

From Missouri: “Re: Cerner. FYI, Cerner is in Missouri, not Kansas!” My apologies. I knew that, now that I think about it. The Missouri connection reminded me of some mindless trivia I learned a few years back. Who knew that the Missouri’s state animal was the mule?

From Travelin’ Man: “Re: healthcare spending. A WSJ article from 9/22 might be of interest in discussions with your readers. Rising out-of-pocket expense is having an impact. CitiGroup says the hospital market will be flat for the next couple of years." The article says that Americans are cutting back on healthcare spending, with examples: first drop in filled prescriptions in decades; physician office visits are down 1.2% year over year; 22% of people say they’re going to the doctor less often because of the economy; areas hit include hip and knee replacements, mammograms, and ED visits. On the other hand, more than 3/4 of people say that economic conditions are stressing them out, leading to other medical problems.

From Man Connoisseur: “Re: Peter Pronovost. I can’t be the only one who thinks he gives Prince William a run for his money in the perfect man department, can I be? Damn.” Agreed. He’s quite the package.

From IT Writer: “Re: ultraportable laptops. Looking for those who are either using or managing the use of them, such as the Asus Eee PC. What are the special security considerations? This article is scheduled to appear in Computerworld. Drop me a line at ekeiser@john-edwards.com. Eve Keiser." This note came my way via Gwen Darling of HeathcareITJobs.com. If you can help, you might earn 15 minutes of fame.

I’ve been checking out MGMA sessions and exhibitors and was surprised by the absence of PHR-related ones. I realize many physicians question the value and validity of a patient-maintained record and perhaps see PHRs as one more administrative task. And, for the most part, patients aren’t rushing to get their PHRs updated. But for exactly those reasons, why wouldn’t Microsoft, Google, etc. want to jump on the chance to educate a captive audience of thousands on the virtues of PHRs? It seems odd that they don’t find the MGMA crowd important enough for a bit of self-promotion.

Speaking of the economy’s effect on healthcare, a Hewitt Associates study estimates that in 2009, overall employees’ healthcare costs – including employee contributions and out of pocket costs – will increase 8.9%, from $3,513 in 2008 to $3,836 in 2009. Who’s getting that additional money? Not the providers, I bet.

Good news for the Drink and Download e-mail crowd. Gmail has a new feature called “Mail Goggles” (cute name) that will prevent you committing e-mail faux pas, like sending nasty-grams to co-workers or whiny notes to your ex after a night of drinking. The system can be set up to make you answer five simple math problems when sending e-mail at odd hours. If you can’t get them right within 60 seconds, you will have to wait until you sober up the next day.

HIMSS Analytics and the American College of Clinical Engineering are jointly conducting a research study of medical devices in American hospitals. The goal is to evaluate patient safety and quality care benefits of medical devices that share data.

athenahealth COO James M. MacDonald resigns as the company’s COO and EVP due to health concerns.

DR Systems announces four new contracts for its Unity RIS/PACS totally about $2.19 million.

StatCom announces survey results showing that 89% of healthcare execs believe their facility has poor patient flow. The root causes: poor communication (67%), ineffective scheduling of activities and resources (36%), lack of beds (36%), lack of staff to help facilitate patient flow (34%), and poor centralized knowledge about the location and status of each patient (32%).

Merge Healthcare releases preliminary 3Q financial results through the end of September. Expected net income is $.01/share. Considering their long string of losses, even that small profit is good news.

Not so good news for the folks at UTMB Galveston. Following $709 million of hurricane damage last month, officials are contemplating layoffs for up to 4,000 of its 12,000 employees. State lawmakers are looking at ways to avert the workforce reduction to Galveston Islands’ largest employer.

E-mail Inga.

News 10/8/08

From Pharmacy IT Goddess: "Re: layoffs. Layoffs coming at the University of MN Medical Center-Fairview. Sounds like multiple departments." Fairview announced Monday it will cut 150-200 jobs this month, caught in a bind of declining investment value, increasing interest rates, lower Medicaid reimbursement, and unpaid patient bills. The first of many hospitals that will have the same unfortunate problem and solution, no doubt.

