News 8/1/08

From The PACS Designer: "Re: faster networks. Sentara Healthcare has installed 10-gigabit Ethernet adapters to improve network speeds with the advent of large file sizes coming from newer modalities. TPD can remember when 10BaseT Ethernet was the rule in the 1980s, so we’ve come a long way since then speed-wise. Back then, the talk was ATM (Asynchronous Transfer Mode) was to be the big thing in networking, but Ethernet overcame that thinking with faster adapter cards that everyone could benefit from without ripping out existing networks. Now, the recent talk has been about Converged Enhanced Ethernet (CEE), and Fibre Channel over Ethernet (FCoE) to provide 10-gigabit per second speeds for both storage area networks (SANs) and the Ethernet protocols." Link 1, Link 2.

From Vanessa Loring: "Re: Jordan. I heard that Perot won the contract to install WorldVistA in the nation of Jordan despite promising not to bid on the work since they were involved in the initial selection. The point was to keep them neutral so they wouldn’t recommend a system they would later sell. My source is reliable, but consider it an unsubstantiated rumor." The customer must have agreed to ignore the contact clause, either for good reason or because they were easy to convince. Good for Perot in any case.

From Popeye Doyle: "Re: RelayHealth/HealthVault. Did you see this connection announcement? RelayHealth physician/patient connectivity engine and Microsoft’s HealthVault for personal health records. Interesting play for both organizations." It’s hard to guess the scope and importance of the deal, so it’s not obvious whether this is just another of many services available to HealthVault users or something bigger. I’m sure we can get more information.

From Jailbird: "Re: Microsoft. Oh, language. Regarding your quote of Bill Crounse, of Microsoft Worldwide Health. His comment: ‘I think the speaker from HSG was misunderstood.’ Note he puts the onus on the listener. Not that the speaker was unclear or may have misspoken, but the listener may have been at fault. Says more about the attitude and atmosphere of a company than most anything else." This was from an HIStalk posting last week in which a reader reported that Microsoft’s Health Solutions Group told the audience that they were not part of Microsoft and had their own support mechanisms. User error? Doubtful. I agree … instantly blaming the customer without even asking the HSG people what they said is a little too pro-company for my taste.

From Puff Daddy: "Re: press releases. What happened to the days of old where you called out puff press releases? Just because they are a sponsor you give them a pass? You called out Misys last year." I ripped them because of the idiotic headline they put on their puff release, which led off with "The Momentum Continues:" which seemed right up there with "It was a dark and stormy night" except it deviated from the press release convention of pretending to sound objective. It was unremarkable otherwise. As far as sponsors go, I’ve said repeatedly that the only benefit they get is that I’ll sometimes give a brief mention to their not-so-newsy press releases, usually without further commentary.

SilenceOfTheLambs says that a corporate e-mail confirms that Kevin Smith, the alliance manager of Intermountain Health Care’s GE relationship, has left the organization. I’m not sure anonymous confirmations count, but there you go.

From The Atlanta Observer: "Re: McKesson. Territory shake-ups and delayed commission payouts seem to be causing an exodus of good sales and client service people from McKesson. Jay Deady at Eclipsys seems to be the real beneficiary since he can just keep the door open in his cross-town office without even needing a headhunter." Unconfirmed and sales people change all the time (from both companies, in fact, and probably for those same nearly universal reasons) so I’m not reading anything into it other than it’s tough to be  in sales.

From Suziesales: "Re: pregnant saleswomen. [Name omitted] is laying off pregnant saleswomen about to go on maternity leave. Is this even legal? Seems you have to be a non-pregnant male to have job security at [vendor]." If an attorney wants to render an opinion I’ll run it here, although the details are skimpy. I’m leaving out the names of the manager and the vendor since I don’t know the story. I’m sure the legal answer will involve the layoff criteria, the mix of employees involved, and any FMLA complications (i.e., the company had better not be discriminating against pregnant employees, but on the other hand, pregnant employees  aren’t supposed to get preferential treatment over equally qualified coworkers). You can’t be dismissed simply for being pregnant, obviously, and I can’t imagine an employer doing that (or admitting it, anyway).

From Franklin Rose: "Re: Sutter. California Pacific Medical Center – flagship affiliate of Sutter Health – will dissolve ties with its corporate parent. Lack of a good business case for Sutter’s $1 billion Epic implementation is a driving force behind the divorce, among other issues." Confirmation of that fact would certainly be interesting.

From CommonSense: "Re: heparin errors due to confusion between 10 units/ml and 10,000 units/ml concentrations of vials in routine use. New machines, barcoding everywhere, sounds like a bunch of techies. maybe we should just make the vials/syringes a different color." Bad idea, actually. Color-coded tops cause more errors than they solve — there are lots of drugs and only so many colors. The last thing you want a nurse to do is choose your critical drug by color, container shape, or other memory shortcuts. There’s only so many ways to fix a problem in which people don’t read the label (pharmacy staff in this most recent example). Confirmation bias is a big problem (i.e., I’m assuming this drug is right unless I see something wrong and even then I might disbelieve my eyes). I’m all for fixing problems in the simplest possible way, but technology is the only way to go here (and of an unusual kind: that which automates/checks processes inside the pharmacy, not at order entry or administration).

From Bob: "Re: OHSU. On 4/13, OHSU became one of the first academics (if not the first one) to go-live with Epic inpatient on time, on schedule and on budget. Six weeks later, CPOE was live in adult care areas."

From Winston Zeddemore: "Re: HIPPA. Another bozo ‘HIPPA’ eruption. From the good folks at iHealthBeat, nonetheless. Copied and pasted directly from my email: ‘HHS Fines Providence Health for Previous HIPPA Violations.’  Ouch! Here’s a link, if they haven’t fixed it already." The link is dead and the article is now here, so they did change it. One good thing about printed publications: they can’t just change their mistakes and pretend they never happened. However, searching their site for ‘HIPPA’ provides two previous articles where they made the same mistake and this particular goof is preserved courtesy of Google’s cache. Busted. I’m sure I’ve made a few howlers myself, although the ‘HIPPA’ one is nearly unforgivable (even more so than ‘HIMMS’, maybe).

From Wink Martindale: "Re: EMRs. Thought you’d appreciate Waegemann’s recent discussion on ‘The Wrong National Strategy for EMRs’" Link. Peter Waegemann of MRI (a private business, not a non-profit like you might have thought, as I mentioned recently) says we’re on the wrong track. I don’t see much original there, although he advocates cheaper, non-proprietary systems and rips CPOE a little. Minor gripe: he argues that we need to "give low cost systems a chance" even if not CCHIT-certified. They’re available, so what more chance do they need? Nobody says you have to buy CCHIT-certified systems and if the market wants cheap systems, they ought to be selling (the real problem is that the market doesn’t want systems at all if they are inconvenient and provide no ROI to the purchaser, so cheap isn’t cheap enough).

From Christopher Little: "Re: HIStalk. Your site – because of its freshness, relevance and unswerving dedication to the light of day – gets a lot of good traffic, based on the traffic we see from it. We are close to some first closed deals, even." Chris is VP of new HIStalk sponsor Loftware and has a strong HIT background, so when he e-mailed that comment to me, I shamelessly asked if I could quote him. And so I just did.

I’m back after my longest Internet-less hiatus ever. Inga did a super job not only keeping up with the usual stuff, but also bringing in some guest authors, don’t you think? I see lots of page views and comments. Thanks to Jonathan Bush, John Glaser, Mike Gleason, Frank Poggio, and everyone who commented. Guest articles are welcome even now that I’m back, should you care to write one (including those "What I Did on Summer Vacation" tales that Inga was soliciting). Thanks, too, to Wompa1, who got Inga all bedroom-eyes’ed with his instant classic, "Ode to Inga."

Listening: Radio Birdman, short-lived, mid-70s Australian indie/punk. Still soundin’ good in cyberspace as I air-bass along with the lads.

Here’s a tiny ethical dilemma I’m struggling with. A vendor CEO wants to write something for HIStalk and I’m sure it would make a good read. However, in the past, the company has refused to confirm reader rumors I’ve asked them about, saying they have a policy of not responding to blogs. I’ve also heard that they’ve warned their employees not to post to blogs (including this one) unless the marketing department has reviewed their postings. Would you run the piece?

Tiny ethical dilemma two: a vendor PR person asked us to interview the division CEO (it’s a conglomerate). Those don’t usually go well because those folks (no offense) are hardly trail-blazing original thinkers and contrarians, being more company careerists unwilling to rock the mega-boat by being quotable. But, to be nice, we said OK. The company then e-mailed back that, upon further review, the CEO only does top-level print publications and conferences (i.e., HIStalk isn’t worth that person’s time) but they would offer up a general manager. We said no, figuring we were doing them a favor in the first place. Should we have interviewed the GM?

Going back on time, Inga was trying to confirm that Medsphere is moving its headquarters from Aliso Viejo, CA. It is (or has already moved, I should now say). Our contact says rapid growth required a doubling of space, so they’ve moved to Carlsbad, CA.

Layoffs coming: Elsevier (Orlando, FL), 77 employees over the next year. Select Speciality Hospital (Conroe, TX), closing and laying off 85 employees today.

A UK government minister with a glass-half-full perspective says that the roster of vendors pulling out of NPfIT, most recently Fujitsu, is actually great news. "The fact that Fujitsu’s contract was terminated is in fact a sign of the programme’s strength. The programme is still on course and our contractors are not paid until they have delivered. In that sense, no money has been lost." Expressing a preference to keep the project money rather than have vendors meet deliverables suggests that NPfIT was a bad idea in the first place, not that politicians are the best source of astute analysis.

The local paper covers the ED tracking system of A.O Fox Memorial Hospital (NY), which appears to be McKesson’s.

It’s a travesty, at least according to the ambulance chasers: Florida doesn’t require doctors to carry malpractice insurance as long as they make that fact known and pledge to personally cover at least $250,000 in a malpractice award. That reduces lawsuits, which of course reduces lawyer incomes, so personal injury attorneys are warning patients to steer clear of those docs (as a purely humanitarian gesture, of course).

Daughters of Charity CIO Richard Hutsell gets a mention in the San Jose paper for rigging streaming video that allowed a hospitalized patient to see his son’s wedding and reception (what, no live honeymoon coverage?)

Scott Shreeve weighs in on the apparent DoD-led conniving to dump VistA in favor of vendor applications. Given that DoD has given big consulting firms billions of dollars to develop its AHLTA system, you can bet that lobbyists are whispering in a lot of political ears to make VA follow the big bucks model, which unfortunately trumps any consideration of VistA’s superior track record. The VA has made some boneheaded and ego-driven IT mistakes, but VistA isn’t one of them.

Old news by now, but I’m behind: athenahealth bags a deal to provide software to up to 200 RediClinic retail clinics located in Wal-Mart stores. Interested HIT Investor saw it coming.

Jobs: Pharmacy Requirements Director, SurgiNet Case Tracking Consultant, Systems Administrator, Software Engineer, Healthcare IT Sales, Director of Marketing, Legal/Healthcare.

Data and information provider Verispan, started by Quintiles and McKesson in 2002, sells out to rival SDI. The company was most recently known for whining about a New Hampshire law that would have stopped them from selling prescription data to drug companies.

In Australia, the Victorian Department of Human Services says a letter that claimed all but one hospital there didn’t want Cerner Millennium was a hoax. It was not said who perpetrated it.

Tyson Roffey is named CIO of The Children’s Hospital of Eastern Ontario. The article doesn’t say, but I think he used to be director.

RSNA is healthcare’s biggest trade show based on exhibit space (which is the most important measure of all, apparently). HIMSS is a distant second. Maybe that’s why HIMSS is moving to expensive, cold Chicago next year, hoping to sell endless McCormick Place boat show acreage to close the gap.

Hospital for Sick Children (Canada) is testing IBM software that will monitor a constant stream of neonatal physiologic monitor data, looking for early symptoms of infections.

Aurora Health Care (WI) goes live with evidence-based nursing protocols developed with Cerner and the University of Wisconsin-Milwaukee College of Nursing.

The first HIMSS Middle East Conference will be held in Bahrain in May 2009.

I received a Rumor Report about supposed implementation problems at an Ohio hospital that certainly don’t sound characteristic of the vendor involved, including cost overruns on the $100 million project. I’m not naming names without on-the-record confirmation, so first-hand reports are welcome.

A reader is researching companies that need to audit hundreds of medical records from a single provider offsite. How do you get those records, especially if the provider uses an EMR? If you have thoughts, let me know and I’ll pass them along.

Atlanta’s Grady Hospital still needs a CIO if you need a challenge.

MediSolution (Canada) will sell its healthcare information systems business to Healthvision. I don’t know much about the company, but they have order entry, care plans, a portal, CDR, departmental systems (lab, rad, pharm), registration, scheduling, and EMPI. If anyone knows more about their products, chime right in because that’s a pretty broad line.

