An HIT Moment with … Peter Pronovost

An HIT Moment with ... is a quick interview with someone we find interesting. Peter J. Pronovost, MD, PhD is Professor, Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management; Medical Director Center for Innovations in Quality Patient Care; and Director, Quality and Safety Research Group, The Johns Hopkins University School of Medicine, Baltimore, MD.

On September 23, Peter was announced as a 2008 Fellow of the John D. and Catherine T. MacArthur Foundation, recipient of a so-called "genius grant" that will pay him $500,000 over the next five years, no strings attached. The fellowships are awarded to "talented individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction" to "encourage people of outstanding talent to pursue their own creative, intellectual, and professional inclinations."

What was it like hearing that you had been named a 2008 MacArthur Fellow? 

Amazing. I do not consider that I fit the bill of genius. What I do is try to make complex ideas simple and use them to improve patient outcomes.

What will you do with the grant?

I’m not sure. I have been toying with trying to make a checklist maker, an IT tool to tap the wisdom of crowds and make a more efficient knowledge market. I believe certain markets are so fundamental to society, like buying a home, healthcare, and retirement, that we need to guarantee that they are efficient.

What is the status of your "List" projects and have you had any interaction with IT vendors?

Still working on it and not working with vendors. I am trying to work out the "plumbing" first and see what product we can create.

What are your big projects going forward?

We are developing programs for MRSA and decubitus ulcers, evidence-based checklists and measures.

Are you a star back at Hopkins now?

I am not a star. I am very much a doc in the trenches doing patient care. That is what keeps me grounded and provides ideas of what we can fix.

I am delighted that patient safety was recognized. It has been very hard to get this field accepted as a legitimate science or as important in healthcare. Though we have a ways to go, we are making progress, and the MacArthur certainly helps.

Misys Says Allscripts, Misys Shareholders Have Approved Merger

Misys announced this afternoon that shareholders of Allscripts Healthcare Solutions have approved its merger with Misys, with Misys shareholders also approving the transaction in a separate vote. Misys says the closing will occur by Friday.

Monday Morning Update 10/6/08

From Lisa LaPorta: "Re: practitioner certification exams. EMR vendors with an enterprise content management solution already pull all the information together to allow the physician to make a final diagnosis. The only piece that’s missing is test delivery and psychometrics. Any of the big players could create something that would have a larger market space than just certifying boards (universities, teaching hospitals, and residency programs)." Seems like a natural for McKesson, if indeed there is a market, since its May acquisition of Vivalog (now called Horizon Study Share) put it into the radiology teaching and reference case business.

From Louie Dampier: "Re: Misys/Allscripts. The first joint sales meeting starts Sunday. I’d like to be a fly on that wall." I admit that I’m not a fan of the deal because it came in a moment of Allscripts weakness (Touchworks v11 and erratic revenues) and I wouldn’t want Misys involved. Once it happens, though, I hope it works out since it affects the livelihood of a big bunch of people doing good work who can’t be blamed for iffy Misys leadership.

From The PACS Designer: "Re: CUI. Microsoft has rolled out its Common User Interface with the hope that we healthcare professionals will be willing to contribute help then improve patient safety and lower the number of medical errors. TPD has been experimenting with the Microsoft CUI and will try to enlighten HIStalkers in future posts." Link. That’s actually pretty cool, although showing its UK origins (paediatric, nil by mouth). I need to study it a little since I was surprised at its depth and detail for specific clinical situations. It would be nice to have good human factors design principles and consistency in healthcare apps. As always, though, standards=commodity to vendors, so it’s a hard sell.

Speaking of Microsoft’s CUI and not to steal TPD’s impending thunder, but their Patient Journey Demonstrator is just about the coolest thing I’ve seen in awhile. I was also impressed that, even though it requires a Silverlight download, it seemed to work in FireFox. Click on the pic for a better look. Some of the stuff’s actually live and working, while other parts are mocked up. CUI also has an online community. I have no idea who’s actually doing anything with this. 

Lisa LaPorta’s comment reminds me that this is a good forum for vetting potential HIT-related business ideas. I say that self-servingly since I’m intensely interested, but I think everybody likes brainstorming. I’m a great idea man, but my value drops off quickly after that. I’m damned annoying when someone innocently says, "What do you think of this idea?" and I start speaking in tongues with about all the stuff racing at hyperdrive through my head. Inga gets all kinds of odd-hours e-mails full of stuff like, "What if we started a ‘systems we’re using’ site for CIOs? Should we do another electronic newsletter? What kind of fun can we create at HIMSS? Can you get that celebrity psychologist Dr. V to do some fun stuff with us?" Loyal co-conspirator that she is, she always tries to sound slightly supportive while hoping I’ll forget about it.

MediNotes CEO Don Schoen says sales leads tripled the first day after its acquisition by Eclipsys, speculating that doctors are familiar with the Eclipsys name from their hospital work. Don will stay on, the company won’t move from Des Moines, and the MediNotes name will apparently live on as a wholly owned subsidiary.

Bad times are good for entrepreneurs, attendees of a Massachusetts Technology Leadership Council "un-conference" were told this week. Reasons: laid off people think more creatively, operating guys regain control over the finance guys, and companies often gain competitive position during slowdowns. That’s a stretch, but you play the cards you’re dealt.

New poll to your right: do you agree with the HIMSS decision to not support Pete Stark’s HIT bill because it advocates open source software?

Kaiser Permanente Southern California has the highest rate of breast cancer screening in the country according to an NCQA analysis, crediting KP HealthConnect’s record flagging that allows any KP employee to remind the patient that they can get a no-appointment mammogram or make an immediate appointment. Criticisms aside (cost), it appears that Kaiser is really using its EMR to do some darned interesting things that benefit patients. Once you get the application up to a critical mass of usage, you can put all kinds of value-added functions on top of its data and real-time patient encounters.

Fulton County Hospital (AR) and CIO Phillip Hughes get mentioned in a local newspaper’s story about the hospital’s PACS.

Jobs: Director of Clinical Informatics (AZ),  Senior Software Engineer (IN), Senior Systems Analyst – SoftLab (FL).

Turnaround consultants from Wellspring Management want to extend their contract at Natividad Medical Center (CA), raising their CIO rate to $44,000 a month ($275 an hour) plus expenses. $528K a year to run the MEDITECH shop of a 172-bed county-owned hospital? Seems a bit rich. The company’s CIO has been there since January 2007, starting at $374K a year as an interim "until a permanent chief information officer could be hired." How hard could they be looking?

If you’re at Cerner’s shindig, how about a live report? I thought having clients blog live from it was fun a couple of years ago, but I haven’t heard anything about it since.

Listening: Big Star, a power pop cult band that should have been huge, but instead broke up in 1975. Also: new and excellent prog from Half Past Four.

It’s been a long time since I did this, but about a revival of Companies Invoking HIPAA’s Name to Sell Stuff But Misspelling It: Incentive Logic, Emtec, and Frost & Sullivan, not to mention dozens of newspapers. It’s amazing how many newspapers run the full name, but still put HIPPA in parentheses after it like they didn’t even notice what they just wrote. And as a reader wrote me, "Another healthcare acronym that’s sure to ratchet up the HIPPA not HIPAA misspellings … The Medicare Improvements for Patients and Providers Act (MIPPA)." That’s one thing that annoys me about healthcare – we make up long, cutesy names for stuff, then have to derive contrived acronyms because we’re too lazy to pronounce the long, cutesy names we made up in the first place. My blood pressure goes up every time I read a medical journal, especially when it’s obvious that an author has taken the opportunity to add to the acronymical abyss (AA) by making up his or her OWN acronym. You just know they’re also using some eye-rolling pronunciation to go with it. People saying "Jayco" for JCAHO used to drive me up a wall. Years ago, the HIMSS people were coached to say it out (H-I-M-S-S) but nobody picked up on their lead, so it died fast.

I was accepting some LinkedIn connection requests and Dann’s HIStalk Fan Club group popped up, so I took an unplanned look and was amazed to see 281 big-name members. It’s a fine networking list, that’s for sure. Maybe I should send the next ultra-hot insider rumor just to that list. LinkedIn has grown and improved unbelievably over the last few months, so it’s cool to see everybody on there and especially to see their pictures.

$175 million to support eight Cerner sites for two years? That’s what BT wants to charge NPfIT to replace Fujitsu.

University of Illinois at Chicago is offering a fully online MS in Health Informatics. I would think that would interest clinicians who want to add formal credentials or maybe CIOs coming from other industries. I snooped around a little more and it appears to be 45 credit hours at $675 per hour, or about $30K for the program. That’s pretty reasonable for that kind of school and program. They’re running a text ad to your right, which is how I found them, although I think they’ve had a HIMSS booth in the past. They also offer post-Master’s and post-Bachelor’s certificates in health informatics. All of us industry long-timers used OJT to get where we are today (sorry about that!) so it’s exciting to see folks with formal education coming in, even though they’ll probably take our jobs.

Hawaii’s Big Island is losing three of its five orthopedic surgeons, including the president-elect of the state medical association. The problem: low reimbursement and high malpractice costs. Interesting fact: malpractice plaintiffs get no award 85% of the time, but the doctor pays an average of $150K per case to defend themselves.

1450 brings up a free online tool that helps physicians choose the most appropriate version of Dragon Medical for their practices.

Allina is eliminating 300 positions, among them that of former Fairview CIO Gary Strong, promoted to chief administrative officer in July 2007 and now headed for unemployment.

I hate CNN’s web site with its junk entertainment headlines, endless videos instead of stories, and so-called iReporters ("user-generated news") . One iReporter posted a message Friday morning falsely claiming that Steve Jobs had been taken to the hospital with chest pains, sending Apple stock down 9% and triggering an SEC investigation into whether the poster was shorting shares. Some of the hard-hitting investigative stories on CNN now: Howard Stern’s wedding, a Texas man is building a house of mud, somebody’s selling surfboards featuring naked women, why men cheat, and the world’s fattest man gets married. No wonder everybody else in the world thinks Americans are stupid – we get our news from the Enquirer.

The Illinois attorney general steps in when Cook County Hospitals and Health Systems refuses to release its budget after it was approved, claiming it’s a draft until Cook County Board President Todd Stroger makes any changes he feels like before submitting it to the county board. Apparently the budget calls for big increases in budget and headcount.

Health Information Exchange of New York will start moving data on Halloween.

BIDMC rolls out its self-labeled Web 2.0 site.

Northampton General Hospital in the UK bans staff use of Facebook after finding a cell phone picture of a topless night shift nurse on duty and in uniform on the site, with recognizable patients in the background.

Vendor Deals and Announcements

• Dell, Intel, and Motion Computing are teaming up to offer a new wireless assessment service that provides comprehensive wired and wired network analysis, design and validation.
• Quantros announces its acquisition of Medcast Health Analysts. The companies’ combined solutions will provide clinical, financial, and operational data assessment tools within a single platform.
• The first 10 products receiving CCHIT ’08 EHR certification include MEDENT 18, eClinicalWorks 8.0, Epicare Amulatory EMR, PrimeSuite 2008, Practice Partner 9.3, MedLink TotalOffice 3.1, MedPlexus EHR 9.2.0.0, NextGen EMR 5.5.28, Pulse Patient Relationship Management 4.1, and SmartClinic 16.
• ConnectivHealth names Steve NeSmith to the newly creative role of vice president of interactive. (huh?)
• St. Luke’s Episcopal Hospital IPA (TX) selects Valence Health to help them become a clinically integrated provider organization.
• ZLB Plasma is now a licensed user of Mediware’s RecruitTrak software.
• Steve Case’s Revolution Health is merging with Waterfront Media in a $300 million deal. The combined entity will be known as Waterfront Media.
• Garden City Hospital (MI) has implemented three Web-based scheduling software modules from Concerro, formerly known as BidShift.
• Seattle Children’s Hospital and the University of Washington will implement Microsoft’s Amalga technology.
• Cerner expects 7,000 people to descend on Kansas City on Sunday for its 2008 Cerner Health Conference. The city is hoping for a $4.5 million economic boost.
• Zynx Healthcare announces that in Q3 it added more than 1,755 evidence-related charges to order sets and plans of care in its clinical decision support products.

E-mail me.

News 10/3/08

From The PACS Designer: "Re: Microsoft going virtual? Amazon has announced that they are testing Windows Server on their Elastic Compute Cloud (EC2) platform. We could be seeing Windows Server (for virtualization)  as a monthly service soon!" Link.

From Tippy Martinez: "Re: Pfizer. So much for the expensive advertising of drug companies about how they’re out there searching for cures and helping people. Between the lines: ‘Since we lost our two big cash cows (Lipitor & Norvasc) and can’t make any more obscene profits on heart drugs, we’re quitting. We’ll go after other cash cow drug with patents. Oh, we have other heart drugs in the pipeline, but there’s no profit in pursuing them" Link.