From Pedro Guerrero: "Re: Picis departures. Nivaldo Diaz, Chief Technology Officer, and Scott Lentz, Sr. VP of Business Development, have resigned." We asked Picis. "We can confirm the recent departure of Nivaldo Diaz from Picis. Nivaldo was a long-time member of the Picis team and we will miss him. Scott Lentz, on the other hand, is still with us in a consulting capacity. It’s not unusual for talented technology executives to choose to make a change periodically. Each made his recent career decisions for his own set of personal and professional reasons. We owe much to both of them for the success the company has experienced."

From Pitt News: "Re: big changes at West Penn Allegheny Health System. The latest is the CIO position." Pitt News forwarded the internal e-mail announcing the departure of CIO Nick Valadja, effective October 6. John Foley, new in the CTO job, is named CIO. He doesn’t appear to have a healthcare background. West Penn found a $73 million revenue overstatement in July that got the SEC’s attention, but it’s not clear whether that’s related. According to the Pittsburgh business paper, West Penn hasn’t released fiscal year results that were due June 31 ("30 days hath …")  Maybe it’s like those leap year babies that have a birthday only one year in four.

From Kelly Tarr: "Re: HIMSS 2008. I’m trying to find an electronic version of the exhibitor list. Does anyone have one to share?" If anybody does, e-mail it my way and I’ll pass it along.

From Nancy Greenly: "Re: HIT adoption panel next week." Link. The panel discussion will be next Thursday, 10/16, in Chicago, with Steve Lieber of HIMSS, Jane Horowitz of NAHIT, Dan Michelson of Allscripts, and Ralph Fargnoli of Beacon Partners. The topic is rather veiled, referred to only as "the pending healthcare IT bill," surely meaning Pete Stark’s bill (warning: PDF) that HIMSS doesn’t like (may we assume that the invited co-panelists aren’t fans either?) Another clue: HIMSS dearly loves every other HIT bill because they all call for more government spending, but the blurb says this: "some think that its official passage is inevitable," like they are referring to global warming or prostatitis. What HIMSS doesn’t like about it: it calls for open source solutions, it does not pay specific homage to CCHIT for certification, and it stiffens HIPAA penalties and allows patients to request audit trails. The party is at the Sheraton Chicago if you’d like to crash (well, register first, anyway) and argue the other side.

Trivia: we stayed at the Sheraton Chicago once and while Mrs. HIStalk was watching While You Were Sleeping on TV in the room, we recognized that several scenes in it were shot right outside the hotel, on the river. Mrs. H can’t get enough of Sandra Bullock’s mindless chick flicks (she’s a big Miss Congeniality fan).

From Frank Pulver: "Re: HIStalk. I have not only enjoyed, but have also benefited greatly from your breaking news and insights. Not a lot of industry rags that I choose to keep up with – issue of effort versus value. You are very much appreciated!" That e-mail made me feel so good I anonymized it and put it up here like a proud mom sticking pictures of the kids on the refrigerator. "Frank" is a quite high-ranking vendor guy and I’ll leave it at that. I sure do appreciate everyone who reads here.

Speaking of Picis, Christine Cournoyer takes over one of three titles held by Todd Cozzens, being named president in addition to her current COO title. Todd is still CEO and vice-chairman of the company. Lourdes Engel, as mentioned above, also gets an expanded role as SVP of product development and CTO.

ValueAct Capital is down $35 million on its Misys investment that hasn’t even closed yet, raising its estimated losses in the company to nearly $160 million overall.

If you work with databases of any kind, you’ll thank me later for telling you to download and try this $150 query tool.

Just in case watching the world economy implode isn’t depressing enough, here’s a year-old tome (warning: PDF) that predicted it all. There’s some great stuff in there about the mysterious Federal Reserve, the certain failure of policy efforts to create prosperity, and the postulation that we’re now entering Kondratieff Winter (15 years of hard times that will be needed to correct the previous 45 of prosperity). I hope it’s wrong since I’d rather not work until I drop, at least at jobs other than HIStalk, anyway.