Odd hospital lawsuit: a Sutter hospital sues an elderly patient for trespassing after the family declines to sign her release papers. Sutter says she’s been in there for a year already and is ready for another level of care, blaming the doctors who say she should be moved to a subacute facility (are those still around?) or a nursing home.

E-mail me.

HERtalk by Inga

Yippee! Mr. H is back! My biggest fear was that no one would be reading while he was out, so thanks to everyone for hanging with me the last couple of weeks. It was fun, but I am glad that the pressure is off!

As Gwen Darling of HealthcareITjobs.com suggested, I am keeping the HERtalk name for my little piece of HIStalk real estate. We’ll just say that the “HER” part of the name stems from Bill Gates’ preference for women over EHRs.

Park City Healthcare (UT) has selected (warning: PDF) iMedica’s EHR/PM solution for its 10-doctor practice. I am hoping that Mr. H’s new friend Michael Nissenbaum will ask me to go onsite to interview the physicians and staff about the implementation experience. I am sure I can find a couple days during ski season to check them out.

I realize some people could care less about hearing some ex-Congressman talk about anything, but I wouldn’t mind sitting in on Tom Daschle’s keynote at Misys’s upcoming conference. He’ll be stumping a new book and sharing wisdom about the current state of the healthcare industry and what needs to be done to curb spending and provide all Americans with access to high-quality healthcare. I’d rather hear that presentation than sit through some motivational speaker’s rah- rah about ways to live life more fully.

Perot announces Q2 earnings, which beat analyst estimates. Revenues were up 11%, though healthcare rose just 3%.

Rice Memorial Hospital (MN) selects MEDHOST’s emergency department software for electronic documentation.

MEDSEEK announces a 67% increase in new contracts for the first half of 2008 compared to last year. Fifteen new US and Canadian hospitals signed up for MEDSEEK’s enterprise portal solutions.

HIStalk reader and Ironman competitor Ed Marx of Texas Health Resources was one of 11 people named to the Texas Health Services Authority. The organization is responsible for coordinating a voluntary and secure electronic health information infrastructure for the state.

Eclipsys releases Q2 earnings and revenues were up 11% year on year. Excluding certain items, the company earned 24 cents per share, better than the predicted 23 cents. Things sound pretty rosy.

ACS announces a couple of big wins. The City of New Orleans EMS signs a five-year, $4 million contract to equip ambulances with FIREHOUSE Mobile EMS software. Chump change compared to the $100 million, five-year contract with UMass Memorial Healthcare. The UMass deal is for extensive IS services and extends an existing six-year relationship.

Earlier this week I noted that Crescent City Physicians in New Orleans was moving to Sage EHR/PM. New Orleans EMS is adding some technology, and now Ochsner Health Systems announces it will deploy Carefx’s interoperability platform Fusion for 15,000 users. Sounds like healthcare facilities finally have the funds, time, and energy for HIT three years post-Katrina.

Michael Leavitt tells a recent audience he believes blogging is a very powerful engine for public policy setting. Though he has his own blog, I’m sure he was really referring to all the policy shaping contributions from HIStalk readers.

On that note, I am cutting it short tonight. I’m back to relying on Mr. H for the heavy lifting, witty commentary, and musical selections.

E-mail Inga.

Readers Write 7/31/08

Mike Gleason on Reasons Small Practices are not implementing EHRs a fast as we would like

A little history on me so you don’t think I’m some new hire right out of training class.

I first started in this field known as HIT in 1984. After completing a run in Washington DC as a Manager of a third party maintenance company I decided the switch to hardware support for a small company, (who doubled my salary) would be a great move. The second week at my new company as the new hardware support guy, every software support tech quit. Yep, both of them. Not due to me, mind you, but due to “budgetary constraints” or some people would say bounced paychecks. I had already bought my groceries for the week and I was able to stick it out till new checks were cut next Wednesday. (One time where it paid to get a keg vs. 2 or three 12 packs). I figured, “How hard could it be to support Medical software” and cracked open the user manuals and then quickly developed a relationship with my vendors phone support. And like all pain in the rear VAR’s I eventually worked directly with the president of the company. (Articulate Publications, Medicalis and Dentalis) He was also one of the chief software designers. Back then CEO’s still knew how to code too. I think Bill Gates retiring has completed that run as CEO’s who also code.

My journey of 24 yrs has lead me through titles of account manager, territory manager, inside sales, regional sales manager, Project Manager, Implementation specialist and a host of other titles with 3 prominent HIT companies.

Being an EHR implementer for the past 7 years has given me (I think) a unique perspective on why Dr’s make decisions and defer decisions. It differs for most Physicians’ but I think I can provide a few reasons. I’m sure it applies to all of us as well.

1. Fear
2. Ego
3. Money
4. War Stories
5. No one wants to go first
6. Product not perfected yet
7. Waiting on Govt mandates
8. Waiting on hospital install or Stark gift
9. I have people for that
10. Change

Fear

We all have it but MD’s and Nurses often fear the EHR implementation more than taking a rectal temp. Doctors don’t want to appear inept in front of their patients, nurses don’t want to feel inadequate when they are used to getting what they need in a few lines in a chart. Both have invested years in education and residency training and this little laptop can erase all that prestige in one office visit. Many clinicians start off training with these fears.

A proper implementation can alleviate most of these fears. Small steps like outlining the install process. Training the practice to customize their EHR so they feel comfortable making changes. Implementing in phases to minimize the changes. Outlining workflow ahead of time and training to your workflow documents are a few ways to calm fears.

I also like involving all levels of the practice in the implementation; this allows the whole practice to own the process.

So not only MD’s, NP’s, PA’s, LPN’s, RN’s and MA’s but also the Ultrasound tech, The lab phlebotomist, front desk, surgery scheduling, office admin, billing, etc. Many times in small practices these are the same people.

Involving the billing office is key. This assists in customizing with proper ICD-9’s, CPT’s, admin codes, modifiers etc., a benefit not often felt till we start passing charges from the EMR to the PM charge entry. We need to build the EHR customization so we are billing properly to maximize reimbursement.

I also recommend to all my installs prior to go live to take live patient charts randomly from the day’s schedule and complete a few notes per day with the current customization on test patients. This helps in guiding where you might need to add or adjust your customization. I also recommend Faxing sample scripts and progress notes to your own fax machine if possible from these same test patients. Set up a test pharmacy with your fax as the pharmacy fax. Print the DME scripts and the referrals and make sure you are happy with how they look. Seeing the fax coming out on your manual fax goes a long way to calming fears.

In typing this paragraph I’m reminded of an event at an install 5 years ago. I was teaching a nurse class and we often pair class members according to computer confidence levels. Experts with experts, newbie’s with newbie’s etc. I was teaching what I refer to as a catch all class. All nurses thrown into one class. One nurse was really struggling and I was not sure if she was just a smart alec or really dense… After struggling through the class we had a lunch break. I asked the nurse that was slowing down the class if we could speak in private. We went to a conf room and when I asked if there was anything I could do to help her get up to speed…. she proceeded to tell me with tears in her eyes that she had feared this EHR for this exact reason. She’s had a learning disability since elementary school and it was causing her to drop behind the other nurses. She was the Lab supervisor and felt she was looking bad in front of younger nurses that were better at computer skills than her and were thinking she was slow. I told her I was sorry for not noticing and offered to teach her over lunch breaks the next 3 days. She came every day and we spent our lunch hour teaching her the EHR instead of hitting Chick-Fil-a. This gave her confidence and she was very adept at the lab functions and able to run lab audits etc. by the end of my week of training and go-live support. On my last day onsite I came early about 7:30am and she called me into the lab. She introduced me to her husband who had come to work with her that morning. He wanted to meet me, shake my hand and thank me for helping his wife out and for helping her confidence in her job. He let me know she had not been the same for the previous 2 weeks and was complaining and thinking of quitting and he knew something at work was not right. Once we started our lunch training sessions he said she would come home and talk about what they learned that day and they made dinner together while she talked to him and she was so proud of sharing what she learned. He then gave me a bottle of wine from their favorite local winery, told me how proud he was of his wife and shook my hand and told me thanks for taking the time to work with his wife. She was just all giggly and had to show him all the lab screens and how she could replace manual processes with the EHR. I was blown away. I never realized how such a small thing on my part could help someone so much.

I still have that bottle of wine unopened on my desk…along with a Viagra clock a Urologist gave me for helping him learn to e-prescribe 4 years ago. My desk is littered with little drug rep tokens that all represent specific people at clients who have said thanks for taking time to give them some extra support to alleviate their fears. Even transcriptionists have thanked me. I collect these drug rep freebies as a hobby and my clients often show their thanks by presenting me with their favorite drug rep pens, clocks, note pads etc. I’m very proud of my collection all proud EHR students. Knowledge is power and power goes a long way in alleviating fear.

Ego

Not all installs go well. Many physicians think implementing an EHR turns them into a transcriptionist and they went to school to practice medicine and not type progress notes.

Also not wanting to look inept in front of patients applies here.

Money

We all know the reason here. New EHR or college tuition. Many Doctors are faced with tough monetary decisions every day.

War stories

Every practice has colleagues, or neighbors who have had a failed EHR implementation. These failed implementations are the bad news that circulates 10 times more than the one good install. I’m currently working with a solo MD that is now on his fourth EHR since 2000. Wish me luck.

No one wants to be first

Being the first is often a drawback for many physicians. They want to see what other practices implement and then ask them how it went.

Product not perfect yet

You see it all the time. Wait and buy the third generation of the computer not the first version. Vista is a good example of this. Many physicians’ think the current levels of EHR’s are just not advanced enough for them yet.

Govt Mandates

Why spend the money until the Govt says I need to? We all know this has occurred now with the recent house resolution. First they provide incentives then they provide penalties. Smart way to do it.

Waiting on local Hospital or Stark donation

Many practices don’t understand that hospitals move in 2 or 5 year increments not quarterly. If you’re waiting for a hospital to make a decision will they cover your loss of incentives and pay your penalties between now and 2010?

I have people for that

And many are the MD’s relatives… My mentor back in 1984 explained the HIT market to me this way. A doctor is the only business person I know that will place their business success in the hands of a high school graduate rather than a CPA or MBA. Meaning many office managers or front desk managers in small offices, are high school graduates with little to no business experience. Not as true today as it was back in the 80’s.

Man, many of these Doctors are loyal to a fault. I know many clients who have called me asking for advice on how to catch an embezzling biller, office manager, front desk employee. Or worse, how can we find out how much they stole? I have seen all types: Changing check names, billing false claims, taking cash payments, writing off to collectors that are their family members and getting kick backs. Many doctors have little fiefdoms and they love being the overlord. This can often cause them to become detached from their day to day operations. They often think, Doctors see patients and dictates, transcriptionists transcribe, nurse gives injections and prep patients to maximize my time, and medical records handles the charts. Sometimes the wife as the office manager really helps in this instance. If they are spending too much money at the office they have less to spend at home.

Many Physicians’ are very proud of how they can provide a living for their employees. They often develop deep bonds similar to family ties with employees. If you are selling them on reducing FTE’s know that they may not want to get rid of their “Family members”. If you approach it with freeing up the Medical records clerk so they can attend MA school or Ultrasound school to become a revenue generator they are much more receptive. One of my first large installs (22 MD’s) back in 2002 had over 8 medical records clerks in one office. Five of the eight were related to each other and they were all related to the office manager. Today the medical records room is gone and one person handles all incoming faxes electronically and scans all incoming paper and handles all outgoing faxes of medical record requests. They now have over 75 MD’s on the EMR with 3 specialties. What happened to the family members? One manages the records requests, two are MA’s, one is an office manager of a new remote office and one is now a PA. Key is: THEY ALL STILL WORK FOR THIS PRACTICE.

Change

Many people fear it some embrace it. Why is there such disparity? If you fear change it may be due to lack of knowledge or lack of a comfort factor. Training and exposure to the new workflow as well as input into the new workflow goes a long way in alleviating fear of change. I’ll be the first to agree many nurses and Dr’s can write in a chart faster than they can use an EHR. Keep in mind they have used paper for hundreds of years in medical charts. Tough argument to win with a new client only interested in time factors of documenting the current visit. Just ask them to run a report of all patients they gave X injection to with Y lot number and you will win that argument. Graphing lab trends from the last 3 labs also helps win this argument. I often take before and after pictures of the practice and bring them out at my 2 month follow up to show them how many paper charts were just laying around in stacks. You would be amazed at the change in just 2 months much less 2-3 years on an EHR.

One Dr had a funny take on it. He had a nurse that decided to retire after 25 years of nursing at the practice rather than under go EHR training. I was talking to him about it and apologized for not doing a better job of getting her trained enough to stay.