From Otis Sistrunk: "Re: Siemens. The corruption situation is about to get messy. Some believe they’ve been getting information from subcontractors on what competitors are developing." Philips files suit against Siemens Medical Solutions for patent infringement.  

From Nick Carlton: "Re: I’ve said before, but just can’t stop myself from saying it one more time – damn, you’re good …" Please, if it makes you feel better, keep saying it. You’re too kind, or at least I think you are since I’m not sure what I did to elicit such a nice comment.

From SPEECHtoTEXT: "Re: speech recognition. What does this mean now for partners of Philips SpeechMagic that were/are competitors of Nuance (Dictaphone/eScription)? This includes Dolbey (uses SpeechMagic as speech engine), Medquist (used to be owned by Philips and uses SpeechMagic), 3M (former SoftMed). Nuance will own the market in 24-36 months and you will pay four times more than you do now."

From Elvira Hancock: "Re: more graphics instructions for the world. Before holding down the shift key so as to not distort the image, please make sure the 10-megapixel, 35-megabyte image file has been reduced to a manageable (under 100 KB) file size. If you don’t know what this means, please don’t add pictures to your Word document and if you do, please don’t email it to me." Yessir. I remember a previous employer’s HR department, which constructed highly elaborate Excel pivot tables for even the simplest information (like which three of your employees had missed their TB check). They put the whole hospital’s employee database into one worksheet and e-mailed all 25 megabytes to every manager and supervisor in the organization.

From Adam: "Re: GE. The troubles at GE indicate to me that we may see GE HC exist at some point in the next year or so as a separate company. This could then trigger similar moves at Siemens and Philips. We may soon be witness to a dramatic restructuring of HCIT on a global basis." GE shares fell another 10% today, even as the company offered $12 billion in new shares that were discounted to the price Warren Buffet paid. Like everybody else in the financial business, GE claims its GE Capital lending division isn’t all that exposed. Nobody believes that.

Lawson Software’s Q1 numbers: revenue up 2%, EPS -$0.01 vs. $0.03.

Some of the reader comments about financial issues were justifiably gloomy, but here’s a thought for both providers and vendors. The risk of pulling out of the stock market in times like these is that you lose money going down, but miss the chance to make it back going up (and the market is notoriously impossible to time). From a business perspective, your competitors could leap ahead while you’re dusting the cobwebs off sales, R&D, etc.

Two Partners Healthcare IT employees and an IT consultant are charged with bribery for allegedly steering business to Future Technologies in return for kickbacks.

If you’re registering for HIStalk Discussion using a non-work e-mail address, please let me know ahead of time so I can activate your pending request. The Russian spammers are sending through dozens of automated signups each day from Gmail and other free accounts, so I’m just deleting those that look fishy.

CMS says (warning: PDF) providers can no longer sent orders with stamped signatures, but electronic signatures are allowed. I know SCI’s Order Facilitator can send electronically signed orders from community hospitals to physicians. What that means for hospitals: a marketing advantage to docs (meaning: $$$).

Virginia HIMSS will feature a healthcare debate between the presidential campaigns at its conference in a couple of weeks, with Rep. Michael Burgess, MD (R-Tex) taking McCain position and Blackford Middleton, MD (Partners Healthcare) speaking on behalf of Obama. I see that Blackford is pictured on Obama’s site, saying "This country may suffer in fail in significant ways unless we fix healthcare." Healthcare’s now a tiny bump in the road compared to the obstacles in front of us, unfortunately.

Charles Colander is named CIO of Elmhurst Memorial Healthcare (IL), moving from Northwestern Memorial Hospital.

A software company’s "fake snow" mail promotion shuts down Gunnison Valley Hospital (CO) when the leaking white powder is noticed by a hospital mail clerk and emergency authorities evacuate part of the building, fearing anthrax. Before the contents were verified, 40 people had to strip naked and shower in an inflatable decontamination tent in the hospital’s parking lot. Says the hospital’s culinary director, "We got to take a shower, that was nice. It was a different day altogether, that’s for sure." The vendor makes help desk software (notice the Instant Snow promotion – that was the stuff) so the package was probably headed to the IT department. SnoWonder is the snow and it’s cool (no pun intended). I’m thinking of getting some and burying someone’s office at work. The picture above is of the Gunnison stuff, but a fake snow competitor (who knew?) has a video.

John at Chilmark Research is offering a free download of the executive summary of its May PHR market study.

ZocDoc, a service that lets patients schedule doctor appointments over the Web, gets a few million from Amazon’s Jeff Bezos. It also includes patient ratings of providers, I noticed.  One big gripe: they aren’t national, so if you search for an area they’re not in, you get a "Notify Me" signup box that can’t be closed. Nothing like annoying people first thing.

Think about it: CPOE for the Wii. CPO-Wii. Just sayin’.

For hospitals roll out consumer portals from MEDSEEK.

Palm Drive Hospital (CA), withdrawing its plan to exit bankruptcy, says it will use open source computing to save money and operate more efficiently. Guess they didn’t listen to HIMSS.

HP is pulling the plug on its Identify Center security applications, so IBM wants them to think Tivoli. It’s been awhile since I looked at it, but it was highly complex and expensive back then.

E-mail me.

HERtalk by Inga

From Elsie EHR: “Re: Bizarre skin disease. MSNBC reports on a peculiar skin disease called Morgellons which is being studied by the CDC. Page 3 of the article says: ‘The study is a joint project with the northern California research division of the giant HMO Kaiser Permanente. California seems to be a Morgellons hot spot, and Kaiser uses electronic medical records — which allows investigators to search among 3.5 million patients for complaints of fibers and either skin lesions and/or itching or crawling sensations.’” Link. It’s encouraging to see that EMRs really are helping in disease detection and healthcare studies. The report also indicates that roughly one new disease is identified every year. As EMR use becomes more widespread, the data mining potential becomes invaluable.

MidSouth eHealth Alliance (TN) is transitioning to Informatics Corporation of America’s (ICA) patient exchange technology. MidSouth has been using Vanderbilt’s version of the same product. The ICA technology was developed based on a platform developed originally by Vanderbilt Medical Center.

Wal-Mart associates are now able to take advantage of Dossia’s personally-controlled health record technology.

Stephanie Alexander has apparently resigned her senior VP post at Premier Healthcare Informatics.

I love the name of EnovateIT’s new articulating wall-mounted arm. The Fluid makes me think of some hunky WWE superstar. Actually, the Fluid is designed to serve clinicians in confined work space or can be configured as a wall-mounted computer station (if you visit the EnovateIT web site, you can see a fun little clip of the arm in motion). For an arm, it’s actually kinda sexy.

Former Misys exec Andrew Lawson is now president of MedAvant Healthcare Solutions. MedAvant had filed for bankruptcy protection back in July, then PE firm Marlin Equity acquired the company for about $300 million.

Perot Systems names Harry Greenspun, MD its new executive VP and CMO for the healthcare industry group.

If you’re a Texas Medical Association member, you can now get DocSite PQRI tools as a membership benefit. The solution provides physicians with tools satisfy PQRI requirements and qualify for incentive payments.

CHIME and the AHA name University Health Systems (TX) winner of their annual Transformational Leadership award. UHS was recognized based on their investments in health care technology, including the development of EMR, CPOE, and PACS systems.

In yesterday’s Readers’ Write, a top prediction for vendors was an increase in consolidation. Here are a three more small deals, in addition to this week’s Nuance/Philips deal and GE’s Agility Healthcare acquisition:

• Amcom Software has acquired Commtech Wireless. Amcom makes call center and paging technology while Commtech provides technology to connect nurse call alarms, patient monitors and similar technology to healthcare providers.
• IdentiSys acquires CardSmart Systems. Identisys sells and integrates ID and access control products. CardSmart specializes in ID and card issuance products.
• Quantros, a provider of safety, quality, and compliance software data infrastructure solutions for the healthcare industry, acquires Medcast Health Analytics a provider of web-based clinical utilization and financial analytic solutions.

There is also the ongoing Allscripts/Misys saga and Eclipsys’ purchase of Medinotes. Definitely sounds like a consolidation trend to me.

E-mail Inga.

CIO Unplugged – 10/1/08

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

Brigades, Battalions, and Budgets
By Ed Marx

Ah Fall. The crisp air. A scenic array of dancing leaves. Squirrels foraging for groceries. And of course, football.

Oh yes, and budgets!

Each year at this time, corporate America undergoes a fandango abounding in ritual. We perform the dance of sworn improvements, promising to enhance processes and reduce pain. But at the end of the day, or should I say months, little has changed. The mist of illusion dissipates, and we find ourselves reinstating the customs of familiarity and comfort. Insanity, as some describe it—expecting change while doing things the same way.

Part of the corporate America ritual goes something like this. Create and submit a pork-filled budget. Mandates go out to make across-the-board cuts. We make the cuts, and inflated budgets become more realistic. Additional mandates call for further reductions and managers dutifully wince and deal. Dependent upon the financial outlook, the budgets find acceptance; nevertheless, the call goes out for another round of cuts. This forces managers to sub-optimize valuable programs and services, targeting areas that, as a rule, should remain untouched. Without counting the cost, they sacrifice so-called discretionary spending: travel, training, education, and entertainment.

Here’s my take on the ultimate solution. Avoid across-the-board budget reduction mandates altogether. Instead, target programs and services that have a wide swath across the organization’s traditional budget silos. Eliminate or delay a planned integrated initiative before you reduce associated expenses and end up with a sub-optimal outcome. “You can’t cut your way to prosperity,” as I learned from a former mentor, Tom Zenty (CEO, University Hospitals, Cleveland). Choose to heavily invest dollars in areas that will push top line revenue growth so as to create more opportunity for clinical advancement.

The unfortunate reality? This rarely happens in corporate America.

As an Army Combat Engineer Officer (Reserves), I lived out a similar budget cycle. We platoon leaders had to decide what to cut and how to avoid sub-optimizing services and product. While in this environment, I adopted an approach that I use today when confronting across-the-board-mandates. I’ll sum it up with a question: Would you rather carry 40 average soldiers into battle or lead 35 of the best trained, equipped, skilled, and talented?

As a junior officer preparing for a major military exercise, I tackled the following dilemma. Assessing my platoon of forty untrained soldiers, I looked for the champions: those with the solid attitude of a soldier; any man or woman who displayed leadership talent; and the ones eager to learn and improve. After sifting the wheat from the chaff, I invested in the promising soldiers, training and equipping each one. Judgment day arrived. During the exercise, we surpassed all production expectations. My 35 soldiers outperformed peer platoons that operated with full numbers but lacked the advantage of an empowering investment.

Although it may appear counterintuitive to some, I have since applied this principle throughout my healthcare career. The effort is worth it, and the end product speaks for itself. Leaders reap what they sow, as do corporations. When the budget reduction mandates come, and they invariably will, I’ll pursue the 35 trained, equipped, skilled, and talented.