I’ve temporarily overcome my frugal tendencies and am sending Inga to MGMA in San Diego, so she’ll be reporting from there starting next weekend. We like meetings and it’s fun to write live from them, but it’s hard to get away.

MedAptus announces its charge capture solution for physicians who bill for providing hospital services, such as hospitalists, intensivists, and anesthesiologists.

It’s a pleasure to introduce you to new HIStalk Platinum sponsor Informatics Corporation of America (ICA) of Nashville, TN (that might be my favorite company name – it says what they do and it’s unapologetically old school). ICA’s solution offers an aggregation platform (patient lists, filtering, alerts and reminder), workflow tools (messaging, patient portal, forms, eRx, chart deficiencies, and outpatient orders), and population management (dashboards for wellness, disease, and clinical metrics). Vanderbilt created the technology to address inefficiencies among its organizations that allow process improvement without ripping and replacing; ICA is commercializing it. Bassett Healthcare (NY) had 90% physician utilization in a month. Thanks to ICA for supporting HIStalk and the people who read it.

ScriptRX says it hopes to earn 35% of the urgent care eRX market. The Florida company‘s system costs $7,000 per year.

Board members at Regional Medical Center (SC) are still fighting over the hospital’s proposed Cerner contract and the bidding process that preceded it. The topic morphed into heated discussion about procurement policies and parliamentary procedure.

Medsphere adds the VueCentric GUI to its commercialized VistA product. VueCentric apparently changed its company name to that of its main product, MortgageDashboard, so I don’t really know what that’s all about, but the press release says it has unspecified roots in the VA. Medsphere is odd; they blast press releases, but then don’t get them up on their own site quickly, so you won’t find it there.

The Department of Justice joins a whistle-blower lawsuit against McKesson and other companies for Medicare fraud. The complaint says McKesson paid kickbacks to nursing home operator Beverly Enterprises in return for earning its durable medical equipment business.

A guest blog post by US Senator Sheldon Whitehouse (D-RI) pitches billions in savings from "a national health information technology system," which he says is like the interstate highway system (no, not too expensive to afford – "a national solution proportionate to the problem"). Here’s his bill. He wants money, of course, and makes this argument: "The financial market knows how to capitalize a revenue stream, and the market discipline on the revenues and capital will be beneficial." I think we’ve seen some good examples of how the financial market capitalizes a revenue stream ("irresponsibly" comes to mind). Still, given specifics, he might have some good ideas.

"The MRI machine has finally arrived," the headline says, referring to the MRI machine Lockport Memorial Hospital (NY) won in the Siemens contest early this year. I had visions of them excitedly flinging packing material everywhere while standing in the box like in A Christmas Story, when the Old Man gets his leg lamp delivery, announces "It has arrived," and then ponders over the wording stenciled onto the box ("ruh JEE lay … that must be Italian") until Ralphie’s mom points out that it actually says Fragile since the F is off the edge.

RelayHealth gets a mention (even if its name is misspelled) in a story on patient satisfaction in Most Wired hospitals. Memorial Savannah cites patient-physician e-mail capabilities, appointments, prescriptions, pre-registration, and bill-paying as RelayHealth services that patients like.

While I’m thinking about that, I had a great ED experience recently that made me appreciate IT from the patient’s viewpoint. I drove to the ED in the middle of the night (nothing serious, just worrisome), gave only my name and address, and the ED person pulled up all my records from the hospital’s affiliated practice where my PCP works. No further questions, no discussion of insurance, no handing over an insurance card for photocopying, etc. The wrist band printed from existing information, the nurses and doctors worked from swing-arm EMR monitors and had everything right there: allergies, meds, history, etc. I’ve never been to the ED as a patient and expected the worst, but it was an utterly satisfying, compassionate, and efficient experience. IT is ugly from the trenches, but as a patient, it was just damned cool. I should pimp myself out as a spokesperson for the vendor.