His reply? “If I knew all it took to get her to quit was implement an EHR I would have done it 2 years ago when I bought the practice!” That made me feel better.

Workflow documents are key here. Making sure the Dr and Nurse can get their pre EHR duties done quickly and easily helps many clinical staff to buy into the process at go live.

There is a process all clients go through. Some take 3 months others take 6 some take a year or two.

Phase one is the Go-Live. You are basically shooting for 100% EMR documenting as the goal and if you hit it you’ve done your job as an implementer. You may leave the practice somewhat worried if they can keep it up.

Phase two is when they can see the same amount of patients per day pre EHR vs post EHR. This can take 3 months sometimes. You do still get those freaks that do it from day one.

Phase three is when the practice starts looking for new ways to maximize efficiency and use modules like reporting, PQRI, advanced customization, interfacing more office devices, implementing lab or radiology interfaces etc. Show me more that I can do with your EHR. They become an EHR user who does not know how they ever worked on paper. These are the golden reference site,

So I think the rate of adoption in a small practice is a combo of all of these and maybe a few we have not thought of. Just my take on it from someone who is immersed weekly with new installs at new clients.

News 7/30/08

From: Esther. “Re: Picis. FYI – Just got notification from Picis that they have re-evaluated their offerings and are stopping enhancement on the nutrition services applications. From the letter – ‘Our decision regarding the direction for Dietary Manager is that it will continue to be fully supported, but we will no longer be actively enhancing the product.’ I’m sure that we’ll see more of this with the current state of the economy.” I checked in with Ann Joyal, Director of Corporate Communications at Picis and here is her response: “At Picis our focus is on delivering results in the high-acuity areas of the hospital (emergency department, surgery and ICU). In a recent evaluation of our product portfolio, we made the decision to de-emphasize our non-high-acuity products, including our dietary management product line. Even though we do not plan further enhancements, we believe these products continue to provide high value to the current customer base, and we will continue to support those current customers.”

From: Art Vandelay. “Wal-mart in Telemedicine – Hat tip = Health Populi. I saw the following on Health Populi. Wal-mart has now made a step towards telemedicine with University of Texas Medical Branch at Galveston. This touches upon two guesses in a post from nearly a year ago. I guess health care may start moving at Wal-mart speed. In the Health Populi link, be sure to check-out the ‘retail world is flat.’ If we can have data centers in containers, why not doctor’s offices?”

From: Trace Gal. “Re: HERSS. HERSS could stand for: Highly effective & remarkable sister systems OR Highly effective & remarkable superior systems.”

From: Music Guru. “Re: Inga Radio. I love your eclectic musical taste, Inga! Mr. H trips me up with all his “listening to” Eveel Kaneeveel– 70’s throwback with heavy influences from Echo and the Bunnymen, and BurkaBurka – Mongolian Rolling Stones tribute band (former screamer lead man from Your Yurt or Mine.) Does he actually listen to all that or does he just have a bad Indie music generator!???” I guess Mr. H really listens to his recommendations. Then again maybe he is making up all those funny bad names to see if anyone is paying attention. (In fairness, I think HIStalk Radio has many fans. Inga Radio is just more mainstream, I suppose.)

From: Hotstix. “Re: Inga Radio. I have listened to Pandora for about a year, and never could find that right eclectic mix of music . . . until YOU! I find myself listening to this constantly. Great music for the summer! I particularly like your selection of Alison Kraus.”

Virtual Radiologic announces their first international contract, a multi-year agreement with Lion City Radiology in Singapore to provide preliminary interpretations of CT and MRI studies for imaging centers affiliated with Lion City Radiology in Singapore and United Arab Emirates.

On Monday Virtual Radiologic also released it Q2 results, highlighted by a 22% increase in revenue from the same period last year. Adjusted EBITDA and adjusted income were both up 27% and 70% respectively. Net income was $.12/share. The market’s response was an 18% decline in the stock price.

The 38-physician, 12-location Crescent City Physicians (LA) has selected Sage’s Intergy EHR and PM solution.

British-based E-Health Insider obtains records that detail Milton Keynes Hospital’s Cerner Millennium deployment. The article outlines the numerous product and implementation difficulties throughout the two year project.  Though it sounds like a mess, I wonder if the situation is that much worse than situations we’ve seen here (with a variety of vendors.)

Premise names John Hannon as its new CFO/COO. Hannon served in a similar role at Mangrove Systems and was a GM/VP with Ascend’s Broadband Access group. The appointment coincides with Premise receiving $2 million in Series B funding.

The Healthcare Growth Partners folks have published a Q2 2008 Healthcare IT transaction report. The document provides an excellent overview of the capital markets and M&A activity. Despite a gloomy economy, the HCIT world seems to be faring better than most.

Eclipsys reports they now have more than 1000 trained pharmacists and technicians using Sunrise Pharmacy.

Several Nuance products received high rankings in KLAS’s new Speech Recognition report. PowerScribe for Radiology and RadWhere for Radiology took the top spots for front-end speech recognition category; eScription and Dictaphone Enterprise Express Speech System claimed two of the three top spots for back-end speech recognition vendors.

Business intelligence and patient outreach solution provider MedVentive names  Nancy  J.  Ham  as  president  and  a  member  of  the  Board  of  Directors.  Ham formerly served as president of both Sentillion and Proxymed. The appointment coincides with the closing  an  additional  $3.55M  Series  B  investment  from  existing  investors.     

3M and Sonitor are teaming up to provide Sonitor’s Track and Trace RTLS technology to 3M’s customer base.

For about 400,000 yen ($3,700) you can buy a Japanese “Intelligence Toilet” that allows you to stand at your bathroom sink to measure and record your blood pressure, blood-sugar, weight, and body-fat. Clearly the coolest thing about the product has to be its name.

Healthcare analytics company MedeFinance has secured $50 million in funding, led by Bain Capital Ventures. Mede plans to fund new growth initiatives and acquisition opportunities.

The Military Health System awards General Dynamics a contract worth a potential $5 billion. The 10-year “indefinite delivery, indefinite quality” agreement is for planning and management services. I don’t understand what indefinite delivery, indefinite quality means but it sounds like I need to include that term in my next employment agreement.

I’m happy to report that Mr. H should be back any day now!  My stint has been made perfect after receiving this long-awaited love sonnet (of sorts) from Wompa1.  It’s a masterpiece.

Ode to Inga

Prosperous and informative laid the Blogdom,

Mr. H, sometimes jaded, leader of thought,

Glanced at his site tracker,

And smiled at what he wrought.

Then they came in numbers too great,

Asking for more, too much more of him,

Mrs. H never saw him,

He said “enough! I’m almost dead Jim!”

He sounded the electronic call

Throughout the Blogdom went the story, (okay not really)

“I can’t report it all,” he said,

Is there one who will cover ambulatory?

He clings to hope,

Who will answer his cry,

Golden locks flying,

She stands and calls: “I.”

She stood tall and bold,

The German princess, the mystery,

All we see

Is Angelina Jolie.

The golden maiden brought

A true golden age,

Like Mr. H.,

She too was a sage.

Brave the maiden Inga,

Ready to don the crown,

When Mr. H.,

And Mrs H. find themselves out of town.

Endless toiling,

Searching the news,

Pausing but seldom,

To shop for new shoes.

O but heavy is the head,

Power feeds the need for more,

First the HIMSS doubles,

Dare we wonder what’s in store?

As the pendulum swings too far

The temptation too great as such,

HIS becomes HERs

The chance to seize it; too much.

But she is steadfast and trusty,

The king’s lands will not burn,

The watchful warden holds

The keys ‘till his return.

HIStalk Guest Writer: Frank L. Poggio and The Ten Commandments of Healthcare Information Technology

Since joining HIStalk, I’ve  been surprised numerous times by our readers’ impressive credentials.  Looking over the subscribers list is a bit like reviewing a Who’s Who List of HIT leaders.  Today’s guest writer has is right up there with the best of them.

Today Frank is President of the Kelzon Group, a firm specializing in healthcare information systems consulting.  Over the years, he was GM of Mediware’s Blood Bank Division, President of Citation Computer Systems, and founder of Health Micro Data Systems (the developers of the first client/server-based system for healthcare organizations that later merged with CITATION and was  subsequently acquired by Cerner.)

Have fun reading!

– Inga

The Ten Commandments of Healthcare Information Technology

(or, What Moses downloaded while on the mountaintop!)

It is a little known fact that Moses was not only a prophet, but also a hospital CIO. That fact should be self evident when you think about it. Prophets communicate critical information from a unique source to the rest of the organization. What the organization does with that information is beyond the control of the prophet. The prophet can neither require the masses to listen to it, nor does he have the power to require the masses act on it. Sounds pretty much like today’s CIO!

So, thousands of years ago when Moses went to the mountain top what did he download into his ‘Blockberry’? Fortunately, Moses was big on backups and he would routinely transfer his electronic files to stone carvings. Recently while excavating in a cave in the middle-east I came across his backup tablets, which included Moses’ original annotations!

HIT – Commandment 1

Thou shall never have enough project time.

Annotation: Actual project development always takes at least three times longer than planned. God created the world in six days. That was the first and last project ever completed on time, which is why s/he could rest on Sunday, and you can’t.

HIT – Commandment 2:

Thou shall never have enough resources.

Annotation: All projects will exceed budget by at least a factor of two. God made man a wasteful and inefficient being. Hence, there can never be enough resources.

HIT – Commandment 3:

Thou clinical users shall constantly and continuously change requirements and medical protocols.

Annotation: Medical requirements will always be changing and usually at the worst possible time. God created nature to be in constant change so why shouldn’t user requirements?

HIT – Commandment 4:

Thou shall always upgrade when least convenient and unprepared.

Annotation: New version will always set you back a month and reverse all previous fixes. Failure to install new versions will bring seven years of famine.

HIT – Commandment 5:

Thou shall sunset immediately.

Annotation: As the sun rises, so does the sun set. And clinical system vendors know this and therefore will sunset their products immediately after sunrise (a.k.a. go live).

HIT – Commandment 6:

Thou shall forever run legacy systems.

Annotation: Once a system is installed and running it must live forever. To ignore this commandment will bring a plague of bugs, glitches and gremlins on your hospital and all that work there.

HIT – Commandment 7:

Thou shall not worship newer technologies.

Annotation: There is only one technology and there will be no technology after it. True believers know the next best technology never is, and cannot be. To believe otherwise is blasphemy and all who do will be destined to spend all eternity in the hell of constant upgrades.

HIT – Commandment 8:

Thou shall not idolize the demo.

Annotation: The demo is Satan. To believe in the demo is the ultimate sin.

HIT – Commandment 9:

Thou shall never be trained.

Annotation: Your staff will never get enough training, the vendor will never deliver enough training hours, and even if he did you could not afford to pay for them.

HIT – Commandment 10:

Thou shall never have enough support.

Annotation: Vendor support will always be insufficient, and if it ever is sufficient, the vendor will quickly install a new release (see Commandments 4 & 5).

In our archeological diggings we could see that there were more stone tablets but the erosion from weather and wind exposure made them all unreadable. I am sure most CIOs can guess at what they said.

News 7/25/08

From: Dr. John. “Re: Purkinje. EMR vendor Purkinje is going to focus on its Medicare Advantage insurance and cut/reduce is EMR software sales business. Guess they see the insurance business being more profitable than the EMR software business….duh. Unfortunately, they let go some really talented folks!” I reached out to the Purkinje folks but didn’t hear a response back, so currently unconfirmed.

From: Steve McGarrett. “Re: Hawaii. The situation in Hawaii is a mess, especially the Neighbor Islands. The North Hawaii Community Hospital situation is a bit different since that’s a private hospital as opposed to Kona which is part of the state system. If you can believe it NHCH even kicked Earl Bakken to the curb. Something is wrong when that happens to the guy who developed the wearable pacemaker, especially when you consider that he helped found the hospital a dozen years ago. If you want more info regarding the situation both Big Island papers have run numerous articles. The Kona paper is at www.westhawaiitoday.com and the Hilo paper is at www.hawaiitribune-herald.com. Keep up the good work while Mr. H is away.”

From: HERbie. “Re:  HERtalk. Hi Inga – the acronym is fine as is. Whenever you try to type ‘EHR’ in an MS Office document, spell check auto changes it to HER. I’m sure I’ve sent dozens of emails with ‘HER’ instead of ‘EHR’ thanks to the spell checker (Of course I could always go to the custom dictionary and fix it once and for all.) The story could be that you tried to create the blog as EHRTalk but spell checker changed it to HER.”  That makes perfect sense to me, especially since I’ve never figured out how to make the custom dictionary not auto correct HER (see – it just did it again.)