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 10/1/08

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

A Summary of Reader Predictions of How Economic Issues Will Affect Healthcare

Employment

• White collar markets (including healthcare) will be flooded with hard working but ethically questionable employees displaced by the dismantling of the financial industry
• HIT employment will drop slightly, but will increase in 2010-11
• A big jump in unemployment will occur if the credit market seizes up
• Consultants will do well because big system vendors will minimize headcount to keep P/E ratio looking good
• Process redesign work increases as hospitals have to live off their own revenues instead of bond money
• Sales reps will turn over because it will be hard to make the numbers and sales costs are easy to cut fast
• Hospitals will reduce headcount before they reduce payments to vendors
• Vendors will cut projects that haven’t gained market traction and those teams will be cut

Hospital Spending

• No change
• Slowdown in big capital projects due to funding problems
• Ambulatory surgery center niche market dries up
• Projects will shift from clinical improvements to operational improvements
• Emphasis will be on throughput, staffing ratios, and cash flow
• Projects that result in more referrals, lab orders, and radiology orders in the IDN’s big hospital will get focus

Physician EMRs

• Physicians will buy only when affiliated hospitals insist
• Downward pricing pressure
• More interest in e-prescribing and disease registries, which cost little and provide benefits like CMS incentives
• Less interest in EMR adoption because primary care providers will be squeezed even more
• Physicians and physician groups will face tight credit and postpone big outlays

Healthcare Reform

• Consumer-driven healthcare dies when consumers lose what little clout they had
• Healthcare reform is moved back at least five years
• High deductible health plans will increase, forcing employees to shop on price or defer treatment
• Population health will decline as patients can’t afford chronic care
• Employees will underfund health savings accounts
• Emergent care will increase
• Providers able to communicate value and patient relationships will compete for the fewer patients with enough healthcare savings account funds to afford care
• Uninsured patients will rise in number
• Only private pay will flourish
• Patients will go overseas because of bad press about US healthcare
• Providers will need to collect for the care they deliver since self-pay will increase due to uninsured patients and higher deductibles
• Hospitals will struggle with how aggressive they should be in collecting payment and will be challenged on pricing

Provider IT Investments

• A shift to those providing quick financial wins, probably at the expense of clinical and patient-centered systems
• HIT will be pressed to prove the value of technology
• Hospital EMR projects will be scaled back or not purchased because of long-term expense
• No change in the short term because budget cycle is already underway
• IT departments need to educate the executive team about their focus and value
• Hospitals will scrutinize capital outlays more carefully since some will face liquidity crises because of their investments are in securities
• Solutions with quick ROI and a cost that is not prohibitive will get purchased

Vendors

• Consolidation due to credit constriction
• Niche startups encouraged, other new entrants discouraged
• R&D will be hard to fund for new companies trying to develop products with long cycles
• Sales will keep dipping
• Reductions in training and travel budgets, hiring freezes, salary freezes
• Less presence at conferences
• Foreign investment increases
• Non-real estate investment companies will still look for companies at $20 million, but smaller will be too risky and not worth the trouble
• Companies themselves will postpone IPOs, but mergers and acquisitions will pick up in hopes of finding synergies and cost savings
• Increased push to outsource
• Healthcare won’t be recession-proof this time
• Small companies with an undifferentiated product will die more quickly
• If the economic crisis lasts 2-3 years, mid-tier companies will be squeezed for operating capital and will be acquired
• Large vendors will weather the storm if they monitor expenses
• Middle tier companies will suffer, but more innovative companies will appear in 2-5 years
• Lag of new technology development will create cheaper and better solutions in 4-10 years
• Sales cycles will extend and some purchase decisions that are close to signing will be cancelled or postponed indefinitely
• Small vendors will face more financial scrutiny from customers who fear being left holding the bag
• Well capitalized vendors may use the uncertainty to push clients into term licenses or subscription models, which are less attractive than license payments, but require less cash and provide more flexibility
• Minimal change in M&A activity because vendors will seek exits, but downward valuations will convince them to wait out the storm

Nuance Acquires Philips Speech Recognition Systems

Nuance announced this morning that it has acquired Philips Speech Recognition Systems of Vienna, Austria, a European leader in healthcare in speech recognition, for $96.1 million in upfront and deferred cash.

“Nuance has been disciplined and focused in our pursuit of the healthcare opportunity in North America, a strategy that has paid dividends both in our rapid growth and the broad adoption of our solutions,” said Paul Ricci, chairman and CEO at Nuance. “PSRS provides a solid foundation of customers, partners and European language-solutions as we expand our business in Europe and enable broader geographical leverage for Nuance’s portfolio of healthcare products and services.”

HIStalk reader EMR Wannabe predicted the sale last week, saying, "Within the next ten days, Philips will announce divestiture of its SpeechMagic division. Conjecture is that SpeechMagic is getting resistance from large inpatient vendors because Philips competes in areas where GE, Siemens, and others make big money (radiology and PACS systems). SpeechMagic is about to take another run into the U.S. market, starting in 2009, but it does not fit into the Philips technology portfolio." 

News 10/1/08

From oneHITwonder: "Re: a low-tech PHR. Pros: providers might actually look a a piece of paper vs. a flash drive or log onto the Internet. Cons: storage space limited for anyone with a chronic condition." Link. Great idea. It’s the one platform that’s compatible with what 99% of doctors use.

From Spart: "Re: private enterprise. You obviously have a very right-leaning and libertarian slant on things, with one exception. You deride HIMSS for being pro-industry and private enterprise." I’m right-leaning and libertarian on fiscal and government role issues, liberal on social issues (don’t you get my grassroots populism and anti-establishment tone?) HIMSS is a nonprofit member organization and I pay dues, so it’s a little different. Like RSNA, AMA, ASHP, etc., they need to work harder to keep the commercial side away from the supposedly scientific side if you ask me. Like they used to, in other words. I wouldn’t enjoy the conference nearly as much if vendors weren’t involved, but I might like it a little more if I didn’t feel constantly manipulated by HIMSS to consort with them. It’s like having the junior high school dance chaperone pushing you publicly toward the wall-hugging row of girls before either of you have worked up the nerve to talk. In my generation, anyway.

From OB1: "Re: HIStalk. I just don’t know how you do it. You have a full time day job and yet you are able to post regularly and troll to find relevant and interesting information. Have you managed to slow time in your universe?" Apparently not because it’s flying by on this end. I can’t wait to get home from the day job to do HIStalk stuff, although it takes many of my waking hours (counting all the e-mail and web maintenance stuff I do that I don’t mention). You know I enjoy it when a cynic like me blathers on about how much fun it is, as though I had Kim Kardashian’s hand in my back pocket or something. As I write this, I’ve been at it for 3.5 hours without even getting out of the chair and another hour to go and I’d swear it was only 15 minutes. The saddest sound of the day is when XP shuts down. What a nerd.

You may have noticed that Leah Binder, CEO of Leapfrog Group, added a comment to Monday’s posting. I’ve invited her to me one of our "An HIT Moment With …" guests and sent her five questions, so she’s got the floor if she wants it.

Listening: King’s X, hard rock/prog/semi-Christian from some mighty talented guys from Katy, TX. And speaking of Texas (maybe my favorite state), I had barbeque at the epicenter of brisket above on a recent trip. Name the place and you get … well, satisfaction.

GE Healthcare acquires Agility Healthcare Solutions of Glen Allen, VA. The privately held company uses a Real Time Locating System for enterprise visibility and patient flow management. I knew CEO Fran Dirksmeier in a previous life.

University of Washington’s Institute of Translational Health Sciences and Seattle Children’s Hospital sign for Microsoft Amalga (just the Azyxxi part, apparently, since they’re a little sloppy with that name).

Jobs: Soft (SCC) Implementation Manager, Developer, Customer Support Representative, Solutions Executive. Employers who ask Gwen nicely will get her Halloween gift – a free introductory job posting in October.

A Cisco survey says outsourcers in China, Brazil, and (to a lesser extent) India are unsure how their employees handle sensitive data or already suspect they’re sending it outside the company. Employees there are more likely to tamper with the security settings on their PCs, use P2P networks on work devices, and install unauthorized software than in the US. The Grady transcription breach is mentioned.

Exempla Healthcare (CO) signs a deal with Novo Innovations to deliver data directly to practice EMRs, moving up from Novo’s drop box data exchange.

Since I’ve never had anything to do with Virtual HIMSS, I didn’t realize that the signup page requires answering questions similar to those asked by the "never had a paid subscriber" rags before sending you the subscription you don’t really want, leading you to just randomly check blocks here and there to be done with it. The footnote suggests that if you aren’t a hot vendor prospect, you’ll pay $79 instead of getting in free like everybody else, a reader tells me.

FDA will spend $2.5 billion on new IT systems over the next ten years as part of what’s called a bioinformatics initiative, but it mostly sounds like infrastructure and data center relocation.

Victoria, Australia is going back to the drawing board on its ambitious HealthSmart project after falling two years’ behind schedule and failing to bring up even one site on Cerner Millennium. "A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 – the biggest price blowout so far, the audit office found."

Speaking of Millennium, a key Connecting for Health doctor thinks iSoft’s Lorenzo will be used more than Millennium because Lorenzo is newer and better suited for web deployment.

Yet another medical helicopter crash: four die in Maryland when a helicopter goes down taking a patient to Prince George’s Hospital. One of the two teen patients being transported was the only survivor. Condolences to those affected.

Doctors in Iraq will be allowed to carry guns to encourage them not to leave the country in fear. Over 2,200 doctors and nurses have been killed since the 2003 US invasion. The article says at least 20,000 of the 34,000 are already gone and healthcare is worse than it was pre-invasion. Bet they’re really glad we John Wayned right in there.

HIMSS backtracks on its curt statement that it won’t support Pete Stark’s HIT bill because it calls for making open source systems available. HIMSS says "there has been some confusion" and claims "with some modifications to the legislation, common ground can be made to meet stakeholders’ goals." You know they’re sweating when a fact sheet (warning: PDF) is produced. It says, "This would be like the Department of Defense developing a new automobile to compete against Ford and Chrysler." First, we’re already bailing Ford and Chrysler out of their own stupidity with taxpayer billions, so that’s not much of a free market example. Second, much of healthcare is non-profit and we all pay for it without having a choice like we do with cars. Third, the bill doesn’t require developing new systems; VistA is the obvious incumbent and nobody seems too threatened by it other than HIMSS. Last, why does HIMSS even need to weigh in on whether the government builds an IT system? And while I’m at it, maybe HIMSS should have polled use dues-payers before presuming to make snide statements on our behalf. This might be the second case in a couple of days where an out-of-touch administration misrepresented its constituency and was shocked at the backlash.

Speaking of HIMSS, open source advocate Ignacio Valdes, MD, MS leads off his editorial with, "HIMSS response, while predictable, is misguided on so many levels that it is difficult to know where to begin." But he does.

A Florida newspaper article covers a local women who, faced with an estimated $4,000 to $5,000 worth of diagnostic tests in multiple locations even after her insurance paid its part, heads off to India and gets it all done in six hours in one place for $350. Unlike HIMSS and its anti-open source stance, AMA’s board chair actually sees it the patient’s way: "We are not opposed to the idea, especially when institutions are accredited properly. Some of these institutions overseas are wonderful, and many of their physicians have trained in the United States." In another example, a woman went to Mexico for two root canals, two extractions, airfare, and three nights in a hotel in a mini-vacation with her daughter for $1,600.

QuadraMed will offer real-time BI tools from InterSystems in its revenue cycle applications, providing dashboards and key performance indicator monitoring.

Moses Cone (NC) will spend $2 million to put Centricity in its 29 clinics and physician offices.

In the UK, Ascribe Group acquires the healthcare division of WCI Consulting.

A Florida ambulance service gets a local paper mention for its unnamed technology that sends a patient’s EKG results to the hospital ED, reducing the door-to-balloon time for a heart attack patient to just 12 minutes vs. the national average of 112. Now that’s cool.

A note to the entire world: please hold down the Shift key when you resize PowerPoint or Word images so they don’t get distorted. Thank you.

Greenville Memorial Hospital (SC) will require ED and night visitors to wear electronic security badges linked to their driver’s license and destination.

Ontario restructures its eHealth programs under one organization.

A Massachusetts company’s technology allows filtering text messages and BlackBerry e-mails, using the example of a hospital’s blocking all outbound messages containing the name of a VIP. From the website, the product also allows setting white/blacklists for user smartphones, archiving messages, and maintaining BlackBerry PIN addresses even when devices change. Sounds like a big brother’s delight. I just wish restaurants and other public places would install that technology that blocks all cell phone use.

Lawson’s CEO obviously has vested interests, but his quote is still fun: "Getting signed up as a SaaS customer is fast, but getting out is just as fast, whereas traditional software is like cocaine — you’re hooked. It’s too difficult and expensive to switch providers once you’ve invested in one. If it were easier to jump ship, a lot of people would’ve hit the eject button on SAP a long time ago."

I wish I hadn’t found this page because I screwed around with it for most of Sunday afternoon: a complete list of Web 2.0 applications and descriptions. Some I liked and may use, most I laughed at, especially the dumb "you can’t sue us because it’s not a real word" names.

E-mail me. I read every one and always reply to the nice ones. I thank you – seriously – for reading and contributing. Over 61,000 visits and 94,000 page views in September … I’m honored and pleased. Thanks, too, to BFF and co-conspirator Inga.

Misys announces its Q1 earnings. The healthcare division’s revenue was flat compared to last year, with ILF revenue falling seven percent. Not too surprising given the uncertainty associated with the Allscripts acquisition and iMedica lawsuit.

I wonder if this is a sign of the times? Virtual Radiologic’s stock fell 34% Monday after the company announced weak September sales. The company continues to sign new customers but the number of procedures performed dropped. The company speculates that higher gas prices have resulted in fewer motor vehicle accidents and thus fewer radiology tests. Or perhaps people are avoiding medical treatment all together to avoid co-pays. Is it a start of a trend?

CCHIT announces the first 10 products to receive ’08 Ambulatory EHR Certification.

Cardinal Health is spinning off its clinical and medical products business as a separate company. Current Cardinal vice chairman David L. Schlotterbeck will lead the group. When the spin-off is completed in 2009, current Cardinal Chair and CEO Kerry Clark will retire. His replacement is George Barrett, who has served as vice chair and CEO of the Healthcare Supply Chain Services group.

Baptist Healthcare Services (KY) is rolling out in-building cellular infrastructure across its five acute-care hospitals.