Speaking of EDs, Parkland Memorial Hospital (TX) is on the hot seat after a patient waits 19 hours for treatment in the ED and finally collapses in an exam room, dying of a heart attack. He had checked in on the ED’s fancy kiosk, but that wasn’t much consolation since he was 165th in line among a logjam of accident victims and non-emergent patients. A study last year found that patients waited nearly 13 hours to be admitted to a bed there. The bad thing is that it’s not just them – that kind of situation is common. Hospitals just haven’t been able to use available tools and technologies to unclog the ED, which is mostly not the fault of the tools and technologies.

Greenway Medical announces that its PrimeSuite EHR meets 2009 requirements for earning the 2% increase in Medicare reimbursement for e-prescribing.

Baton Rouge General (LA) outsources IT staffing and services to PHNS.

Southern University (LA) is live on an EMR system in its student health center after Hurricane Katrina convinced it to move from paper. They chose a system from South Carolina-based Fox Meadows, which says it’s the leader in EMRs, but I don’t think I’ve heard of it. The site features many happy-looking stock photo people.

E-mail me.

HERtalk by Inga

I will be checking out all the latest in the medical practice news and trends at MGMA in San Diego starting next weekend, and of course, visiting the exhibit hall. My plan is to collect lots of trinkets and also check out a few EMRs, PMs, and assorted other technology. I’ll be sending reports back to Mr. H at headquarters to keep all informed of my findings. Just thinking about it makes me want to go buy some new shoes!

The Bronx RHIO is the first NYC RHIO to begin exchanging data. Since July, the RHIO has received consent forms for over 4,000 patients of the borough’s 1.36 million residents. dbMotion has provided the RHIO’s technology platform with additional services and applications provided by Emerging Health Information Technology, Initiate Systems, and RxHUB.

John C. Lincoln Hospital (AZ) and a hospital in Vietnam sign a joint venture agreement to provide American healthcare expertise and technology to Vietnamese patients.

Former Healtheon/WebMD COO Steve Curd is taking over as PracticeOne’s new CEO. Curd was also CEO of VantageMed until its acquisition by Nightingale.

SAP appoints John Papandrea senior VP of its healthcare industry business unit. He comes from Deloitte Consulting, where he advised healthcare organizations on IT strategy.

The Cerner user conference is not the only big HIT event in Kansas this week. Mercy Health Center, located about an hour and a half south of Kansas City, happened to go live on Epic the same day the Cerner event commenced.

Lenox Hill Radiology (NY) claims it reduced A/R 40% since integrating ZirMed and MedInformatix’s RIS. Since going paperless, Lenox has also grown the practice 200% without hiring more staff and has reduced check-in times from six minutes to one.

Here’s a creative strategy for raising revenue by the end of the year to offset ongoing losses: Merge Healthcare announces an amnesty program to address unauthorized use of its software. Users can pay up by the end of the year or the company will seek damages starting in January.

Emdeon announces the appointment of Frank J. Manzella as the company’s senior VP of corporate development.

Eclipsys is hosting its user conference this week in Atlanta. About 1100 clients from 250 sites are participating in the 2008 Eclipsys User Network Outcomes Conference.

This news may be a bit troubling to parents. A survey finds that nearly half of pediatricians would not disclose a medical error to the parents or patient. However, if the error were obvious, they were more likely to admit it.

Public Hospitals Authority in the Bahamas purchases Sunquest’s LIS, along with some other Sunqest solutions, for $1.5M.

If you are in the ambulatory care world, particularly if you have an interest in EMRs, Jewson Enterprises’ new POMIS Report is a must read. You can download (for free!) the 135-page document to learn all you need to know about vendor market share, delivery models, marketing spend, practice demographics, and more. Jewel and Vinson Hudson have spent 35 years studying healthcare IT for physicians and they clearly understand the market. Did I mention it was free?

Mr. H is always coming up with creative ideas to keep me from going back to a real job. To that end, I need a few reader volunteers to assist on two different projects. If you are either a physician or a CIO (or a high level hospital IT exec), drop me an e-mail saying you’d be willing to participate in a 10-minute survey (either via e-mail or phone.) In return, I will fill you in a bit on our secret plans.

E-mail Inga.