From: ElsieEHR. “Re: This and That. HERtalk — Simple: HER = Healthcare Electronic Records… Especially since any time you type "EHR" in MS Word, the AutoCorrect option changes it to HER. Hospital Layoffs — UMDNJ may cut 300 jobs, according to today’s Star Ledger (Newark, NJ). You say tomato — C-C-H-I-T vs. C-CHIT; H-I-S-talk vs. HIStalk. I always sort of slurred the name, saying H-I-S-stalk (as in ‘stalker,’ but I guess it could have other meanings as well).”

From: HERcules. “Re: I wonder, while you’re busy changing HIStalk to HERtalk, whether you want to send up any test balloons on changer HIMSS to HERSS. What on earth would THAT acronym stand for? Love your blog. Keep up the good work in Mr. H’s absence.”  I’ve been working on this one all day and nothing yet, so creative assistance appreciated.

From: Mountain Man. “Re: Layoffs – What does all this mean? It means that margins are razor thin, that reimbursement is down, expenses are up. Healthcare is not immune to the economic strife that the rest of the country is in. Starbucks closed stores, GM and Ford can’t make it and your small business owner is closing at alarming rates. We have to do more with less. This my friends is where we are all so important to the solution. The solutions we provide to the end user, will help us deliver better quality care at an overall lower unit cost. Technology is the only way Healthcare can be delivered in a more efficient way that is safer for the patient. The use of Technology to drive real change will be the salvation of healthcare as we know it today. These layoffs are treating the symptoms of rising costs. The cure is to be more efficient and the magic pill is technology.”  I am afraid Mountain Man (LOVE that name) is right.  Healthcare institutions are cutting back, as well as the vendors.  Look for more sales reps to become more virtual because companies can’t afford to send them to every last hospital and doctor’s office. Which will lead to more competition for those post-cheerleaders wanting to become drug reps.

From: Angela. “Re: Microsoft’s Health Solutions Group. I recently sat through a support presentation with Microsofts Health Solutions Group. I left confused. They keep referring to themselves as NOT Microsoft? One of the value propositions for us is that they ARE Microsoft and we can assume the same quality care and support that we are used to getting. The speaker made it sound like they had their own support group and infrastructure. Needless to say this was a huge turnoff for most of the staff. Granted Microsoft’s support had some issues in the past, but our Premier contract ensures that we get the help we need when we need it. I am really puzzled by this. Can anyone out there confirm that the Healthcare group is starting their own support organization? I mean when you have a world class support structure why in the world would you re-invent the wheel? Not a very strong selling point. We are still discussing the opportunity but someone needs to tell the healthcare group that coming across as a stand-alone company does nothing to enhance the sales process.” I was able to connect with Bill Crounse, Senior Director for Microsoft Worldwide Health. His comment: “Thanks for drawing this to my attention. I think the speaker from HSG was misunderstood. While our Health Solutions Group is developing their own sales and support channels, they are very much a part of Microsoft. If anything, their desire is to exceed the service levels people have come to expect from Microsoft.”

Yesterday’s Guest Writer was athenahealth’s Jonathan Bush, who raised questions about what can be done to encourage small groups to use EMR. No one seems to have a reasonable model that addresses the true effect of EMR, especially in a small office. Jonathan closed his post saying, “One of the core reasons I like Mr. HISTalk, Inga and this blog so much is that it has emerged as a disruptive presence in how folks in our industry get their news and discuss topics and trends. So let’s discuss this…maybe we can get an actual dialogue started here that will begin to disrupt our industry’s stagnant approach to the small physician market.” The dialogue has clearly started with many folks weighing in. The only consensus so far is that the issue is complex, and, that the smaller the office, the more the human factors affect the project’s success or failure.  I wonder if there are any doctors out there in small practices that want to brag about all the extra money in his/her pocket because of a great EMR install.

Misys announces its preliminary annual earnings for the fiscal year ending May 31. Overall revenues were up 6% and operating profits 37%. In the healthcare division, both revenue and total order intake were up 2%, though ILF revenue declined 2%. Maintenance and Payerpath revenue seem to be sustaining the group with revenues up 6% and 4% respectively. An 85% increase in operating profit from 11% to 20% indicates all the cost-cutting activity has had an impact.

McKesson announces their Q2 earnings (flat,) though profits rose 9%. Actual profits were $.03/share less than analysts’ predictions, coming in at $.77/share. McKesson raised its full year earnings prediction to $4-4.15/share.

Hayes Management Consulting and InterSystems are partnering to provide InterSystems Ensemble to the global healthcare IT market. Hayes plans to develop solutions to integrate disparate healthcare systems for business and clinical end users.

For those of you missing Mr. H’s music recommendations, give Inga Radio a try, though I should point out tastes are definitely different than Mr. H’s HIStalk Radio. Some recent favorites: Jon Nolan, Keb’ Mo’, Andrew Lipke, and Etta James.

Medavant (aka Proxymed) has had numerous troubles over the last year or so, including upper management turnover, a troubling auditor’s report, sell-offs of multiple assets, and major revenue declines. When Medavant filed for an extension on their 10-Q in May, Mr. H noted that it "wasn’t a good sign." This week Nasdaq issued a notification that the stock price had failed to maintain a minimum $1 stock price for more than 30 days. The fact the company filed for Chapter 11 bankruptcy protection Wednesday is thus not much of a  surprise. With problems going back so many months I don’t believe you can simply blame the situation on a softening economy. However, it does make one fearful that over the next few months we’ll see more HIT vendors struggling to their keep their lights on.

Coming soon: a new online source for deciphering your elderly mother’s various medications or determining if your itchy skin is poison ivy (and not some sort of skin-eating strep.) Medpedia, the world’s largest collaborative online medical encyclopedia is launching at the end of the year. The Wikipedia-like project is a big collaborative effort between multiple healthcare institutions and all the contributors either PhD’s or MD’s.

The Illinois Primary Health Care Association is implementing NextGen products in five affiliated health centers and potentially 25 more in later phases.

If you are bound for Epicland, you’ll be happy to read about plans for a number of boutique-style hotels in Madison, Wisconsin. All are being designed with the tech-savvy traveler in mind and promise to be swank, hip, and priced in the mid-range.

Blue Ridge Medical Management (TN/VA) expands their investment in Misys products, adding 125 new Vision licenses. Blue Ridge bought an additional 250 Vision and 325 Misys EMR licenses to provide hosting for East TN State University College of Medicine.

Kudos to the 700 GE Healthcare employees from South Burlington (VT) who helped Habitat for Humanity build five homes for people in need.

HIMSS announces new officers and board members.  Charles E. Christian and Liz Johnson are the incoming chair and vice chair along with eight other board members who officially started July 1.

Thanks for all the encouraging notes, by the way. I know everyone is missing Mr. H’s expert commentary and amazing wit, so I am thankful you are sticking with the under-card in his absence.  I’m feeling the love, though I’m still waiting for those love sonnets to come my way.  Email me.

HIStalk Guest Writer: Jonathan Bush and Getting Small Groups to use EMRs…with no Cash Promise

I met Jonathan Bush right after the HIStalk/Healthia cocktail party at this year’s HIMSS conference.  As a HISsie winner in every category he or his company was nominated, athenahealth CEO, President, and co-founder Jonathan Bush was gracious enough to receive his honors in person and then entertain the crowd with his commentaries on HIMSS, the industry, and boat shows.  After the festivities, I went to whisper in his ear that I was "Inga" and he thought I was trying to give him a peck on the cheek.  Of course in return he gave me a little air kiss – and then a big laugh when he realized I was just trying to tell him my secret (it was so very cute.) 

Besides being cute, Jonathan has proved to be an innovative and successful leader, leading his company to last year’s most successful IPO. And he is big HIStalk fan (I think he and Mr. H are tight.)  We appreciate and thank him for taking the time to share his wit and wisdom with other HIStalk readers!

– Inga

About 50% of doctors practice medicine in small groups. The vast majority of them don’t use EMRs. Why not?

For the past 5 years, we have seen a huge uptick in the buzz around the adoption of EMRs and what it will mean for healthcare. EMR software companies issue press releases on new functionality or new versions and the prospect of a paperless delivery system. With all this innovation by software companies, and HIT conferences popping up every month to discuss "interoperability" and "standards," why on earth haven’t more doctors in small groups adopted EMRs?

Better yet, why do the small-doc practices that have EMRs resist using them to their fullest advantage?

The other day I was on the phone with a Wall Street Journal technology reporter, discussing the lack of adoption of EMRs by physicians practicing in small groups. I was glad this got the attention of a journalist who doesn’t normally cover healthcare. A little over 8% of 1-3 doctor practices have some kind of EMR…and the actual usage of "fully functional" EMR technology stands under 5% (data from MGH’s Institute for Health Policy). Earlier, more optimistic estimates were closer to 15-20%, but so far, no go.

The problem is, EMRs are usually tools, not services, I explained. If they were services that docs could use properly while increasing cash flow, they’d be flying off the shelf.

So the journalist asked a reasonable question: How much cash flow does athenahealth’s EMR service provide for physicians?

And I had a totally unreasonable answer: "Uh…"

The fact is, I don’t know! Here’s what I do know: Our EMR increases cash flow by removing paper from the process. Unlike old school EMRs, our athenaClinicals service handles all of the documents that enter our clients’ office as part of the service.  So far, that’s more than 60 documents every day per FTE physician — 68% of which would have to be handled manually by the client. This means that even if they had traditional EMR tools, our clients would still be handling a large portion of their documents manually. But how much was it costing them to handle those manual documents before they got onto the athenahealth network?? Not the foggiest clue. What about if they got some consultant or custom programmer to build a bunch of interfaces and maintain them every time something changed at the lab?  Not sure, but it sounds ugly and expensive to me.

What’s the solution? Actually, I’m not sure. What do you guys think? Invest in a time study? Wait for real P4P payments to kick in before the REAL docs out in the community adopt or let the academics with endowments lead the adoption wave?

So I will stop my post here, because one of the core reasons I like Mr. HISTalk, Inga and this blog so much is that it has emerged as a disruptive presence in how folks in our industry get their news and discuss topics and trends.  So let’s discuss this…maybe we can get an actual dialogue started here that will begin to disrupt our industry’s stagnant approach to the small physician market.

News 7/23/08

From: Susie Q. "Re: CCHIT. I recently sat in on a CCHIT workgroup and was amused by how much time was spent emphasizing that the correct pronunciation is ‘C-C-H-I-T’ and not ‘C-CHIT.’ I can’t figure out what the big deal is. As if this branding distinction is a) going to work and b) be meaningful if it does. It’s notable, if simply funny, that this is what they are worried about.” Too bad Mr. H is gone because this would have been the perfect opportunity for him to remind readers this blog’s name is “H-I-S-talk” and not “HIStalk” (as I always and still call it.) The rebel that I am I’m sticking with C-CHIT.

From: Eclipsys Observer. “Re: Bob Elson. Inga, I just heard Bob Elson is no longer with Eclipsys for about 2 weeks now. Any thoughts on why or where he went?” I was able to track down Dr. Elson and he confirmed that he is the “former” CMO for Eclipsys. Says Elson: “I left Eclipsys on July 1st to pursue other interests.” The only other thing he mentioned in his note is that he is a “big” HIStalk fan.

From: What Happens at Eclipsys Stays at Eclipsys. “Re: Changes. There are lots of changes going on. There is a huge push to increase our KLAS scores, everything is now tied to those (perf evals, bonuses, etc…) Services impact that the most, hence the changes in Stearns and Wagner.” Eclipsys is announcing second quarter earnings on the 30^th so we will see soon enough if financial considerations play any part in the changes.

From: Wondering. “Re: Kevin Smith. I heard an unconfirmed rumor that Kevin Smith, head of the GE/IHC partnership at IHC is gone.” Anyone?

From: Dyan Cannon. "Re: Hospital Layoffs. Good Samaritan Hospital in Suffern – 80 employees, union & nonunion. This follows a layoff of 57 in February.  North Hawaii Community Hospital – 59 employees (~13% staff reduction.) Kona Community Hospital – 55 employees (looks like Hawaii has seen better days!) Ingham Regional Medical Center – 100 employees.  St. Peter Regional Treatment Center – 32 employees, possibly up to 100 total by September." That’s almost 400 people. I will defer to you industry experts to explain what it all means.

The Military Health Systems claims no decision has yet been made about what EMR could replace the VA’s Vista. The MHS press release contained a bit of an update on for work on the AHLTA system and the VA’s VISTA electronic health record.  No clear indication if the plan is to update/converge/replace. Posters on the MHS site are expressing dismay at the billions already spent, at suggestions of a piecemeal option, and at the current usability limitations with the products today.

Cerner announces Q2 earnings, beating analyst projections by $.01 per share. Profits were $.10 a share higher than last year and Cerner predicts full year revenue growth to be about 10%.

Loftware announces the official debut of its new healthcare specific blog, designed to promote product identification and labeling in the healthcare industry.  The Loftware Blog on GS1 and Healthcare is found here.  While checking out their site I noticed that the Premier healthcare alliance has become the first group purchasing organization to endorse GS1(R) supply chain standards, requiring all their contracted medical device manufacturers to commit to the standards.