In case you missed it, we debuted last night our latest HIStalk feature, “An HIT Moment With…” We will run these periodically and will include just five questions. Thanks go to Matt Grob for agreeing to be our guinea pig. Check out Matt’s comments about the state of the economy and the effect on HIT budgets. Here’s something to add to your stress level if you are a techie type: “Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like.” Anyway, if you would like to participate in our HIT Moment (or nominate an interesting person) let us know.

MediConnect Global announces it will provide at no charge digital backup copies of archived medical records to any patient or organization losing medical records during one of the recent hurricanes.

Stratus Technologies and Orion Health are teaming up to offer continuous availability of patient health portal data running on Stratus servers.

Emdeon acquires GE Healthcare Technology’s patient statement business.

Several readers have mentioned they’d like to hear where our presidential candidates stand on healthcare IT policy. Here is a bit of information courtesy of Health08.org:

McCain

• Supports the rapid deployment of 21st century information systems and technology that will allow doctors to practice across state lines.
• Believes if the system demands information on outcomes, then the market will respond to provide the HIT infrastructure.

Obama

• Believes the use of HIT should be a requirement for participating in government health programs.
• Supports a government investment of $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
• Would phase-in requirements for full implementation of HIT and ensure that patients’ privacy is protected.

Innovative Consulting Group, a healthcare IT support services provider and HIStalk sponsor, sent over a link to their latest newsletter (warning: PDF). In addition to some tech tips and client profile, they feature an interesting by a Cerner practice director about maximizing EMR for quality initiatives.

One of my official HIStalk duties has become tracking the HIStalk Web traffic. I am pleased to report that September has been our biggest month ever in terms of number of visitors. So, thanks, readers, for allowing us to keep you current and/or entertained!

E-mail Inga.

An HIT Moment with … Matt Grob

An HIT Moment with ... is a quick interview with someone we find interesting. Matthew Grob is Director, Health Care Consulting with RSM McGladrey, Inc.

Of all the ways you could have gotten involved with HIMSS, why did you choose CPHIMS?

I had been an annual conference reviewer for a few years and then served for three years on the HIMSS Foundation Scholarship Committee. I was looking for something a little more involved and the CPHIMS program had always interested me.

I sat for the exam at its inaugural offering at HIMSS 2002 in Atlanta and truly saw the value in the credential – what it means to clients, colleagues and employers as well as the personal satisfaction in having it confirmed objectively that I actually know something about what I do for living.

In 2005, I applied and was accepted for a two-year term on the CPHIMS Technical Committee. At the end of that term I was asked to chair the committee for the next year. I must have done something right because they asked me to chair for a second year, which is where I am now.

It has been an exciting time because aside from having the opportunity to work with some really smart and dedicated people who really know their stuff, we recently revised the exam content to reflect both current practice as well as the fact that it is quickly becoming a global credential – I will be presenting on it at the World of Health IT in November in Copenhagen.

For next year, I will be on the ballot for the HIMSS Nominating Committee and urge all your ultra-hip and sophisticated readers to vote for me!

What hospital trends are you seeing in your consulting work?

My practice also deals a lot with the ambulatory and primary care side of the business. We are seeing a shift in hospital environments to tying the two sides of the house together.

There are so many good reasons to do so. The benefits on the clinical side are clear for safety and continuity of care, but we are also seeing it come together on the patient accounting/practice management side as well. Layering business intelligence tools on top of all of those systems are also on the uptick as organizations want a better way to monitor and manage the health of their patients, populations, and their organizations utilizing the wealth of data that is collected throughout the continuum of care and the organization.

How do you think the economy will impact IT budgets in hospitals?

Wow, what a timely question. I see it as a chicken-and-egg scenario. It is clear that the way to better manage the health of our population is through IT and that will, in turn, result in reduced healthcare costs. Payors already recognize that through pay-for-performance initiatives. But to get the benefits, it all takes investment and I suspect that access to capital will be that much harder as we enter this uncertain time in our country’s economic history.

Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like. I suspect that will be happening elsewhere as well.

You spent a lot of years as an analyst at NYU Medical Center. If you had to take a hospital job again, which one would you want to work for, what job would you want, and why?

I don’t see myself leaving New York in the near future. Given that, I would want to go back to NYU. They were the gold standard when I was there and continue to be leaders in the industry.

Paul Conocenti, the CIO, came from banking but managed to understand pretty quickly how to run IT in a large medical center that has a history of innovation and success. Pravene Nath, the CMIO, is also visionary and understands how to do things right the first time. I would want to use my leadership skills and abilities to improve workflow and operations using technology as an enabler, with a focus on clinical systems. I’ve worked on the revenue cycle side of the house, but my first and true passion is the clinical.

If I were to leave New York, I would love to work with John Glaser up at Partners, Edward Marx at Texas Health Resources, or Buddy Hickman at Albany Medical Center as they are all great leaders and thinkers and they just plain get it. When I started in consulting at Ernst & Young back in the mid-90s, Buddy was one of my team leaders. I often point out that we share not only that history, but a hairline (or lack thereof) as well.

What do you like about living in New York?

I think the question with the shorter answer would be what I do not like about living in New York.

My wife and I were both born and bred on the Upper West Side where we live now. We live a block and a half from Lincoln Center, steps from both Central Park and newly developed waterfront along the Hudson River, and walking distance to most museums. It’s about a 30-minute walk to my office, so I actually get to see my kids most nights when I’m in town rather than sitting in traffic or on a train or bus.

But I’m also spoiled. I am used to being able to find pretty much anything I want 24/7 and within walking distance. The city has a rhythm and vibe that is very hard to find elsewhere and diversity in all aspects is what keeps it interesting. Growing up in apartments, we never had a lot of space and the city and Central Park were our backyards so while yes, it would be nice to have some more room, we’re pretty well adjusted to the confines of a Manhattan apartment. I’m just happy we bought ours 11 years ago. We’d never be able to afford one today!

Misys Gets Allscripts Merger Funding

Misys PLC announced this morning that it has signed agreements to obtain the $325 million it needs to fund its proposed merger with Allscripts. A group consisting of HSBC Bank, Bank of Ireland, and Royal Bank of Scotland will provide $150 million as a revolving credit facility over 18 months, while ValueAct Capital will provide $175 million under a subordinated credit facility over 20 months.

A revolving credit facility provides funds that the borrow can draw down and pay at its discretion over the specified time period. A subordinated loan is repayable after all other debt has been satisfied and is therefore riskier to the lender.

The Financial Crisis – Let’s Hear Your Thoughts on How It Will Affect Healthcare

As I write this, it appears likely that Congress will approve spending $700 billion to bail out financial companies whose risky investments came back to bite them. They don’t really have a choice, of course, since the alternative is even less savory. Even Warren Buffett says the alternative is "the biggest financial meltdown in financial history." Gee, everybody said things were great until just a few months ago.

Some of that money may be repaid in sales of assets, but that’s only slightly likely. In the worst case, the national debt jumps to $11.3 trillion, the dollar tanks even more against more stable currencies, and inflation jumps along with unemployment. Foreigners start buying everything in sight at fire sale prices. All of that reduces tax revenue.

Average citizens are hopping mad that Wall Street is dumping its garbage on Main Street, which seems to have surprised the Washington insiders. They’ve been burned before by false declarations of national urgency (chasing nonexistent WMDs in Iraq). As in that situation, the demand is that full trust is put in a very few hands inside the administration to spend the money wisely and to prop up a system that isn’t working efficiently.

It looks like the same government insiders helping out their private industry pals behind closed doors. It doesn’t help that Treasury Secretary Hank Paulson’s last real job was CEO of Goldman Sachs, which made a bundle on subprime mortgages and short selling and gave him compensation of up to $37 million a year and a net worth reported to be $700 million (giving Sachs a nice position as all of its competitors are now out of the picture and making Paulson something close to the CEO of the country when the bailout passes). Or that his views on exactly how much the socialist-like help Uncle Sam should give failing financial houses seemed to change day-by-day as the government reacted to the crisis only after it happened.

Those who pay their bills and taxes on time will suffer. Those who don’t, the same folks who simply walk away from financed cars whose value is "upside down," are likely to take advantage of loose bankruptcy laws and simply stop paying for houses worth less than they owe, reducing the value and future prospects of Uncle Sam’s cash flow stream on so-called "toxic" investments (homeowners were speculators, too, after all). And, there’s no guarantee that banks will start lending again just because they get to dump their failed bets onto the backs of taxpayers. Formerly affluent neighborhoods may look like Rust Belt cities, full of boarded-up houses that the collapsed real estate market can’t absorb.

Unemployment is reminding middle income citizens of just how much wider the gap has become between them and the highly compensated CEOs, and more than 1,000 billionaires whose net worth jumped a lot more than theirs, especially since the homes and 401ks of the average citizen suddenly don’t look so lucrative. The illusion that all of us were getting wealthier together has been shattered. The "have nots" will likely use the one advantage they have — at the polls — to punish those they see who prospered while they didn’t.

Some reactions seem obvious. Democrats will claim it’s yet another example of Republicans favoring the wealthy and will benefit at the polls, yet they won’t have anything left in the federal till to pay for their expensive social programs even if they win offices. The financial industry will wither, with high unemployment and a loss of luster that may never be regained. Taxes will rise, entitlements will finally have to be curtailed, and uncompensated healthcare will certainly rise with unemployment and debt.

Here’s where you come in. HIStalk has a lot of smart readers, some of them in the investment industry and in executive positions. What will the impact be on healthcare and, specifically, healthcare IT? Click Comments at the end of this posting to share your thoughts, maybe thinking about these areas:

• How will hospital IT spending change?
• Will physicians keep buying EMRs?
• What exposure do vendors (publicly traded and private) have to changes in financial conditions?
• Will market conditions cause vendor consolidation and discourage new entrants?
• What changes can we expect for HIT industry employment?
• If healthcare costs have to be dramatically and painfully cut, can IT justify its cost?

Nobody else is talking much about this. It’s not about politics, but about reality. Let’s hear what you have to say.

Monday Morning Update 9/29/08

Goroko General Hospital in Papua, New Guinea (148th of 190 countries in world healthcare) is the first hospital in the country to set up a web site, which was created by its volunteer IT manager Robert Schilt. It looks great and is running in WordPress. Schilt has also established a 12-PC training center, rolled out 50 PCs, set up Internet and e-mail access for staff, built several departmental applications, and almost finished a hospital Intranet and a discussion forum for doctors. He build everything using open source software. He’s also looking for second hand items to help the locals, who he says "do not have two spare coins to scratch together." You’ll notice that his own family has donated a long list of items. Why can’t we get a selfless volunteer IT guy like Robert on the HIMSS podium instead of the usual Taj Mahospital people?

Microsoft chooses Philips SpeechMagic for Amalga. Wonder if the reader’s rumor will pan out that Philips will sell it? Maybe MSFT is interested.

Tom Skelton’s new company, MedcomSoft, turns in not-so-great FY2008 numbers: revenue down 46%, expense up 5%, losses up to $5.8 million. They’re running low on cash, have never made money in seven years, and need ongoing financing to stay open (good luck with that). Surely Tom’s job is to clean up the books and shop it around. Shares are at $0.06 and market cap is $6.2 million. If you want to pick up a CCHIT-certified vendor as an acquisition (and consider MEDCIN to be an advantage), you could probably get a great deal. I had heard it was expensive, but the company claims it’s $11,500 for the first doc and $6,500 for additional ones, still not the cheapest, but far less than some.

Fred Trotter seems surprised that "HIMSS is a lobby for proprietary for Health IT vendors," basing that on its refusal to support Pete Stark’s health records bill that includes pushing open source systems (not necessarily new systems – you may recall that the President’s early call for HIT specifically said VistA was to be made widely available). I’ve been pointing out the HIMSS business model for years:

• Bring in provider members cheap ($140 a year, now basically free for Organizational Affiliate organizations that pay $2,975 a year for the all-you-can-eat plan for unlimited employees, apparently designed to boost the numbers and increase booth traffic at the conference)
• Sell the usual books and all that, but push the annual conference like crazy since that’s where the profit comes from (cheap, too, for provider attendees – the Ladies Drink Free approach to bringing in the horndog men — vendors — who pay full price and expect ROI)
• Charge vendors astronomical prices for booth space and ad exposure during the conference (aka Boat Show booth)
• Provide feel-good infomercial publications that send a message that buying IT is always the right thing to do, making sure to spin or avoid stories suggesting otherwise and minimizing the organizational expertise needed to actually get ROI (you saw it in a booth, so write that check and don’t worry about the change management aspects that most hospitals do poorly)
• Give CIO decision-makers extra special treatment during the annual conference and CHIME, letting vendors pay the tab in return for even more access to them
• Provide some OK education during the conference (even letting vendors themselves take the podium for some of it), but make sure to leave huge swaths of non-education time during prime hours to force attendees into the exhibit hall, which will be even easier in Chicago in April when it’s too cold to be tempted away by golf or enjoying nice weather
• Buy up vendor-specific user groups (Cisco and Microsoft, for example) to give even more sales opportunities to vendors
• Get provider members to give HIMSS Analytics all kinds of internal information for free, then sell their information dearly to the vendor members so they can make well-informed cold sales calls to those same members who willingly participated
• Create advocacy organizations whose charter is 100% vendor-driven (buy more stuff and lobby politicians to use taxpayer dollars to do it)

HIMSS should not disappoint anyone since its methodology is obvious: get providers to join and attend its vendor-heavy conference, a neatly closed loop that makes HIMSS the paid matchmaker. There is absolutely nothing wrong with vendors and they are straightforward about participating in HIMSS to get an audience with prospects. HIMSS members sometimes are naive to that fact (although they’re rarely decision-makers anyway) and somehow expect that HIMSS will advance only inarguably noble and unbiased causes (no different than they expect of hospitals, and with which they are equally likely to be disappointed). I pay membership and conference costs out of my own pocket, so obviously I think it’s a good deal. You just have to swim against the tide sometimes to avoid being controlled. Do I feel they represent the best interests of my hospital employer or me personally? Absolutely not, nor do I expect them to. It’s a trade show, nothing more and nothing less, and free software doesn’t pay those bills. That’s my opinion and you are entitled to your own, of course.