DATATRAK International has retained Healthcare Growth Partners to explore a possible sale or merger. DATATRAK provides eClinical solutions for the clinical trials industry.

Arnot Health is replacing their Mediware perioperative solution in light of Mediware’s announcement to no longer invest in operating room software products. SIS Essentials from Surgical Information Systems is the replacement product.

HHS predicts Medicare will save up to $156 million between 2009 and 2014 as physicians migrate to eRX solutions. The savings are attributed to the avoidance of 1.5 million adverse drug events.

The lovely Gwen Darling of “Healthcare IT Jobs” fame (details to your right) pointed out that in light of Mr. H’s extended leave, I should take the liberty of renaming the blog HERtalk. We separately spent time drinking wine with girlfriends over the weekend and attempted to come up with the perfect name to match the acronym. My working name is Healthcare Estrogen-Reflected Talk but email me with any other creative suggestions.

HIMSS and the Electronic Health Records Vendors Association (EHRVA) announce the election of a new chairman, vice chairman, and six executive committee members. Greenway VP Justin Barnes will lead the group and McKesson Physician Practice Solution chief medical officer Dr. Andy Urdy takes the vice chair spot. The new members include Michele McGlynn (Siemens,) Charles Parisot (GE Healthcare,) Charlie Jarvis (NextGen,) Rick Reeves (CPSI,) Don Shoen (MediNotes,) and Steve Tolle (Allscripts.)

The Barbara Ann Karmanos Cancer Institute (MI) has contracted with Eclipsys for the deployment of its Sunrise clinical/revenue cycle solutions.

McKesson recognizes six healthcare organizations for vision, innovation, and results-driven performance using McKesson and RelayHealth solutions. Here for the list of 2007 VIP Award winners, each of whom wins a  $10,000 grant to their foundation or charity of choice (I like that part.)

A Florida bookkeeper is accused of setting up phony corporations with names like “Cardinal” and “McKesson” to steal several million dollars from her oncologist employer. Over the least eight years, she created checks payable to her non-existent entities, often instead of paying the real pharmaceutical companies.

Siemens has formed a strategic partnership with Imprivata to market their OneSign SSO solution to its customer base.

Opus Healthcare Solutions introduces its OpusLaboratorySuite solution which includes remote reporting, allowing clinicians to view results on a smart phone or PDA via a cell phone network or hospital Wi-Fi connection. The product works with most major HIS products.

I was giddy seeing all the comments in response to John Glaser’s guest posting.  I promise we will have an equally entertaining guest writer tomorrow. Send juicy news my way and thanks for reading!

HIStalk Guest Writer: John P. Glaser and The Top 10 Cool Things About Being a CIO

When Mr. H started making his vacation plans, he determined only an elite group of HIT superstars could fill his shoes. Or, perhaps he concluded only a few people would want to contribute to an obscure blog. In any case, Mr. H asked but a handful of experts to provide guest columns in his absence. Partners HealthCare Systems VP and CIO John Glaser was definitely on his short list.

Mr. H and I were thrilled he agreed to participate because he is a funny guy. And, John’s credentials are certainly pretty stout as well. He is the former IS VP at Brigham and Women’s, was CHIME’s founding chair, and was a past HIMSS president. Additionally, he is a PhD, a HIMSS, CHIME, and American College of Medical Informatics fellow. Plus now a published HIStalk Guest Writer.  Enjoy!

– Inga

I have been a CIO for a really, really long time – over 20 years. And while I wasn’t sure about the role at first, after a while it kind of grew on me.

I was asked – what are the top 10 cool things about being a CIO? There are 10 things that I like but I could only remember 7 (this job does nothing for your memory or intelligence).

You get to go to lots of meetings. I realize that most meetings are pretty boring. But they can hardly be called hard work or dangerous work. All you have to do is be able to sit for long periods of time, avoid dozing off and be able to make up facts should a question come your way.

How hard can this be? You don’t have to actually do anything substantive like write code, support users or write documentation – you just have to show up at the right meeting at the right time and keep your eyes open.

You get to go to lots of conferences and events. In order to “stay on top of the industry,” “develop a valuable network of colleagues” and “engage in meaningful dialogue with vendors and consultants” you have to go to multiple conferences and events. Usually these are held in nice places, give you time to play golf, result in your being fed well and provide you the opportunity to wear a badge with colored ribbons.

Your staff are back at the ranch slaving away while it is snowing outside. You, on the other hand, are advancing the organization’s strategic IT agenda as you toss down a couple of cold ones with industry movers and shakers – pool side.

You get to give lots of presentations. The board wants to know the IT strategy. The organization’s leadership wants to understand that projects for next year. Your staff want to hear about efforts to improve the effectiveness of the IT department. As a result, you will need to give lots of presentations. Presentations give you opportunities to show really cool moving bullets, present graphs that build, play video clips, listen to audio clips and, if you’re really good, leverage a hologram or two.

Don’t worry about substance. That isn’t the point of presentations. Entertainment and high tech wizardry are the point.

You get free publications. To get free industry publications all you have to do is fill out the qualification card that says that you approve every IT decision in the organization and that you have installed every technology ever made and that your organization is going to be engaged in major buying decisions in the next year. You may not know what some of this equipment does. You may not know if you really have this hardware or that operating system installed. And you may not have a clue what the IT purchasing plans are in the year ahead.

This doesn’t matter. The publication doesn’t really care whether your responses are accurate or not. They just want to show advertisers that they have important readers so that they can charge top dollar for a full page ad. Once you get the publications you don’t have to read them other than to scan them to see if there is a picture of someone you know. You should however keep big stacks of these publications in your office. This helps to create the aura that you are well informed – see next section on pronouncements.

You get to issue official pronouncements. Every now and then you are expected to make important decisions. Which vendor should we choose? Should we participate in a RHIO or not? Where should we make budget cuts?

You might be worried about the pressure to make the right decision. Relax. All you have to do is decide. You don’t have to be right or wrong – you just have to decide, announce your decision and deliver that decision with a tone of voice and a body posture that indicates that this decision is well considered.

If you want help in deciding you can use the Magic Eight Ball or Rock-Scissors-Paper. Don’t let the rest of the organization see you do this – it has a way of diminishing the appearance of the decision being well considered.

And if someone points out “That decision you made last year didn’t work out so well. What happened?” All you have to say is, “Overcome by events.”

You get a nice office. Being a CIO generally means that the organization gives you an office in the same area as the other muckety-mucks. This office is usually large, has plush carpeting, is appointed with a big desk and a mini-conference table and has a really big screen to go with your ultra-fast computer. Plus there is free coffee nearby.

You may wonder – why do I need all of this space? And why do I need the space to be this luxurious? You need the luxury so that you can appear important. It is important that you appear important when you make official pronouncements. The key part of the space is to have enough room, on the carpet, to lie down and take a nap. Being a CIO can be tiring.

You get free doo-dads and trinkets. Conference exhibit halls (particularly HIMSS) have dozens of opportunities to stock up on pens, key chains, little flashlights, coffee mugs, note pads, bags and lots of other quality merchandise. Vendors, in an effort to grab your attention, will mail you golf balls, radio controlled cars without the radio controls, umbrellas, kaleidoscopes, back scratchers and shirts. And you get all of this because you are top of the IT heap (and you filled out your qualification card as I instructed above).

You have family presents for all of the major holidays and life events for the rest of your life. You can use the shelves in your spacious office to exhibit your loot. While you have meetings in your office you can invite the attendees to play with the doo-dad of their choice helping you to avoid a conversation that you’d rather not have.

These doo-dads and trinkets show you that, while the rest of the organization thinks you should be shot, your vendors and consultants care enough about you to send you presents.

My CHIME colleagues may not admit it. But the above reasons are the real reasons that we are all glad to be healthcare CIOs.

News 7/18/08

From Dr. Bob: "Re: The origin of Johns Hopkins name. Oh Inga, spelling Johns Hopkins without the ‘s’ is like spelling Wahington or Pittburgh. :-)) Wikipedia  explains the origin of Johns Hopkins’ name. ‘The peculiar first name of philanthropist Johns Hopkins is the surname of his great-grandmother, Margaret Johns, who married Gerard Hopkins. They named their son Johns Hopkins, and his name was passed on to his grandson, the university’s founder (1795-1873).’ Also, at the end of the Wikipedia entry there is a humorous piece about Mark Twain and John(s) Hopkins.” Ug. Mr. H. hadn’t even closed his suitcase yet and I committed a major sin! I’m blaming it on my post-vacation fuzzy head. I loved this history lesson, though, and Mr. H says the Mark Twain reference is a must read.

From Rosemary Thyme: “Re: Sage Software Restructuring Response. She’s right. Sage Healthcare is not a callous company. Her quote, on the other hand, was callous. More so now that she’s confirmed there wasn’t a misquote. In context or out of context, reporter or no reporter, sensitivity matters in situations like this. It matters to those that are leaving and to those that are left. Sage shouldn’t have sent the SVP of sales in to publicly represent management’s decision to be open about employee lay offs. They reported that the cuts to sales and other "customer facing jobs" were minimal. So why send sales and marketing in to comment on such a strategic corporate action?? We should’ve heard from someone closer to it. Sales should be selling. There are 1400 employees left that are counting on the revenue. Calling it a PR mistake and moving on.” Ms. Thyme is referring to the recent HIStalk comment from Sage sales VP Sharon Howard.

From Dyan Cannon: "King-Harbor Hospital in LA just can’t stay out of trouble. The hospital made headlines in 2007 when it left a dying patient on the ER floor for 45 minutes, going so far as to “mop around her.”  Shortly thereafter, the hospital lost huge amounts of funding and limited to outpatient care.  Now, after talks of trying to breathe new life into the hospital by UC, King-Harbor has fallen under public scrutiny yet again.  Following a company wide background check, 16 employees have been suspended for undisclosed criminal convictions, one of which includes rape.  This, coupled with reports earlier this month that 22 former employees connected with the closure of the hospital are still employed by the county as a result of a ‘computer glitch,’ simply adds mileage to the already lengthy rapsheet they’ve developed.  I’d be curious as to the burnout rate of their Human Resources and Public Relations departments."

From Who Knew: “Re: Medsphere. Medsphere is moving offices to Carlsbad. Downsizing? Upsizing? Better surfing further south?” I asked Medsphere COO Rick Jung and he said the company is indeed packing their bags (no mention of surfboards, however.) “I can confirm Medsphere is indeed moving as the rapid expansion of our Company has required we more than double our physical space. Our new offices are in Carlsbad, CA.”

Medsphere, by the way, also just announced a new partnership with WebReach, Inc. The agreement provides Medsphere with comprehensive support for WebReach’s healthcare messaging integration engine which facilitates interfaces and data exchange within the Open Vista EHR.

GE names John Dineen president and CEO of its $17 billion healthcare division. Dineen moves from GE Transportation where he held a similar role. Dineen is a 22-year GE employee, though this appears to be his first stint in healthcare. Will his healthcare deficiency help or hurt the division?

TeraMedica and Hyland Software team up to create faster physician access to medical images and other types of clinical digital content through healthcare organizations’ existing EMR systems.

PatientKeeper announces its MEDITECH customer base now includes over 200 hospitals.

Mr. H’s parting words to me included a request that readers send us updates on their summer vacations. Creating your own essay entitled “What I Did on My Summer Vacation” is sure to remind you of the first day of school, new clothes, and searching for your locker.

WiFiMed Holdings, the parent company for EncounterPRO Healthcare Resources and CyberMedx Medical Systems, is expanding into the European market. The company signed a Memorandum of Understanding to purchase UK-based Integrated Telecare and Position System Limited.

iMedica announces that Blue Cliff Partner will resell their Patient Relationship Manger and EMR products in Hawaii.

Now that Congress has approved the Medicare eRx incentives, will more physicians jump on the electronic bandwagon? The highest payment rate is 2% in fiscal 2009 and 2010, drops to 1% the next two years and then 0.5% in 2013. Beginning in 2012, payments to physicians will be reduced by 1%, then 1.5% in 2013 and 2% in subsequent years. Are the incentives/penalties adequate to affect change? eRx vendor Allscripts was quick to announce their pleasure over the act.

The 1105 Government Information Group is looking for bands for their third annual GIT Rockin’ Battle of the Bands. Participant bands must consist of at least two members of the government IT community (government and/or vendor executives.) Five bands will be selected to perform at an October 16^th event in DC. I told Mr. H he should volunteer to be a judge but he thinks we need our own HIStalk Battle of the Bands with winners getting the chance to perform at HIMSS. Any takers?

McKesson adds another product to its portfolio with the acquisition of EN-Chart Scanning Program. EN-Chart provides computer-assisted facility coding and compliance solutions for the ED and McKesson has already been reselling the product for a couple of years. Though the product can be used stand-alone or integrated with other EDIS products, McKesson obviously favors connections with their own Horizon Emergency Care solution.

Healthvision expands northwards to Canada with the acquisition of MediSolution’s Healthcare Products & Service’s division. The $49 million purchase gives Healthvision a bigger installed base to sell its interoperability solutions, plus provides them an EHR and a variety of clinical solutions to market to new and existing customers. Given the soft RHIO market, a bit of product diversification is probably not a bad idea.

Medical Present Value’s purchase of TeraHealth sounds like a good fit. MPV specializes in providing financial tools for managing payor contracts and ensuring maximum re-imbursements. TeraHealth (which is changing its name to MPV) offers electronic insurance and benefit verification tools to ensure accurate reimbursement on the front end.

With its decision to offer LodgeNet Healthcare’s Interactive Patient Television System, will Brigham and Women’s Hospital feel more like a hotel? No mention of whether or not patients will have an option to use the TV to review their charges and check-out.

HHS slaps Providence Health & Services with a $100,000 fine for "potential" HIPAA violations related to Providence’s loss of electronic backup media and laptop computers with identifiable health information in 2005 and 2006.

Thanks to Dyan Cannon for keeping me up to date on a few odd lawsuits.  First, a woman is suing Lake Chelan Community Hospital in Chelan, WA, alleging that in June 2007, while in the hospital’s inpatient alcohol-treatment program, a nurse fondled her.  My favorite was the Virtua Memorial Hospital surgeon who is being sued by a patient for placing a temporary tattoo on her abdomen following back surgery.  He claims it was to lift her spirits, and that past “recipients” have only had positive responses.  She claims it was sexual misconduct and voyeurism.  I think it’s funny. Thoughts? 

If you are reading this it means that I figured out how to do the posting without crashing the HIStalk servers. Mr. H intends to ignore email for almost two weeks so if you use the green Rumor Report then chances are we won’t see it.  So, email me directly with any dirt, encouragement, love sonnets, etc.

Readers Write 7/17/08

Samantha Brown on Most Wired

There are some of us who just aren’t filling out these ridiculous surveys anymore. They are nothing more than vanity plates for CIOs. There are a lot of better wired hospitals who are not on the rankings at all.

Spanky on Most Wired

After 10 years, only 556 organizations see any value in responding to the survey.

The PACS Designer’s Open Software Review – OpenMRS
By The PACS Designer

The ROW (rest of world) is starting to get the digital sense when it comes to record management systems for healthcare. Developers have come together to specifically respond to those actively building and managing health systems in the developing world, where AIDS, tuberculosis, and malaria afflict the lives of millions. They are using OpenMRS to achieve a  better outcome for patients. Most of the core developers are from the Regenstrief Institute and Partners in Health.

OpenMRS is an open source medical record system which is focused on developing countries. Open Medical Record System (OpenMRS®) was formed in 2004 as a open source medical record system framework for developing countries. OpenMRS is a multi-institution, nonprofit collaborative led by Regenstrief Institute, Inc. (http://regenstrief.org), a world-renowned leader in medical informatics research, and Partners In Health (http://pih.org), a Boston-based philanthropic organization with a focus on improving the lives of underprivileged people worldwide through health care service and advocacy. It is web-based, written in Java, and is under active development.

There are several layers to the system:

(1) The OpenMRS data model borrows heavily from the Regenstrief model, which has over a 30-year history of proven scalability and is also based on a concept dictionary.

(2) The API (application programming interface) provides a programmatic wrapper around the data model, allowing developers to program against more simplified method calls rather than having to understand the intricacies of the data model.

(3) The Web Application includes web front-ends and modules that extend the core functions — these are the user interfaces and applications themselves built upon the lower levels.

OpenMRS® is a community-developed, open-source, enterprise electronic medical record system framework. Their mission is to foster self-sustaining health information technology implementations in these environments through peer mentorship, proactive collaboration, and a code base that equals or surpasses proprietary equivalents.

As the ROW gains confidence in OpenMRS, you will see more countries joining this effort to digitize their medical records for patients to improve outcomes. OpenMRS has been implemented in several African countries, including South Africa, Kenya, Rwanda, Lesotho, Zimbabwe, Mozambique, Uganda, and Tanzania.

TPD Usefulness Rating:  8.

http://openmrs.org/wiki/OpenMRS

Art Vandelay on Enterprise Architecture

A number of organizations outside of healthcare have been developing "enterprise architectures" (EA) for some time. My first exposure to the concept was when Gartner introduced, "3 Documents for Healthcare IT Planning" in 1998. Outside of healthcare, there have been some success stories, but many more failures. The cases of failure seem to be due to a poor link to business value (ROI). With the growing complexity of our environments, some level of EA is needed. It is more than a passing fad.

In 1998, we looked at EA as basic standards and filling in the cells in the "Zachman Framework." While a great technique, this was fairly academic at the time. There was little guidance on looking at the present while projecting the future. There were also no formal linkages between the cells or a step-by-step process.

Knowing there was still value in this space, we evolved our concept to what we feel is a practical approach to enterprise architecture. To ensure that we keep true to providing business value, we trace the business value expressed in the form of the principles through all our decisions. We’ve defined a process that is iterative. It involves defining the current state and the path to migrate to the future state.

Whatever technique you use, it is important to set the goals and be sure your key stakeholders buy in to your approach. The proper level of input is important. This usually comes in the form of a steering or governance committee. We then start with reviewing our business and technology strategy. Next, we establish our principles for a defined period of time. Examples of our principles include looking an existing vendors for solutions to consolidate our spend to get preferential pricing and support. Another principle is to look to local vendors to help the economics of our area.

We then define standards maps for how we envision the layers in the architecture evolving over time. At its broadest level, think of the different layers involved in hardware, software and application integration. Within each layer, we also define another dimension for support processes, monitoring, change control, problem management, etc. For example, for integration, there is integration of healthcare applications – usually based on HL7. There is also non-healthcare application integration. We’ve chosen to use XML for the data standards layer.

The standards maps are supported by an approved buy list. We attempt to select the items in the buy list based on some no-nonsense requirements. For example, we use Altova’s XML Suite for working with XML. For servers, we’ve picked a major vendor but work with a local reseller to stimulate our local economy.

Most of the work goes into synchronizing the maps of various technology layers. We also establish reusable patterns to provide standardized solution templates across layers. For example, we have patterns for the various 9’s of availability (ex: 99.99%). Other patterns involve how we work with application service providers (ASPs).

With the advent of service-oriented architectures (SOA), the patterns have evolved to include application services. For example, we have defined an application authentication service that works with our single sign-on vendor and directory services. This is referenced by our web applications. Services have brought about the need for a new level of governance and coordinated planning. Fortunately, with the work we’ve done to define some of the EA, we seem to be adequately positioned to work through the challenge.

If you haven’t started to develop an EA, I encourage you to do so. From a purely IS point of view, as our vendors adopt SOA and virtualization and more integration is expected, the level of coordination increases exponentially. It will also start to evolve our support and project delivery models.

CIO Unplugged – 7/15/08

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

Go to Grow
By Ed Marx

One year ago this month, I dropped off my oldest child at Biola University in LA. We arrived a few days early so Brandon and I could attend the student/parent orientations together. During our free time—and in the name of father/son tradition—we squeezed in some workouts and ate bad but tasty food. After we got his belongings organized in his dorm, we huddled for a final prayer and blessing, embraced and shed a man tear or two, and then I left. Sitting in my car in the parking lot, I watched him walk to the final student orientation. During his life at home I had planted seeds: I encouraged him to grow, encouraged his testing of personal boundaries, and discouraged signs of complacency. Brandon had officially begun his journey into the future and to independence, and the results of my optimistic seed planting were soon to blossom.

What happened next surprised me. As I drove down the Pacific Coast Highway, I began to wail. From the depths of my soul, I cried so hard my stomach convulsed. Wheezing in breaths, I mourned my treasured son’s rite of passage. Then my mourning turned to dancing, and I rejoiced for Brandon and his future. I can only imagine what the drivers in the cars next to me must have been thinking of my spectacle.

In the time that has passed, we have seen amazing growth in our son, growth that could not have occurred had he stayed home. Despite an enriching and loving environment, his potential would not be fully realized without a dramatic change and challenge. Part of us would have loved to have him stay, but we knew, and accepted the truth, that he needed to go to grow.

My career has been much the same. I can’t think of a single employer that I have ever wanted to leave. Yet with each one, I knew at some point I’d need to go to grow. Indisputably, my former employers offered ample career growth and challenges, but for exponential and accelerated growth, I had to enroll myself on a journey: break out of my comfort zones, push the envelope of security. Each successive move has pushed me out of my natural bent toward complacency. They’ve shaped and sharpened my abilities. The breadth and depth of divergent experiences have broadened by skill set in an extraordinary fashion. My talents have gained a sharper focus, and my leadership quotient has multiplied. I attribute my growth, personally and professionally, to pushing my boundaries and circumventing the traditional career path.

I believe it is a leader’s imperative to fight complacency in the workplace and encourage others to go to grow. If it benefits our children and ourselves, then we must be willing to encourage subordinates and peers to do the same. Sound inconceivable? Untraditional? Scary? Of course we need to create internal opportunities and have career ladders, something for every kind of employee. Yet, at some point, the best thing for some will be a new environment, a place that challenges them to accelerate to the next level. An exceptional leader is not afraid or insecure to give away their best.

I have helped some of my best go. I have brought them opportunities for external advancements and served as their reference. At each departure, I felt the loss of their friendship, skills, and talents, and I cried in secret; yet I never regretted a single endorsement. I’ve stayed in touch, and what a thrill it is to see how they’ve grown in ways far more enriching than the opportunities I or my employer could have given them. They had to go to grow, to reach their fullest potential.

Are there people in your life and work who need to go to grow? Does complacency have a hold on your organization? Are you selfishly clinging, or do you have a heart to see the best opportunities made available? (Picture the able-bodied forty-year-old still living at home.) If one of your staff has significant potential but circumstances are such that you can’t fully exploit that, do you give that person the freedom to advance elsewhere? Are there other staff members who need you to encourage them to leave for these same reasons but who won’t on their own out of fear?

We have four years left with our teenage daughter, and we will cherish every minute. But we’ll also do our best to prepare her mind to take on challenges and enriching opportunities. In love, we will push her to learn from the past and fail forward and to maximize the present in preparation for the future. Ultimately, the time will come when she will go to grow, just like her brother.

Now it’s your turn. Go to grow!

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.”

News 7/16/08

From JohnnyReb: "Re: Sparrow Health, Lansing, MI. They have selected Epic as VOC over McKesson Horizon (incumbent) and Cerner. Contracts are in negotiation and no announcement has been made."

From Rudy Russo: "Re: layoffs. A recruiter told me that Essence Health and Purkinje have cut staff in St. Louis."

From Liz Lemon: "Re: Agfa. Rumors about an Agfa acquisition keep pouring in. First, Siemens was said to be interested, then Philips should be the lucky husband-to-be. Let’s see who will end up with the Dutch leftover (Agfa’s shares dropped from >25 Euro to about 4 in three years)." Agfa denies overtures from Philips, although the company brought in an advisor to stop the bleeding after a 77% stock price drop in a year.

From The PACS Designer: "Re: cloud watching. TPD mentioned the cloud solutions of Amazon Web Services in a previous post. If you want to do some cloud watching, Hyperic, Inc. provides complete, easy-to-use monitoring and management software for all types of web applications, whether hosted in the cloud or on premise. They’ve created a website called CloudStatus which will be monitoring the cloud services of Amazon, and then others as they begin providing cloud solutions." Link. 

From augurPharmacist: "Re: robotics. Robotic dose compounders like IntelliFill from ForHealth Technologies do bring a new level of autoID safety checking to the aseptic compounding process in hospital pharmacies. (See also: Cytocare from Health Robotics. I do not work for or otherwise represent any healthcare IT vendors). However, a potentially even more beneficial development is an extrapolation of this kind of autoID technology to the workflows of the compounding pharmacy technician who spend their shifts working in our pharmacy IV hoods. These newer systems work by having the technician scan bar codes and take digital pictures of all the vials and bags used to compound a particular IV bag or injectable dose. There is now more than one vendor of such systems. Again, these kinds of systems fit with my safety bias for an intra-hospital pharmacy supply chain characterized by workflows where, ‘every time a product changes hands it gets scanned.’" I’m a fan of the Fedex model, too. Hospitals in general aren’t interested, unfortunately.