Ivor Kovic, an ED physician in Croatia, likes the iPhone and lists some applications that are useful to doctors.

SCM Microsystems is rolling out this smart card reader, the eHealth 100, to support Germany’s electronic health card for 82 million people.

A city government uses cool PR technology that I’m surprised hospitals and vendor haven’t thought of (assuming they haven’t, of course.) Cheap 1 gB flash drives with logos are handed out to potential investors. Plugged in, they refresh themselves over the Web, then play a slide show, video messages, and provide links to detailed reports and electronic books. The "refresh" part allows running seasonal pictures and other fresh information, infinitely extending their useful life and also allowing the city to track how often they are used.

I noticed that the HIStalk e-mail blast list has just hit exactly 3,000 recipients, so thanks to all of you reading (blasted or not). Daily visits are at over 2,000, so this may be a record month. Thanks, too, to those who signed up for the reader-created HIStalk Fan Club on LinkedIn, now at 264 members. If you’re on LinkedIn, Inga and I would be honored to boost your connection count by approving all requests. You can help spread the HIStalk word by clicking the "E-mail this to a friend" graphic to your right and e-mailing a few of your colleagues about HIStalk.

Paul Newman dies at 83, having given away $200 million to causes such as his Hole in the Wall camps for sick children. He was also a World War II veteran. I can’t imagine today’s pack of shallow "celebrities" doing anything close.

Idiotic lawsuit: a TV reporter (an Air Force veteran) spices up her gun story with a showy stunt in which she fires a semi-automatic weapon at the police gun range wearing a noise-protecting headset. She claims she suffered permanent hearing damage and is suing the police department for medical bills, pain, suffering, and anxiety. The police department says she was negligent and didn’t see a doctor soon enough.

UCI Medical Center (CA) is put under state supervision and could lose its CMS funding over poorly kept anesthesiology records. Inspectors found some post-op forms that were signed and filed before surgeries were performed. Half of the anesthesiology professors signed a 2003 letter complaining that its mission had been altered from education to money-making. Previous scandals include selling body parts and implanting patient eggs in other patients without the permission of either.

Leapfrog Group’s "Top Hospitals" are trending down in number, although not as starkly as its drop-off in members. The numbers: 50 hospitals in 2006, 41 in 2007, and 33 in 2008. They blame a new requirement that requires hospitals show that their CPOE systems provide clinical alerts. If they add a future requirement that CPOE show a demonstrable benefit in cost or patient outcomes, that 33 number will look huge by comparison. Maybe the goal is to have no top hospitals.

Vendor Deals and Announcements

• Virginia Cardiovascular Specialists selects MedAptus’ Professional Intelligent Charge Capture and eRx applications for its 38 physicians.
• The Family Health and Help Center (IN) is implementing PracticeOne’s e-Medsys Solution for their community health center.
• QuadraMed’s Pharmacy Integrated Management solution is now implemented at Ashtabula County Medical Center (OH).
• DB Technology announces the release of its Enterprise RAS solution to automate and streamline paper-centric processes.
• El Camino Hospital (CA) selects eClinicialWorks for its affiliated physician groups.
• Picis announces several new enhancements to its core perioperative and critical care applications. Also introduced: Picis’ new eView for CriticalCare Manager solution to consolidate clinically relevant information for the ICU census and present in a concise web-based view
• With technical assistance from Medicity, the Delaware HIN has become the first fully operational statewide HIE and successfully connected with other NHIN participants.
• Jefferson Community Hospital (NE) has implemented IntelliDOT Bedside Medication Management system at its 25-bed facility.
• BayCare Health System (FL) is using Fujitsu’s PalmSecure biometric security system integrated with its Siemens’ HIS to protect medical record privacy.
• St. James Healthcare (MT) signs with AHI Software for registration QA service.
• Phytel is becoming a member of the American Medical Group Association’s Value-Added Services program to promote the proactive management of health and disease management protocols.
• Sentillion is positioned in Gartner’s “visionary” quadrant in its recently published Magic Quadrant for User Provisioning, 2008. The evaluation was based on Sentillion’s ability to execute and its completeness of vision.
• CareTech Solutions is chosen as IT outsourcer for Port Huron Hospital (MI). The company also announced that it earned the top score (94.6) in a recent KLAS study on extensive outsourcing, including a 100% "would you buy it again."
• United Hospital System (WI) is replacing its McKesson Orbit surgical scheduling system with Unibased Systems Architecture for its periOperative Resource Management System.
• Florida Cancer Specialists is contracting with Fletcher-Flora Health Care Systems for their LIS solution.
• Sacred Heart Medical Center (OR) has implemented Versus Technology’s wireless locating system.
• Harrisburg Hospital (PA) claims a 12-month payback after installing Radianse’s RTLS solution.
• The Health Alliance of Great Cincinnati is deploying Streamline Health’s documentation workflow and coding products across their five hospitals.
• Neurological Associates (LA) has selected CureMD’s EMR/PM SaaS solution.

E-mail me.

News 9/26/08

From EMR Wannabe: "Re: Philips. Within the next ten days, Philips will announce divestiture of its SpeechMagic division. Conjecture is that SpeechMagic is getting resistance from large inpatient vendors because Philips competes in areas where GE, Siemens, and others make big money (radiology and PACS systems). SpeechMagic is about to take another run into the U.S. market, starting in 2009, but it does not fit into the Philips technology portfolio."

From Mrs. Lab Queen: "Re: Sunquest. The Tucson GM initiated a program to turn over the lower third of the staff and 50% of sales as well. Believes this will help increase performance numbers to pay for the sale to Vista. Does this tactic really work?" I‘ll go out on a limb and say yes, sometimes (if the good people don’t leave along with the not so good). Other than the tremendously cold-hearted aspect of that plan, it has always made sense to me to richly reward the top 20% of performers, take your chances in replacing the bottom 20%, and try like crazy to move some part of the middle 60% into that top 20%. The problem, of course, is that it always ends up being subjective since it’s hard to objectively measure who’s contributing, so it turns into a popularity contest and a breeding ground for showy but marginally useful extra effort (people sending e-mails at 2 in the morning just to show how dedicated they are). Tough times make job competition more intense, so it’s probably not going away. Companies may run businesses as though everybody’s a contractor, a concept that I like only conceptually.

From Tina: "Re: Sunquest. As an employee of Sunquest who went through the Misys national nightmare, I love reading all the bad news about Misys. They just about ruined a good company and we are trying to resurrect ourselves to the great company we were before Misys screwed everything up." You will probably enjoy the certain upper management confusion that will arise when Glen Tullman becomes their boss. They’ll be going, "Hey, I thought it was us acquiring Allscripts."

From Joe: "Re: PACS patents. DR Systems has taken to suing a variety of PACS vendors for patent infringement. One of those vague ‘idea’ patents (patent 5,452,416), where the idea may have already been in circulation at the time of filing in 1992.  Basically, DR claims they invented the PACS idea/interface and everyone owes them for it. Currently in the dock: Siemens, Fuji, Kodak, Emageon, eRAD, and NovaRad.  Already sued: Vitalworks and Merge. No way to know who else has settled. If your name hasn’t been mentioned yet, get ready. This has all been conducted on DR’s home court in the Southern District of California. The implications for future of PACS sector are potentially profound." The fulltext patent with drawings is here. Also, a mention of their suit against Emageon (news story here) and settlement with Merge. I also found this mention of a suit against Kodak. Old court records show a suit against Fuji in November 2007. Notice that the About Us /Company link of their site has two entries: Patented Technology and Executive Management Team.

From The PACS Designer: "Re: Top 500. TPD wants to congratulate the healthcare providers who were selected by InformationWeek for their 2008 IT innovations by being selected to be in the InformationWeek Top 500. The top healthcare provider at #7 was Advocate Health Care, led by Bruce D. Smith, Sr. VP & CIO. Baylor Health Care System, led by David S. Muntz, SR.VP & CIO, was #16. Congrats to all on being the best in the eyes of InformationWeek."

An English hospital’s Cerner system crashes again, this time for 12 hours. It’s odd that stories like that always make the papers there, maybe because of some NHS resentment or something.

Odd lawsuit: a patient claims his surgeon stapled his rectum shut, leaving him unable to move his bowels for 17 days.

The local paper writes up the EMR go-live of Blue Hill Memorial Hospital (ME), part of Eastern Maine Healthcare Systems. The paper doesn’t say, but I think it’s a Cerner shop.

WCA Laboratory (NY) goes live on SCC Soft Computer lab. I hadn’t heard much from that vendor in quite some time.

The missing British hospital CDs containing information on 18,000 employees turn up, but the hospital isn’t that happy about it after spending $46,000 sending out employee notices. They thought the CDs were lost in the mail on their way to McKesson, but it turns out a hospital employee had them all along. According to an employee, "It was a massive waste of time and money although everyone seems to be breathing a sigh of relief. It was all a bit stupid. We knew the CDs would turn up."

AHLTA cost the government (us) billions, but now its CDR is getting so big that it’s nearly unmanageable. An MHS engineer called it "failed" as it tries to keep up with a data growth rate of 1.4 terabytes a month, although a couple of statements in the article make it technically suspect.

First they stopped serving meat, now they’re cutting back on patient care. An Australian hospital had to temporarily shut down its X-ray services because of unpaid bills.

The president of RJL Sciences gets three years’ probation and a $10,000 fine for creating FDA-unapproved software for AIDS drug maker Serono that falsely diagnosed AIDS "wasting" that would help sell Serono’s Serostim, which cost Medicaid $21,000 for 12 weeks of therapy. The drug company already paid $704 million for being scumbags, pocket change compared to the $13.3 billion that Merck paid to buy it two years ago.

Scribe Healthcare technologies offers a free version of its dictation, transcription, and document imaging system to solo transcriptionists and small physician practices.

Indian mob hospital news: a group storms a hospital and "blackened the faces" of husband-and-wife doctors, claiming that the gynecologist half of of the couple left a surgical mop in a woman’s abdomen during a hysterectomy.

Kaiser and the VA waste their time demonstrating the Nationwide Health Information Network that works only in the one country that’s too mired in debt to afford it. They should be in the printing press business since it’s going to take a lot of them to crank out the declining value dollars needed to bail out all of our suddenly needy and formerly anti-government capitalists in investments and car-making.

Off topic, I’ll side with non-candidate Senator Ron Paul, MD on the whole bailout issue: "The very people who have spent the past several years assuring us that the economy is fundamentally sound, and who themselves foolishly cheered the extension of all these novel kinds of mortgages, are the ones who now claim to be the experts who will restore prosperity! Just how spectacularly wrong, how utterly without a clue, does someone have to be before his expert status is called into question? Oh, and did you notice that the bailout is now being called a ‘rescue plan’? I guess ‘bailout’ wasn’t sitting too well with the American people."

GE takes a minority position in home monitoring company Living Independently Group. GE Healthcare also announced that it’s shutting down a Maine plant and GE cut its outlook because of its GE Capital unit.

Siemens Healthcare bags a $70 million imaging deal in Korea.

Charlotte, NC-based hospital operator Hospital Partners of America files Chapter 11.

Medical device maker Medtronic encouraged spine surgeons to use its products by lavishing gifts, phony patent royalties, and strip club visits, the company’s former lawyer says.

UPMC implements a salary cap and may lay off employees.