From Neal’s Pizza Guy: "Re: Doug Krebs. He left Cerner and was replaced by Bruno Slosse, former GM in France, and now the only foreign representative on Neal’s corporate cabinet. As reported months ago by ye olde pizza guy, Don Trigg took over the management of UK operations from wet-behind-the-ears-duck-walking David Sides, who now heads up CERN’s global consulting. Trigg, in his first UK town hall a few months ago, seemed oblivious to everything in the UK. And, good news for UK ASSociates that the wicked witch flew her broom back west to Kansas after mayhem, hapless leadership, and undermining everyone in sight. She won’t be missed and neither will Fujitsu. Word is two of the SHAs in the South want iSoft, while one wants CERN. This can’t bode well for future earnings and pizza deliveries." All unverified, of course, but he’s been right before. Guessed the CERN webmaster saw my mention that Doug’s bio was still on the site … all that’s left now is his name. He’s fading fast.

From Big John Cannon: "Re: Intel’s home health device. They lobbied ATT hard to market it for them and help them with networking, etc. Their roadmap is WiMaxx (Sprint – Intel).  No plans yet to go cellular. Additionally, they are not tied to an ecosystem in homecare, unlike  Philips. For instance, Philips has alliance partnership with Homecare Homebase (home care mobile app) and, in turn, HCHB is working with Philips to integrate equipment with their software apps to pull data across from monitoring equipment. Weave together solution with software app, devices/network, equipment, and GPS for mobile workers. Also – Philips is preferred vendor for VNA. I didn’t find them particularly savvy about market needs, reimbursement models, and other healthcare industry drivers."

Listening: The Alarm, Britpunk. They’re in KCMO Saturday night for you Ass-ociates looking for a release. Live video from 1985. Also: The Distillers.

Evanston Northwestern will acquire Rush North Shore (IL), with part of the deal being that Evanston will spend millions to install an EMR there.

Medsphere and WebReach will jointly offer their respective open source solutions, the OpenVista clinical system and the Mirth integration engine.  Both are highly regarded from what I’ve heard.

What does a 94-bed hospital do with a $540K federal taxpayer gift? Buy Misys Tiger and EMR for its physicians. Really.

It’s time for the vested interest cheerleaders to start making a shaky case that their Most Wired survey means anything. AHA’s CEO comes up with this imaginary figment: "The results of the Most Wired survey confirm that today’s patient also understands the benefits of IT in improving care and improving the overall hospital experience." Other highly object critics weigh in positively, including people from McKesson (which sells systems) and Accenture (which sells services for systems) in the magazine (which sells ads for systems) which did the survey in conjunction with CHIME (a membership organization sponsored by companies that sell systems). Conspicuously absent in the glowing writeup: anything to do with those patients who supposedly now understand the wonderfulness of HIT. They were apparently not surveyed, but some acrobatic statisticians came up with the alleged fact that high satisfaction hospitals use more IT by matching two unrelated surveys without any consideration of cause vs. effect. There’s plenty of good information about IT benefits without such an obvious stretch.

Speaking of Most Wired 2008, here are the wieners.

South Miami Hospital (FL) goes live with CliniComp Essentris Perinatal.

Richard Lang is promoted to VP/CIO of Doylestown Hospital (PA).

The folks at Inside Healthcare Computing have packaged up some of my editorials for them as The Best of Mr. HIStalk, Volume 2. Volume 1 is up there too. Each has a table of contents online, some of which amused me all over again because I hadn’t seen them for awhile: Lay Your Hands on the TV to Be Healed: The Emergence of the Superstar Remote Physician; If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?; I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming; and Surprise! Below-Average Doctors Use EMRs, Too. This isn’t a pitch for me since I’m not getting a cut, but I’m thinking that now that I’m a published author (ahem) I may attract literary groupies named Astrid or Marta with black-framed glasses, soulful eyes, and clingy dark clothes. Book tour!

The long-rumored Baylor IT rumblings finally hit the papers. Their IT manager was making $100K — pretty good, but a little light to own a Bentley (paid for in cash), a racing boat, and a $6,200 a month penthouse apartment. He’s accused of scamming Baylor out of $1.4 million by submitting phony invoices to his accomplice, who happened to be his mother. Neither they nor Baylor were too smart, according to accounts: the paid invoices came from an unregistered corporation that bore the mom’s Social Security number instead of an employer ID and included maintenance charges for non-existent IT assets. In addition, the checks were deposited into the IT guy’s Baylor Health Care Systems Credit Union and his desktop contained the invoice originals in Excel. Doh! West Coast Ron dropped hints here back in early 2006. I know executives there draw mammoth paychecks, so if the allegations turn out to be true, maybe they should work a little harder on the financial oversight thing.

Howard County General Hospital (MD) chooses SanDisk Cruzer Enterprise to manage the security of flash drives.

John Halamka not only is an e-mail whip-cracker, he’s also "effervescent." For the non-scientists, that means "gives off bubbles of gas." I’m sure he knows that and cringed a little, preferring its secondary meaning.

More hospitals, apparently, are dumping Microsoft Exchange for an open source e-mail package at half the cost, most often PostPath.

Good idea: Kaiser nurses wear "don’t interrupt" yellow sashes ("KP MedRite" since they apparently required a branded identity) when working with medications. I found this funny: "When first implemented, the flashy attire caused distractions rather than averted them, as curious staff and patients repeatedly interrupted nurses to ask why they were wearing the unusual apparel."

Bizarre: an Australian doctor loses his license and goes to jail for snapping upskirt photos of women to whom he was administering spinal injections after convincing them that their undergarments had to be removed first.

Hong Kong hospitals implement a new positive patient ID barcoding system, but no improvement in outcomes is expected.

A fun business: a nurse and his programmer business partner write a home care program, sell several copies, and quit their day jobs. Definitive Homecare Solutions, the company they formed to sell CPR+, now has 60 employees (most of them quite young, from the pictures) and $10 million in revenue.

"Here we go again" lawsuit: Tenet Healthcare pays $2 million to settle a lawsuit brought when its West Boca Medical Center ED called four neurosurgeons to treat a stroke patient and none of them would come in.

E-mail me.

Inga’s Update

I am back in action after my little get-away and am still catching up on all the HIT news over the last couple of weeks. It’s hard to absorb almost two weeks of information so forgive me if I repeat something Mr. H already mentioned. (Mr. H already accuses me of not reading his stuff – only my own – so I’ve tried to read the last few posts at least a couple of times.)

I was happy that the Joint Commission’s recent alert was overlooked so that I could make mention of my upcoming book. If you missed the alert, it seems that the Commission has concluded that rude language and hostile behavior among health care professionals threaten patient safety and quality of care. This should help sales of my publication, “Inga’s Guide to Making Nice in Healthcare.” I am also considering offering consulting services to help all those mean healthcare workers curb their condescending attitudes and angry outbursts.

Emageon appears to be hunting for a new owner, having hired investment firms Jefferies and Co. and SunTrust Robinson Humphrey as co-advisors to evaluate its strategic options, including a sale of the company.

UNC-Chapel Hill Campus Health Services has contracted with eClinicalWorks for their EMR/PM solution. UNC will also offer ECW’s patient portal, which I bet will be popular with that demographic.

U.S. News & World Report releases its annual Best Hospitals Honor Roll with John Hopkins, Mayo (Rochester), and UCLA Medical, Cleveland Clinic, and Massachusetts General taking top honors. The publication analyzed data on 5,453 medical centers with only 19 deemed of Honor Roll caliber with excellence in six or more specialties. The report also lists the top institutions in 16 different specialties.

Duke University Health System (#8 on the above list, by the way) is sued by 18 patients for fraud and negligence after the hospital mistakenly washed surgical instruments in elevator hydraulic fluid. Duke admits to the hydraulic fluid mishap and has already settled 60 claims, but denies the tools posed risks to patients.

QuadraMed announces a $10.6 million contract with the Saudi Arabia National Guard Health Affairs for a migration to the new QCPR Cache version, as well as additional licenses and services. The deal help boost first half sales 36% over last year, suggesting that the CPR acquisition was a good move.

Two board members of clinical documentation provider Spheris step down to ensure compliance with regulatory requirements. Joel Ackerman and Tenno Tsai are both with Warbug Pincus, which also has an interest in a potentially competing company. Warbug Pincus holds a 60% stake in Spheris.

The 20-physician Gonzaba Medical Group (TX) selects Sage Healthcare for its EHR/PM solution. The group is upgrading its legacy Intergy PM product.

USA Today reports on the growing “medical home” trend, which is really just a new version of an old model. The concept is based on a primary care physician overseeing a patient’s full medical care – and actually paying them extra for coordinating their care. Medicare is conducting an eight state test to determine if paying primary care physicians as much as $35,000 a year more to treat chronically ill patients will improve care and reduce costs. Patient care “teams” within a practice would be utilized to offset the additional time spent per patient. My guess is that if the government can figure out a fair payment system, it could be win/win for both the physician and patient.

Thomas Jefferson University Hospitals (PA) will implement Wellsoft Corporation’s Emergency Department Information System across its four locations.

Guess I am about to be on my own for a few days, so please drop me a note with any newsworthy items, great commentary, or juicy rumors. I’ll never again be given the keys to the kingdom if nobody reads the blog in Mr. H’s absence.

E-mail Inga.

Monday Morning Update 7/14/08

From medHead: "Re: databases. I am looking for feedback from those who have reviewed the Multum Lexicon or VantageRx databases. In particular I would like to hear from those who have chosen NOT to license the content. Any feedback as to your decision criteria would be helpful."

From Grizzled Veteran: "Re: athenahealth. Wal-Mart/Target are still rolling out sites with eClinicalWorks on a daily basis. Without seeing the analyst’s report, I can speculate that the relationship athenahealth has with CVS and MinuteClinic for revenue cycle management (announced in the spring) may be what is causing the confusion. CVS needed this because filing pharmacy claims gets a much quicker reimbursement than medical claims and they needed to employ a company to file, follow-up and collect A/R. Medical claims have a diagnosis and procedure code, pharmacy claims do not. All indications are that WM/Target are pleased with eCW."

From HIT consumer: "Re: Eclipsys. Do we know why Eclipsys has let its top two leaders of its Services group (Frank Stearns and Charles Wagner) go in the past few months? Who is exactly running the show now? What impact will this have on their customer service and their earnings?"

From Blue Hen Dave: "Re: DHIN. Delaware Health Information Network got wrapped up in a lot of state budget cutting, but not too badly. It won’t be a major blow, but it does reinforce the need for state-supported programs to constantly communicate value and accomplishments to government."

From augurPharmacist: "Re: heparin errors due to confusion between 10 units/ml and 10,000 units/ml concentrations of vials in routine use. These products are generally purchased as ready-to-use vials or pre-filled syringes. Hospital pharmacies are not preparing these heparin IV flush orders dose by dose. What’s happening is a supply chain breakdown – the wrong vials are getting from the hospital dock and through the pharmacy to the nurses’ stations. In my opinion, we need to expand our concept of bar coding in the intra-hospital pharmacy supply chain according to the idea, ‘each time the product changes hands it gets scanned,’ i.e., scanned into pharmacy inventory, scanned at pick from inventory, scanned at dispense to the unit, scanned upon delivery to the unit and scanned at the bedside. CPOE does reduce certain types of medication errors. but these heparin errors are from faults beyond CPOE in the intra-hospital drug supply chain."

From Kent Winkdale: "Re: Epic in Dubai. A reader comment said the Epic decision was based on TCO. While cost was important, even there, they won with a superior demo and site visit. Scripted demos took over two days for each vendor, with thousands of line items and many scorers. Epic stuck to the script, showed real software, and ran a great site visit with a difficult schedule. Cerner and Eclipsys had last-minute site visit changes, less client enthusiasm, and facilities that didn’t match the vision of University Hospital at DHCC. Epic just blew its competition away."

A Kansas City TV station joins Leapfrog Group in advocating irrelevant technology that wouldn’t have helped the heparin-overdosed babies in Corpus Christi one iota. Leapfrog, which should have known better given its self-proclaimed expertise in technology and patient safety, shrieked "Everybody should buy CPOE" in response, showing a dangerous naivete in confusing drug ordering with drug preparation. Now the Cerner-friendly local TV station chimes in that bedside barcoding like Cerner sells would have prevented the tragedy. Can we please stop publishing consumer-facing drivel from people who have their own agenda, but no clue what they’re talking about? The statement from CHRISTUS CMO Richard Davis clearly states that the pharmacy mixed the heparin incorrectly (yes, I know that pharmacies don’t typically prepare heparin flushes, but I assume the man knows the situation). To reiterate: CPOE would not have helped (the heparin was ordered correctly). Bedside barcoding would not have helped (those systems can’t check the contents of pharmacy-prepared products, only that the label matches). The only technology that could have prevented the error is something like what’s shown below, which I’ll almost guarantee you won’t find in your hospital pharmacy because all the money to pay for it was spent on CPOE instead.

(I should disclaim that I don’t have any connection with ForHealth, which makes one such robotic IV compounding system pictured above, but I am slightly familiar with their product). 