Medical records of 45 patients of Grady Memorial (GA) were inadvertently posted on an unsecured web server in July. Here’s the interesting part: of the article "Grady outsourced the job of transcribing the notes to a Marietta firm, Metro Transcribing Inc., which outsourced the work to a Nevada contractor, Renee Lella. Lella, in turn, turned the work over to a firm in India, Primetech Infosystems." I found this message from Lella on the website of the Republic of the Philippines looking for transcriptionists, so she was going international (beyond the arm of HIPAA enforcement, as it turns out). I wonder who’s held responsible since Grady probably didn’t know their information was headed overseas?

A patient in a Canadian hospital’s ED dies after waiting 34 hours for treatment, although they’re not quite sure since he may have been dead for several hours before anyone noticed.

No amount of pleading and common sense gets some caregivers to wash their hands, so Arrowsight Medical’s Hospital Video Auditing system offers a solution: put video cameras (warning: PDF) in the ICU. That’s like measuring the medication error rate by observation, but like the lawyers say, don’t ask questions whose answer you don’t really want to hear. That’s where Suzanne Delbanco went, by the way, which we just told you about Tuesday.

Speaking of handwashing stubbornness, that’s one gripe of a Baltimore internist who is quite unhappy with medical centers. "We remain absurdly complacent about rising iatrogenic infection rates, knowing all too well that we are allowing immunocompromised patients to die unnecessarily in our intensive care units. There are alcohol-based hand-washing gels everywhere, but no police or policy with teeth in it to enforce handwashing. We lurch toward physician computer order entry, clinging to the false belief that software programs will prevent adverse drug reactions and delivery of the wrong dangerous drug to the wrong patient. We understaff our pharmacies so that they can’t get the medications to the patients on time or alert us to our own prescribing errors. We burn out our nurses despite years of loyal service. We capitulate to the for-profit insurance industry that informs us they won’t pay for day 4 of Mr. Jones’ hospitalization because he has failed to meet some arbitrary criteria in their manual." His full article (warning: PDF) is here. It’s causing heated debate because it bluntly says what a lot of we hospital people know to be at least partially true nearly everywhere. I notice he’s in private practice now in a concierge model, charging a $1,500 annual fee for unlimited visits and not accepting insurance. Pretty reasonable if you ask me. I might want to interview him.

Big veterinary hospital chain Banfield sells its veterinary telemedicine systems company to a veterinary imaging and practice management software company.

Cell phone maker Qualcomm talks about the Pill Phone, which contains drug information and sends patient reminders.

Joint Commission says heparin mistakes should encourage hospitals to use CPOE and barcoding.

E-mail me.

HERtalk by Inga

From In the Know: “Re: Medcomsoft. The former CEO and VP of Business Development at Misys Healthcare are trying to raise money to invest in Medcomsoft. Tom will be CEO and Rich COO. Likely a new EMR/PM home for the employees lost in the pending Misys-Allscripts ‘synergies.’" Skelton and Goldberg were engaged by Medcomsoft back in June to serve in a ‘consulting role.’ As I went back and read Medcomsoft’s September 8th press release, I realized I may have overlooked this section the first time: ‘In conjunction with development of the revised business plan and associated financing requirements, the Company has identified a senior management team with deep domain expertise and a track record of success in the U.S. HIT market. Subject to completion of the targeted financing and final negotiation of mutually satisfactory employment terms, this senior management team would join the Company to drive execution of the revised business plan.’ Makes sense they would take a few displaced or disgruntled Misys folks with them.

From Fanny Mac: “Re: cell phone pictures of patients. There are bunch of poorly educated, lower-class clowns in hospitals that will always do this or snoop in patient charts. With the significant dumbing down of ‘grunt-level’ hospital workers in the last 25 years, this problem will never go away. Finding top-notch hospital workers is always a major effort nowadays and many are forced to accept – er, marginally capable individuals, primarily aides, therapists and technicians. This security breach and others make a mockery of HIPAA. Those of us in executive positions wring our hands, but simply don’t know about or understand the lower rungs of the hospital staff and what makes them tick. Is this an issue of class? You decide.”

CCHIT reports that there are at least 90 public and private EMR incentive programs. The combined programs represent at least $700 million in potential funding. I wonder how many of those organizations agree the study finding that despite relaxed Stark laws, EMR adoption is still moving slowing.

While I am all for clinical excellence, I wonder how many people would brag about receiving this EIC award to anyone outside of healthcare? Would they include it in their Facebook profile?

Cooper University Hospital (NJ) agrees to pay $3.85 million to the federal government to settle a whistleblower lawsuit. The case alleges that between 2001 and 2003, the hospital submitted Medicare claims that inflated its actual treatment costs in order to qualify on paper for outlier payments.

NIH director Dr. Elias A. Zerhouni announces he is leaving the agency by the end of October.

The Leapfrog Group names (warning: PDF) 26 hospitals and seven children’s hospitals its list of 2008 Top Hospitals. Winners are selected from a Leapfrog survey that evaluates patient safety. To make the list, hospitals must have implemented CPOE and use it to alert physicians of common and serious prescribing errors.

E-mail Inga.

Readers Write 9/24/08

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

Why Sarah Palin is Relevant to HIT
By Wilma Pearl Mankiller

I found it amusing that so many people took Inga’s comments about Sarah Palin and bangs and Botox and turned it into something political. I agree with the readers who think HIStalk isn’t the right forum for politics. We get plenty of that from every cable news channel every night.

That being said, the Sarah Palin story is relevant to our little healthcare technology world. There are some excellent women leaders in our industry, but men far outnumber the women in the top spots. With Palin, we see a working mom who has a realistic chance to be the #2 “guy” in the country. This makes her story relevant, interesting, and inspiring for those of us who have struggled to advance our careers while also balancing our family lives.

Years ago, when I was first newly pregnant, I went to dinner with my husband, a male co-worker, and the co-worker’s high-level executive wife. All but my husband worked for HIT vendors. At that dinner, I recall the wife warning me that no matter how much my husband claimed he was going to help carry the weight, some things would always fall to the wife/mother. At that time, I was young and naive and didn’t fully comprehend what she was telling me. All I really understood was that she and her husband had successfully raised three great kids and she managed to rise through the professional ranks at the same time. I aspired to be like her.

Fast-forward a few years. I supposed I can say that for the most part I achieved what I had hoped for: kids, a nice house, enough money, and some time as an executive. I suppose some would say I had it all. Perhaps I did. But the reality is that getting it “all” can include a few things you never expected or wanted, such as:

• Tears, while sitting in the parking lot of my son’s daycare the first time I dropped him off.
• The discomfort and inconvenience of expressing milk in airplane bathrooms and rental cars.
• Resentment, from both men and women who felt it was unfair that they had to pick up the slack for me while I was getting paid time off just to hang out with a baby.
• Frustration and guilt, for cancelling product demonstrations because I had a sick child at home who needed me.
• Ambivalence, when removing my name from promotion consideration after learning I was (unexpectedly) pregnant again.
• More ambivalence when I asked for lesser job with lesser pay so I would no longer have to travel.
• Guilt and self doubt when others questioned (judged?) my career advancement decisions and my commitment to being a mom (and for some reason, the highly paid men with stay-at-home wives were the worst because they never seemed to understand that not every husband is the family’s major breadwinner).

Obviously and unfortunately, my frustrations weren’t unique to HIT. In fact, the same challenges exist in just about every industry, which is probably why there are only eight women CEOs running Fortune 500 companies. If you are a woman who chooses a career AND motherhood, you face challenges that only other working moms appreciate. The role models in our hospitals and companies are few and far between. While we can all name a few women that have shattered the glass ceiling, these leaders are the exceptions.

So, here we have Sarah Palin, a real mom who is potentially the country’s next VP. She got where she is by some combination of brains, ambitions, timing, good looks, and luck. We can appreciate that she has to take a baby on the campaign bus. Her kids aren’t perfect. She has critics who think she should be staying home with the kids. Unlike Condoleezza Rice or Janet Reno, she has a family. And if she can succeed, then it gives the rest of us hope that maybe more of us will have a chance to run a hospital/IT department/software company one day.

That’s how Sarah Palin is relevant to HIT.

Observations from the Epic User’s Group Meeting
By SNL

Epic is an engaging, dynamic company. They definitely put on a good show. But the smart observer can figure out their MO.

When Epic wants to build a new software tool or enhance an old one, they put a couple of recent college grads on the project. After "research", and whatever that involves and an hour or two of client Webex’s, they release the upgrade. If QA is done, it’s by other non-clinical people.

When a client complains, especially a doc, they shower them with attention, phone calls, a trip to Madison. "We want to work with you and hear your feedback." Then, after a number of back and forths, all volunteer time on the doc’s part, the module is improved. This can take years.

Meantime, no one really asks "Why didn’t you do a better job building the thing before you released it?" Anyone who does and doesn’t volunteer to pitch in is not a "team player".

Who loses in this game? The doctor/nurse/lab tech, and then the patient, who suffers through the risk of alpha software.

Who wins? Epic, who doesn’t seem to ever pay a dime for this expert help. Kaiser Permanente seems to be learning this the hard way.

Do other companies play this game? Has anyone ever been a paid expert for Epic design? Does Boeing design airplanes this way?

From the Mailbag

Got questions for Mr. H or Inga? E-mail them over!

Dear Inga,

Did you see where one of the AAFP directors suggested EMR vendors are part of a big Ponzi scheme and the only ones making money are the vendors? What do you think? – Carlo P.

Dear Carlo,

Dr. L. Gordon Moore is the doctor who apparently doesn’t like EMR vendors. What Dr. Moore said supposedly said was, “Beware of the monolithic, expensive IT vendor, because there are always things they don’t do well. The whole thing can be a Ponzi scheme. The only ones making money from most of these products are the vendors selling them.”

First of all, is there something about making a profit that should make a vendor ashamed? Of course EMR vendors are trying to make a profit. Making a profit is a good thing because it means your vendor is more likely to stay in business to support you and continue developing the products.

So, was Dr. Moore suggesting his EMR did not help his practice become more profitable? Is that why Dr. Moore bought an EMR??? In my experience, the physicians who utilize EMR most successfully are those who initially went into the project looking to improve patient care (by making information more readily available, records more complete, reminders automated, etc.) EMRs can definitely increase efficiencies, which might make the practice more money. Of course some vendors and solutions are better than others and there are always things a particular vendor doesn’t do well as another. This is true with both the monolithic and expensive vendors and the nimble and inexpensive start-ups.

Bottom line, Carlo, I don’t think Dr. Moore is the kind of guy I’d have fun chatting up at a cocktail party.

Dear Mr. H,

I saw a reader comment in an earlier Readers Write about the problem with meetings. What is your take on them? – Lorena

Dear Lorena,

I detest meetings. Really. They are like gases – they expand to fit whatever space and time is allotted to them, yet nothing ever results except a vow to hold even more meetings to which even more people are invited. I don’t like attending them and I don’t like conducting them. I will do anything, including faking an emergency page or coughing spell, to escape back out into the sweet, cool air of freedom.

The really bad ones are when the suit-du-jour is running a meeting of the worker bees. Everybody’s jockeying for the boss’s love and admiration, so it will take twice as long as usual to achieve nothing. When a boss is present (hint: they’re the ones with the suits who came late and are furiously keying BlackBerry e-mails instead of listening to people who actually showed up in person) they will pretend to be fully engaged by randomly spouting out one of these non sequiturs:

• Make sure you document that
• Let’s put that in the parking lot
• How about a bio break?
• Schedule another meeting with (cast of thousands)
• E-mail me the details
• Give me a completion date
• Send me a list of the risks involved
• I need to review that before you send it out

Notice how none of these items really adds any value except to support the illusion that the boss is vital to the outcome?

Some people are meant to conduct valiant battles on a field of laptops, armed with minimal knowledge and maximal need to prove it. Others just get the job done instead of yammering about it.

Dear Inga,

What kind of sales tricks should doctors look out for when considering the purchase of a PM/EMR system? – Suspicious Doc

Dear Suspicious Doc,

Are you buddies with Dr. Moore, by chance? Since when did EMR vendors get put in the same category as used car salesmen? Although I do recall hearing about this sales guy who used to “hide” a second PC and switch box underneath the table during a demo. At just the right moment, he would switch from the computer running the PM software to the one running the EMR. He was such a pro at it that prospects never realized the two products were in no way integrated. He was smooth.

Anyway, I think one thing important to understand is if the software version you are reviewing is actual live and in production. If it is a pre-release version, that is ok, but it’s important to understand whether or not the version you are looking at is fully tested and the one you will be getting. Also, definitely talk to other practices and ask them about implementation, support, and whether or not the software works as advertised. If you believe a particular function is critical for your operations, make sure you talk to at least one practice (anywhere, any specialty) that uses that feature.

Finally, assume that in most cases that whatever price you are presented initially can be negotiated. It’s likely that the vendor is more concerned with the total contract amount than individual line items. If they throw in a PC or an extra day of training, understand the value of the item so you can access if it represents 1% or 10% of the total deal. If you are offered a lease option, keep in mind the sales rep (and maybe the company) receives some sort of commission for the lease, so they may be willing to give you a little bit better deal on the total price. Also, lease rates can usually be negotiated if your credit is good.

Dear Inga,

I know a female sales rep who slept with a hospital IT person and her company’s product was chosen. Is that common? – Ms. Kitty

Dear Ms. Kitty,

That is a one of the oldest sales tricks ever (check out the Old Testament). Seriously, I guess I am just naïve enough to believe that women (or men!) don’t give up their bodies to win business. I bet what happened with your female sales friend is that she just happened to find true love with that IT person and her product just happened to be the best solution.

Dear Inga,

I loved your avatar! I was in love with your mind before, but now that I realize you must also be beautiful I’m beginning to think we might be made for each other. By the way, are you getting all sorts of cyberspace love letters from wacky IT nerds? – Obsessed Fan

Dear Obsessed Fan,

Um, you are the first. (that was a pretty creepy e-mail.)

News 9/24/08

From shimshamrich: "Re: Thompson, HPA. Tim Thompson is the new CIO at Houston’s Methodist Hospital. Also, VCU Health System (Richmond, VA) had a very successful go live on GE HPA. Converted $3.4B of accounts from old McKesson Mainframe system to HPA with 100% accuracy."

From Bob Arann: "Re: Misys/iMedica. I heard Misys let Allscripts look at iMedica’s source code, which led to the lawsuit. Could Misys have been that stupid or were they trying to find a way to get out of the original agreement and take over development themselves?" Pure speculation, I should add, although the nature of the iMedica complaint hinted at something like that.

From IsItTrue: "Re: Hersher. I hadn’t noticed, but did you report the Hersher-CES Partnership?" Link. I missed that. Betsy Hersher’s company is working with executive recruiting firm CES Partners. She’s still doing her CIO coaching thing.

From Rodney Dangerfield: "Re: Peter Pronovost. He’s a new MacArthur Fellow." Link. Peter gets one of 25 $500,000, no-strings "genius grants" for 2008. I interviewed him in February about his "surgical list" idea that was so simple that only a genius would have suspected the massive patient care improvements it could support. From the interview: "I pulled all the teams together and said, ‘Is it acceptable that we can harm patients here in this country?’ And everyone said, ‘No.’ So I said, ‘How can you see someone not washing their hands and keep quiet? We can’t afford to do that. In the meantime, you can’t get your head bit off, so docs, be very clear. The nurses are going to second-guess you. If you don’t listen to what they say, nurses page me any time day or night, they’re going to be supported. There’s really no way around this. We have to make sure patients get the evidence.’"

From The PACS Designer: "Re: CRNAs singing. TPD knows how much Mr. H. likes singing groups, but I bet he hasn’t heard the Laryngospasms! Check out their ‘Breathe’ and ‘Waking Up Is Hard To Do’ videos." Link. They sound good for gas-passers. Seriously good doo-woppy harmonies. "CO2 is high, I think you’re going to die, and this won’t look good on my resume … your sputum is as thick as Cheez Whiz, I’m kissing my stipend goodbye." Found their site here. I’m rocking out to "Little Ol’ Lady with her Fractured Femur," sung to the tune of "Little Old Lady from Pasadena," of course. Excellent.

From HITpundit: "Re: sponsors. Gee, with all the ads on the site, HIStalk is starting to look like Times Square!" Where are those hookers and crackheads I ordered? But seriously, the long-awaited improvements are now finished (smaller ads, better layout, etc.) As of today, the ads are being displayed by a brand new and highly efficient method (one call to the adserver database for the whole page, not once per ad) so HIStalk will display ridiculously faster, so I’m really happy with that improvement. Also, the ads are now displayed in random positions (other than the Founding Sponsor ads), so you’ll get a different arrangement every time you refresh the page.

A couple of new text ads are to your right: DB Technology just announced its Enterprise RAS and Matthew Holt is offering HIStalk readers a $50 discount on registration for the Health 2.0 conference in SFO on Oct. 22-23 (featuring big names Kolodner, Shirky,  Neupert, Shreeve, Parkinson, Bush, and Bosworth).

From Kaimuki: "Re: Sermo. Any thoughts on them?" Not from me, although this guy ("Ben Dover, MD" – nice!) has some major gripe with them that isn’t clear (Sermo tried to have his sermosucks.com domain revoked, but lost). They’re getting investor money and trying to walk a fine line of selling anonymized doctor information to drug companies while not appearing to have gone over to the dark side. I suppose I’m indifferent to Sermo … if doctors like it and use it, more power to them.

From Helskini Hank: "Re: Thomas Hospital. Seen in the wild. The ‘Starting July 15’ signs are still up and they had 12 hours of Soarian downtime Friday."

ChartOne completes the spinoff of eWebHealth, which offers HIM workflow solutions via Software-as-a-Service. George Abatjoglou will run the new organization.

Listening: Dungen, trippy Swedish prog-pop.

Welcome to new HIStalk Gold Sponsor A2M Resources. Vic Arnold (formerly of GE and IDX) has put together a highly experienced consulting team that can handle revenue cycle work, assessments, process redesign, and working in a management advisory capacity. I asked Vic what made A2M different and, to summarize, he said: (a) solving problems that everybody sees over and over; (b) fixing lame technology integration ("paving the cow path"), and (c) overcoming the myth that technology is the answer to every question. Thanks for the support, A2M Resources.

Brian McAlpine, formerly with Emergin/Philips, joins medical device connectivity vendor Capsule as director of strategic products.

Cosmo Battinelli is named SVP of product support services at Eclipsys. Most notably, he’s from Symantec, not ADAC.

BayCare (FL) is using Fujitsu biometric palm scanners to register patients.

St. James Healthcare (MT) signs with AHI Software for registration QA service. I’d tell you who’s involved in the company except their web site doesn’t work with Firefox, so they’ll have to be happy with IE users only (which counts me out).

Almost forgot: I added an "E-mail This to a Friend" button to your right that will pop up a handy e-mail form that you could use (theoretically, let’s say) tell everybody you know about HIStalk, complete with a link to the page you’re on at the time. Just sayin’.

Jobs: Implementation Consultant, Data and Interface (GE Healthcare), Application Development Manager (4Medica), Implementation Project Manager (MedAptus), Regional Sales Manager – Toronto (Apollo PACS).

A New Zealand hospital decides to pass on a project to use RFID chips to identify hospital bottlenecks. "We would be following the patient’s movements from A to B to C, but we already knew what that was."

From an offline conversation I had with a highly informed reader, here’s some bad news. The economy is tanking and Uncle Sam’s only answer is to pump more tax dollars into trying to prop up businesses that deserve to fail (see: France). Big deficits are about to get bigger, tax collections are headed south, and former Wall Street investment sharks are demanding unsupervised control of a $700 billion piggy bank to support current Wall Street investment sharks who screwed up. The result: politicians can no longer avoid the huge chunk of GDP that healthcare and entitlement spending eats up. That’s bad for healthcare, probably.

Hard times could put us in the same predicament as Australian hospitals that are so broke they had to stop serving meat to patients.

And speaking of ridiculous healthcare costs, GE Healthcare’s new CEO blames Washington’s rare desire to save taxpayer money by not subsidizing highly profitable imaging machines for the company’s declining fortunes. He’s working on the bureaucrats: "I don’t think that cutting or limiting the use of technologies like ours is the right answer. I think there’s a better answer. And it’s clear that we have got to be involved in coming up with that answer." I’m not seeing masses of people dropping dead from lack of imagery, so I’m not so sure there is a better answer.

I’m a little more upbeat in this week’s newsletter editorial: "This Is No Time for Timidity: Why Contrarians Taking Bold Steps Instead of Moaning About Poor Financial Conditions Will Win."

I got yer Windows Mobile 5250 emulator right here, pal.

A UConn nursing professor rolls out her NIH grant-funded patient education application, which collects information from patients on a touch screen in the physician’s office, provides education, and summarizes the information for the physician.

A patient dies from a chemo overdose at a London hospital, which the hospital blames on its computer system.

Wake Forest University (NC) will host an EHR conference October 1-3. I’ve heard of nearly none of the speakers other than "of course I’ll be there" John Halamka and I’d question the wisdom of giving Microsoft and IBM a speaking slot, but it might be OK.

E-mail me.

HERtalk by Inga

El Camino Hospital is offering its affiliated physician group subsidies for eClinicalWorks. Members of the Independent Physicians of El Camino Hospital will have the option to use ECW’s PM/EMR interfaced with the hospital’s systems.

Ashtabula County Medical Center (OH) has successfully implemented QuadraMed’s Pharmacy Integrated Medical Management solution.

AHIC Successor announces the appointment of its 15-member board. Members include an assortment of people across the HIT spectrum.

Orlando officials and local healthcare leaders are working together to expand the area’s medical tourism. By leverage its vast tourism resources and ever-growing healthcare infrastructure, Orlando hopes to increase visitors to the region. I can think of all sorts of bad Mickey Mouse surgery jokes, but I will leave those to readers.

Speaking of medical tourism, a Deloitte Center for Health Solutions study concludes that 750,000 Americans traveled abroad for medical care in 2007. The number is anticipated to be six million by 2010.

I am an official Chrome convert, finding it so much faster than Internet Explorer. An annoying problem, however, is that I can’t seem to view YouTube videos with Chrome (I get about two seconds and it stops). I happened to be looking for a video version of the reader-recommended song, “You can have my husband, but please don’t mess with my man.”

What were these guys thinking? Two University of NM Hospital employees are fired for using their cell phone cameras to take pictures of patients receiving treatment, then posting them on MySpace. The photos were mainly close-ups of injuries. The pair was fired for violating a hospital policy against using cell phones in patient areas. Obviously the hospital just wants the matter to go away, calling the situation an employment issue that has not involved law enforcement. Hopefully no ambulance chasers, either.

Picis launches its new eView for CriticalCare Manager solution. The product is designed to consolidate clinically relevant information for the ICU census and present in a concise web-based view. Picis also announced several enhancements to its core perioperative and critical care clinical automation solutions.

Former LeapFrog CEO Suzanne Delbanco is named president of Arrowsight’s new healthcare division. Arrowsight Medical will use video auditing to assure that employees are following quality and safety protocols. Sounds kind of big brotherish to me.

CareTech Solutions is chosen as IT outsourcer for Port Huron Hospital (MI). The company also announced that it earned the top score (94.6) in a recent KLAS study on extensive outsourcing, including a 100% "would you buy it again."

Another organization announcing a milestone is the Delaware Health Information Network (DHIN). Less than a year after being named one of nine initial HIEs to participate in HHS’s NHIN trial implementations, DHIN became the first fully operational statewide HIE. With its partner Medicity, DHIN has also successfully connected with other NHIN participants. Got acronyms?

Meanwhile, the MidSouth eHealth Alliance, a Memphis-area RHIO, announces it has completed two years of data sharing and interoperability. The Memphis RHIO serves over one million lives. If Elvis were still around, I bet he’d be covered, too.

Vendor Deals and Announcements

• Adventist Health System signs up for GetWellNetwork’s Interactive Patient Care solutions.
• El Camino Hospital (CA) is partnering with Microsoft’s Amalga to provide data integration onto a single platform.
• Oncology management system provider IMPAC Medical is teaming up with Accuray to connect Accuray’s CyberKnife Robotic Radiosurgery system with IMPAC’s EMR.
• OrthoArkansas (AR) has deployed athenahealth’s PM and billing service for its 21 physician organization.
• Integrated Health Systems of Alabama will use MicroMD electronic health records software from Henry Schein Medical Systems at its 42 community care centers.
• EDI company ZirMed is partnering with Worflow.com, a provider of PM/EHR solutions.
• Elizabeth Wende Breast Care (NY) will outsource its long-term data storage to InSite One.
• Surgical Information Systems honored four hospitals and medical centers with Client Recognition Awards for their effective use of SIS software to bring out remarkable results in their operating rooms. Not among the winners (yet) is MetroSouth Medical Center that just installed SIS.
• Cerner completes its first sale in Latin America. Clínica Las Condes in Santiago de Chile will implement Millennium at its 220 bed hospital.
• athenahealth signs up for another five years of business process services with Perot.
• Community Hospital of the Monterey Peninsula (CA) is expanding is use of Eclipsys by activating Sunrise Ambulatory Care. I wonder if the hospital will have a chance to offer Medinotes as an alternative?

E-mail Inga.

Monday Morning Update 9/22/08

From Reality CCHIT: "Re: CCHIT participation from vendors. Let’s be clear about the goals of vendor representatives participating on CCHIT commissions and committees. The primary role of these participants is to watch out for the interests of their employer. That may mean adding onerous requirements already met by their company that sets a higher bar for less well-funded competitors or making the case against functionality their employer doesn’t have. A secondary role is to be the first to know what’s coming for technology that will take months or years to complete. Finally, participation looks good on resumes and RFPs."

From Medicman: "Re: Misys. Despite the financing issues with the Misys/Allscripts merger, Misys reps were in Raleigh earlier this week being trained on the Allscripts products. Someone is fairly confident this will go through." It probably will, although who knows what it will cost to get financing in this market. Analysts would say that the expected benefits outweigh the deal’s cost. I would say "expected" rarely proves to be the case. I can’t think of even one good strategic decision that Misys Healthcare has ever made (buying CPR, selling CPR, botching Sunquest, botching ClearPractice, copping out by relabeling iMedica instead of building or acquiring its own product, etc.) Maybe the best value of the merger won’t be the vaunted PM/EMR cross-selling opportunities, but rather clearing out what appears to be several corner offices worth of underperforming executive talent.

It’s not news to HIStalk’s readers since we told you on 9/15 after reader tips, but Eclipsys will acquire physician EMR vendor MediNotes for $45 million in cash and stock. I interviewed MediNotes CEO Don Schoen two years ago, where he said, "This is a huge market with potential and some people will benefit greatly from it. I hope to be one of them." Sounds like that’s what happened.

Parts of Microsoft’s new post-Seinfeld ad campaign were made on a Mac, geeky sleuths have determined. The article says the "Vista sucks, but less than you think" campaign (I made that up, but it has a nice ring, I think) will cost $300 million. The self-congratulatory article announcing the campaign basically says that Microsoft will copy everything that Apple does: hip ads, in-store kiosks, and free expert bars. That’s going to be a tough sell given that Windows 7 hints are already being dropped. Vista could be the next Windows ME. I’m running it on my laptop (not by choice since it was bundled) and it’s working fine, although I don’t really do much on it.

IT folks at the Houston VA hospital scrambled to prepare for Hurricane Ike and are now trying to recover 35 PCs lost when its Galveston clinic was destroyed. "As the storm approached, employees transmitted hourly updates of patient records over a VA network to the Little Rock facility, he said. They continued to do so the weekend the storm hit. Seventeen of the hospital’s 40 technology employees and 23 family members camped out in the facility’s library and server room from Friday, Sept. 12 until the evening of Sunday, Sept. 14, to keep vital computer systems running."

Allscripts sells its Physicians Interactive business unit, which pushes drug company sales pitches to doctors over the web.

Housekeeping: the Google Search box to your right lets you dig through over five years’ worth of HIStalk. Put your e-mail address in the Subscribe to Updates box to get blasts when I write something new (sometimes it’s breaking news, so you will often be the first to know). Click the ugly green Rumor Report graphic to securely and anonymously send me those secrets you’re itching to tell. And, as always, thanks to readers and sponsors for keeping the HIStalk flame lit.

A woman bringing her disabled veteran father to the Boise VA hospital refills her mug with soda from the cafeteria as usual, for which she has always been charged $1 or $1.50 even though no refill price is posted. On a recent visit, the cashier tells her it will be $3.80. The woman refuses to pay, the manager says they won’t take the soda back, and the woman dumps it on the counter and leaves. A reporter calls to tell her that two federal charges have been filed against her, each of which carries a maximum sentence of up to six months in jail. She claims she was identified by looking up her father’s electronic medical records. "They should not have used a veteran’s medical records to find me," she told reporters.

The government of Belize signs a contract for a national health record that will connect every citizen and the entire health sector. "The BHIS consists of a set of mostly interdependent modules surrounding the central Electronic Health Record (HER) and Admissions-Discharge-Transfer functions. The chief functions of BHIS key modules are, electronic health record and admission discharge transfer, clinician order entry, financial, maternal child health, HIV/AIDS, laboratory and testing, supply chain management, public health and human resources." Careful readers will notice the EHR/HER transposition, which surely means Microsoft Word was used to compose the story.

Hamilton Health Sciences, an Ontario hospital group, builds a technology hub for its IT department and vendor test bed. It’s doing innovation work around mobile caregiver technology.

Doctors in Scotland report great success with their Mobile Clinical Assistants, which I assume is the Motion C5.

UCI Medical Center (CA) overhauls its anesthesia information systems by bringing in SIS, putting an end to handwritten reports last week.

Apollo Hospitals, which operates 41 for-profit hospitals in India, will develop a centralized patient records repository in which birth-to-death records are indexed by an Apollo-assigned patient identifier.  

UMDNJ made up a no-work job to keep a powerful former state senator from going to work for a competing hospital, an administration official testified Wednesday. The former senator is charged with bribery and fraud for steering $12 million of public money to UMDNJ in return for the job. The dean of the medical school arranged the job, which officials said was created when the school hired high-salaried doctors for a cancer institute that it lost to Cooper University Hospital when that hospital’s own power broker, "the political boss of South Jersey," shifted the project to Cooper. Do you suppose sick patients realize how much sleazy jockeying is being done by seemingly reputable organizations?

New York eHealth Collaborative issues proposed guidelines for patient consent for electronic data interchange. Public comments are welcome through October 3.

Vermont Information Technology Leaders capitulates to state government demands that it reduce its board size, cutting back from 21 to 11.

E-mail me.

News 9/19/08

From The PACS Designer: "Re: cloud map. Peter Laird, who works for Oracle, has done an excellent job of creating a ‘Visual Map of Cloud Computing’ which gives you the full spectrum of the cloud environment. His map details suppliers of the types of clouds, storage, integration, value-add, and SaaS applications." Link.

From Deb Ridement: "Re: Misys. Both CEOs are way out on a limb with no turning back. If Misys, which has contacts with the CEOs of every bank and lending institution, can’t get the money, the banking industry really is in the toilet. That also says volumes about the HCIT industry and US economy. Employees and shareholders of both companies must be holding their breath."

From Inside Outsider: "Re: GE’s HPA. GE seems to be pushing HPA and they believe that the product exceeds what is in the market, particularly with the CBO product that combines both the hospital and physician billing. In fact, GE reiterated this at their GE Summit this summer."

From GE Centricity HPA Customer: "Re: HPA. I’m a senior IT person at a GE HPA site. At last month’s GE Healthcare Users Summit, Centricity Business leadership stated the HPA billing system was the go-forward billing system for hospital customers. As such, they are continuing to enhance and support HPA. This was the same message GE leadership gave us in March in a private executive briefing. They implied they would be migrating their clients using the old Phamis / CareCast hospital billing system to HPA. But, it was pretty clear Carecast sites hadn’t gotten the message yet. Moreover, I don’t think GE has figured out how to migrate everyone."

From Interested: "Re: GE. Has GE made a big sale EMR in India?"

From Justasquirrel: "Re: the Evanston / NorthShore moniker. They have a contractor going through everything in Epic using Chronicles to change the name on every document. I wonder how much money they are investing in changing all letterhead, business cards, invoices, etc.?"

University of Iowa Hospitals and Clinics votes down the Vocera VoIP communication system for what sounds like a bizarre reason: "There are certain areas of the hospital that cell-phone use is prohibited, for example. Whatever technology you install, you have to make sure that it’s not going to harm patients." I’m going to assume that the reporter or spokesperson got in over his head in trying to explain it because surely the hospital hasn’t found previously undocumented interference issues with the wireless network they’re already running.

Center for Information Technology Leadership says (warning: PDF) that a recent report by the Congressional Budget Office, which concluded that previous analyses (including CITL’s) overstated the benefits of IT in healthcare, is wrong. I admit that I’d probably go with CBO’s assessment, only because I never believe the optimistic outcomes industry folks usually predict. I’ve been jaded by hospitals creating expectations for big savings and improved outcomes, but failing to do anything to actually deliver them.

Former Cernerite Guillermo Moreno joins kiosk vendor Aurillion.

Someone from Microsoft e-mailed to say they had located and removed the PHI-containing Amalga/Azyxxi presentation that an HIStalk reader had reported to us and, sure enough, it’s no longer available via a Google search. Somehow it got out on the Web with some full patient names, diagnoses, EKG strips, and other confidential patient information.

Speaking of Amalga, El Camino Hospital buys it.

David Brailer’s Health Evolution Partners invests in Chrysalis Ventures.

HIMSS supports its big vendor constituency by declining to support the healthcare IT bill that Pete Stark just introduced. HIMSS doesn’t want a new group usurping HITSP’s work and is against the idea of the low-cost open source systems called for in the bill. In other words, the screwed up healthcare system we have has been berry, berry good to HIMSS and all the other member groups out there, so they aren’t about to advocate widespread reform that might reduce their own influence. You can’t blame them, I guess, but it’s a shame that AHA, AMA, HIMSS, etc. talk about real change to improve outcomes and reduce cost, but only in ways that don’t threaten the big money folks.

Mass General will cut 200 jobs.

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HERtalk by Inga

From ORLabRat: “Re: Seinfeld show. Did you notice that Jerry’s computer (on the table by the window) morphed from what looked like a Mac to a PC somewhere around the third season? My timing could be off, but it’s interesting now that he’s a Microsoft pitchman.” I never noticed, truthfully. However, there it is on the desk in the back. Looks like a PC to me.

From Elsie EHR: “Re: Justin Long. As you mentioned, Justin Long — the Apple computer nerd cutie — is known for his role in Dodge Ball; certainly a classic in the genre of ‘nerds band together to save the (choose one) neighborhood / school / summer camp / nursing home / gym / world from corporate goons.’ However, he’s better known for his appearance last year’s explosion-filled Bruce Willis epic, Live Free or Die Hard, in which Long played a (drumroll, please) computer nerd cutie who joins a Luddite cop (Willis) to save the world from evil hackers.” Those Apple guys are marketing geniuses!

Meanwhile, just days after Jerry Seinfeld cashed his $10 million check for his Microsoft spots, Gates and company are pulling the ads (claiming it was all part of the original advertising plan). Yeah, right. Obviously those MS guys read my post on Tuesday.

CCHIT announces eight new commissioners and the reappointment of five others of its 21-member board. The appointees were selected from 85 applications and will serve two-year terms. Among the new folks is Sarah T. Corley, MD, CMO for HIStalk sponsor NextGen. CCHIT also announced it will begin its new HIE certification program on October 1.

According to a poll, 63% of us spend our lunch at the desk plowing through e-mails. Compare that to the 20% who lunch with colleagues or friends, the 8% who work out, and the 9% who have a working lunch with colleagues / prospects / partners. Remember the good old days before e-mail, voice mail, and virtual offices when we actually went to lunch with the office crowd?

Not to bring up the taboo world of politics or anything, but the whole Sarah Palin phenomenon got me curious about how many women are in HIT’s higher ranks. Rich Correll, CHIME president and CEO, informed me that only about 25% of his organization’s healthcare information executive members are female (Rick says he remembers when CHIME was 90% men, so at least the trend is going in the right direction). That is still probably much better than the stats with healthcare IT vendors.

If you are curious what is going on in post-Ike Galveston and UTMB in particular, ER Dr. Angela Gardner has been posting interesting (if not depressing) updates. “80% of the island is damaged. UTMB is not seeing patients of any type at this point. DMAT teams are providing any necessary care. There is no electricity, no running water, and not enough fuel to start pumping water out of the flooded areas. Many of the emergency generators were damaged by storm. Phone lines and Internet connectivity are spotty. Even cell phone coverage is unreliable. Today, UTMB estimates re-opening the doors with a skeleton crew next week. Services will be added as it becomes possible. It is just a guess that we may not be able to have inpatients for 4 to 6 weeks. Full operability of all the hospitals/clinics/outpatient services/area clinics will probably take months. Much of the operability of the hospital depends on the time it takes for the city/county infrastructure to be rebuilt. This is emergency medicine’s surge capacity nightmare. The nearest fully functional hospital is 60 miles away.”

Cardinal Health is awarding more than $1 million in grants to help health care providers improve patient safety and health care quality. Last year Cardinal offered a similar program that resulted in grants ranging from $5,000 to $50,000.

Enterprise portal provider MEDSEEK announces its eMarketing Advisor service to assist hospitals improve web site effectiveness.

The Center for Studying Health System Change finds that, despite relaxed Stark laws, hospitals are not rushing to assist physicians with EMR costs. The Robert Wood Johnson Foundation-sponsored study found limited hospital budgets, conflicting projects, and lack of physician interest were all contributing factors. The third point goes back to a often discussed point that even a free (or almost free) EMR still isn’t enough to entice some doctors.

Note to Dysf(n): if “Tim” is a palindrome, perhaps “Inga” is actually “Agni”. (For the record, I’ve been told more than once that I am "hot").

E-mail Inga.