Allow me to editorialize: CPOE catches mistakes, but the vast majority of them would have been caught anyway (transcription errors rarely cause the wrong drug to reach a patient because someone double-checks, i.e. the Swiss cheese effect). Preventing errors is vastly different than preventing patient harm. Most serious patient harm is caused by IV drugs, so if you want to help patients, spend your money on technologies that address the "sharp end of the stick," such as pharmacy automation, bedside barcoding, and smart IV pumps. All of this was explained in Lucien Leape’s seminal work involving medication errors going back to the 1990s, which showed that only 2% of nurse administration mistakes are caught. Hospitals allowed vendors and consultants to convince them that CPOE would solve their problems, apparently missing the point that it has minimal potential to address the main sources of true patient harm, most of which rests with pharmacists and nurses, not doctors.

I like to think that the Wall Street Journal got this idea by reading HIStalk since it’s awfully darned close to what I wrote before their piece appeared, but I’ll never know, of course. Also lost in all the excitement: do we know for sure that CHRISTUS Spohn doesn’t have CPOE already? They’re a Meditech shop and a 2008 HealthGrades Distinguished Hospital for Patient Safety winner (warning: PDF), so they might. I would hope (but doubt) that Leapfrog asked that question before posting its self-serving and self-damaging press release.

I know it’s sophomoric, but the irony of a hospital named Saline is never lost on me. The piece on EHRs also included a quote from a doctor with a generation-jarring first name of Misty, reminding me of a line from a movie that itself is nearly a generation old now: "Real doctors aren’t named Megan."

I mentioned Medicity in my little RHIO comment last time. Someone involved in a Middle East project e-mailed me to say that he’s run into the company there, so I’m speculating that a deal is imminent. That usually means new jobs, which might interest some of the HIT folks being displaced.

I said before that I’d tried Second Life and wasn’t impressed for business purposes, but most of what I disliked has apparently been eliminated by the most-feared competitor you can have: Google. Google Lively has a small web applet, although it’s still in beta and prone to erratic behavior. If you like avatar-driven social networking or just want to keep tabs on what the Googlers are up to, it might be worth a look (I need to try it myself).

Jobs: Business Requirements Director, C++/Windows Software Engineer, Cerner SurgiNet Consultant, Implementation Project Manager.

Another hospital and its Senator want far-flung federal taxpayers to pay for its EMR, although it’s willing to match the money (pork for 50% off?)

I went by the Apple store Saturday afternoon. The line was around the block just to get in the door. I know the iPhone is cool and all, but it’s a PHONE, people. Then to the electronics store, which reported that you can’t buy a Nintendo Wii anywhere because the millions they’re making are grossly insufficient, even though it’s 1 1/2 years old. At  least some folks have discretionary income, apparently.

Healthcare provides several reader-contributed examples of "The Very Worst Uses of Windows." One: "I was in the Massachusetts General Hospital laying in an fMRI tube because I was participating in a psychology study (and getting compensated financially). After a few minutes of inactivity I wondered when things would start happening – they soon extricated me from the tube. Turns out the cause of the problem was that the Siemens machine running Embedded Windows (as proven by a prominently-affixed license sticker) had locked up while I was entubed, and they had to reboot."

Another crappy quarter from GE, but really not bad given the market and Q1 fears. The company turned in a 6% drop in earnings. GE Healthcare, however, had an 11% increase in revenue and profits were up 8%.

Here’s an Intel picture of its newly FDA-approved home health gadget. Pretty cool, I think.

Eric Morgan is named CEO of AdvancedMD Software of Salt Lake City, which sells web-based practice management systems. He used to be CEO of StatCom.

A brave customer signs on with Emageon for RadSuite.

New York state is considering accrediting the governance capabilities of RHIOs.

Lawson software’s Q4: revenue up 9%, EPS $0.02 vs. $0.04 after a one-time charge.

Merge Healthcare is excited that it regained Nasdaq compliance when shares rocketed above the $1 minimum, but the cork-popping didn’t last: shares are now at $0.82, down 17% and starting the 30-business-day delisting clock all over again.

E-mail me.

Sage Software Restructuring Response

A magazine article about last week’s layoffs at Sage Software included an odd quote from SVP Sharon Howard. An HIStalk reader’s comment said it seemed callous, while I agreed that it was at least questionable. I received this e-mail, which I’m running in its entirety since Sage employees (both the 235 affected and the remainder) should have the chance to hear her response, even if their feelings about the company aren’t necessarily so warm at the moment.

Dear Tim and Inga:

Would you please share the following with your vast readership? I do not want my verbal missteps to reflect badly on our team, who sincerely value all our employees and who took great care to handle the restructuring with respect and compassion.

The Sage Software Healthcare executive management team made a conscious decision to be open and honest about the events of this week … both internally and with the media. By choosing to discuss this topic openly — rather than hiding our actions as some in the industry have done — we believe we are remaining faithful to the Sage Principles of Trust and Integrity. Both the executive management and human resources teams worked diligently to ensure that this painful process would be handled with as much dignity and respect as possible.

One of the pitfalls of being completely honest with the media about difficult situations is the chance that quotes will be misunderstood. That was the case with a recent article related to our necessary restructuring.

The writer was completely professional, and I won’t hide behind the usual, “I was misquoted” excuse. However, I do want to explain how a comment that appeared uncaring ended up in print.

In my effort to be completely open about the status of affected employees, I responded to a question without clarifying what the reporter was really asking. The resulting quote conveyed a tone that in no way reflects my personal feelings.

We all have been affected by this issue, and I hope you will accept my apologies for this out-of-context quote that makes us sound disrespectful of the contributions of our former and current employees.

I appreciate that you mentioned that Sage did not seem like a callous company, because we are not. I’d hate to have people think we are because of my misstep.

Kind Regards,
Sharon

News 7/11/08

From Pills: "Re: Doug Krebs. Tell ‘just asking’ that Doug Krebs left Cerner at the end of May. It was an amicable parting." I hadn’t heard that. His name is gone from the executive list, but his bio page is still up and I saw no announcement. Where did he go?

From Former Sage Employee: "Re: layoffs. My sympathies to the 235 Sage Healthcare employees who’ve lost their jobs this week. If the quote is any indication for how the reduction in force was executed, then it couldn’t have been with much compassion: ”They are all gone now,’ said Sharon Howard, senior vice president of sales and marketing with Sage Software Healthcare. ‘They are on severance. You give them two weeks’ notice, so they’re getting paid.’ As if ‘two weeks notice’ is a suitable exchange for the years of service that these people have given while this company continues to try to find itself through rebrand after rebrand. It’s true that, in this economic downturn, many companies are cutting back. It’s just too bad that these talented individuals weren’t worthy of a better farewell quote from the spokesperson member of the new management team. Best wishes to the 235 in finding a place to contribute elsewhere in our HIT market." Link. I have to admit that my reaction was exactly the same. I’d like to think it was a misquote, but Joe Conn wrote the piece, so I doubt that. I can only hope that something was missing without the context since it did indeed sound rather callous and I wasn’t picking that up from the company until that quote.

From Bill A. Bong: "Re: job change. Subodh Sheth, formerly sales VP of CareCentric, was named VP of Sales with AtStaff, Inc. a provider of patient demand and acuity-based staffing solutions. Not bad for him considering that staffing legislation is moving towards acuity-based staffing and away from ratio-based staffing (re: Illinois, Washington, and Ohio)."

From Buzz Lightyear: "Re: JJWild. As one of the affected JJWild/Perot consultants, I can confirm the layoffs last week. Cut employees got a phone call Monday morning with the bad news; in the afternoon an all-hands call was conducted in which the news was passed on to the remaining employees. Falling profits were blamed for the action. Severance packages were offered. It was specifically mentioned that there would be no press release regarding the layoffs." I can’t confirm, but not for lack of effort: Inga keeps trying, but they haven’t returned her calls. Unverified pending the company’s response, let’s call it.

From Interested HIT Investor: "Re: athenahealth. Interesting analyst report this morning on athena and their retail strategy. Do you know if WM/Target or their retail operators have since selected athena over eClinicalWorks? Figure you are the guy to ask." I haven’t heard, but I have readers who would know. Updates welcome.

From Mary Shelley: "Re: Epic. I heard that someone is using some kind of peer-to-peer alternative to RHIOs that Epic created. Any details?" I know they had developed some kind of information exchange add-on that a couple of hospitals were trying (it only works between Epic sites, I think), but I haven’t heard anything lately. It’s kind of interesting, but only in a town where big Epic customers dominate the market.

Jobs: Implementation Project Manager, Sales Executive – Wireless IT Solutions, Eclipsys Clinical Consultants, Consultant – Meditech Anatomic Pathology. Sign up for weekly job blasts.

Vermont Information Technology Leaders picks its EHR pilot systems: Allscripts HealthMatics, Allscripts TouchWorks, and GE Healthcare Centricity.

Nebraska Health Information Exchange will use Axolotl Elysium for its HIE.

NPfIT is losing its grip on impatient trusts wanting to move ahead with the way-behind project, to the point that trusts are given the green light (and possibly the greenbacks) to buy their own interim systems.

Health Partners (PA) will roll out a provider-health plan portal called AboveHealth. Healthation will do the heavy technology lifting.

Former Meriter Hospital CIO Peter Strombom editorializes about a proposed Wisconsin government interoperability project that just went to RFP for an architecture consultant. His gripe: the cost is estimated at $1.2 billion, it assumes that all hospitals will have EMRs to feed the 3-5 RHIOs it will spawn, and it’s planned as a centralized model with reposed data. He’s advocating a peer-to-peer model running on CCHIT standards, similar to a banking network with the Internet as the dial tone. $1.2 billion with no real funding model other than charging hospitals for access and hoping they’ll pay? I’m with him. My thoughts: the federated model may make more sense technically; a RHIO is a tough-to-run business, not a public good; everybody wants data, but nobody wants to provide theirs; and the high failure rate means proposed ones better do some serious and self-critical homework about financing, governance, and sustainability before spraying grant money over a roomful of panting consultants. And, it’s not likely that top-down mandates will get the job done better than the bubbling-up and eventual interconnectivity of local data exchanges.

So here’s a RHIO question for HIStalk’s readers: now that we’re in generation 2.x of RHIOs, what are the current best practices from a technology and sustainability standpoint? I like the work Medicity has done, I’ve heard good things about CareEntrust and the Indiana group, and I know the Bostoners were leading the charge with some interesting approaches. If you like the banking model, what would it look like in healthcare? Your thoughts are welcome.

Another heparin IV vs. flush error, this time at Christus Spohn Health System (TX), where 17 babies got the frighteningly common 1000x overdose. At least two of them have died, although of uncertain causes. Barcoding is an obvious answer that unfortunately isn’t nearly as effective as you’d think (you can still mix the IV wrong), but I’m beginning to wonder if maybe general care hospitals should dedicate a separate area, staff, and pharmacy for kids. It’s just too easy to miss errors when general staff (especially in pharmacy) are used to handling adult doses, meaning peds overdoses just don’t jump out like they would in a peds hospital. I might be wrong, but I don’t recall that any of these cases occurred in a children’s hospital.

Speaking of the Texas overdoses, here’s a really dumb comment that tries desperately to ride on the PR wave. Leapfrog Group rushes out a statement that quotes CEO Leah Binder as saying, "Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take … If this isn’t a wake up call, I don’t want to know what one really looks like." I’m guessing she doesn’t know what one looks like – according to reports, the heparin was mixed wrong in the pharmacy. None of the recent high-profile incidents had anything to do with physicians or ordering – it was all product delivery, preparation, or administration where what was ordered wasn’t what was administered. Trying to shoehorn in the tired old Leapfrog CPOE mantra is just absurd. And even if it wasn’t so wildly irrelevant, that’s a pretty obnoxious "we told you so" to blast out while the families and hospital employees are hurting. I’m not much of a Leapfrog fan, but this makes me even less so.

Here’s an odd thought I just had. The people at work have no idea that I’m Mr. HIStalk, so I always fight the urge to pipe up and say I know (electronically, anyway) the execs at some of our current or prospective vendors. What if I came out of the closet? Would vendor bigwigs come around to buy me lunch, thereby baffling my co-workers with my newfound popularity? I don’t think any of them read HIStalk, so they’d be like "what’s with him?"

Nancy McDonnell is named IT director at Illinois Valley Community Hospital (IL).

Cardinal Health completes its restructuring into two divisions and may sell its pharmacy management services.

I feel much better about paying big federal taxes knowing I’m helping buy a hot site for a New Hampshire hospital. No problem, it’s not like the country is in the financial toilet or anything.

Lourdes Hospital (KY) will deploy a portal/clinical system from Informatics Corporation of America.

Intel gets FDA approval for its Health Guide in-home chronic condition monitoring system that includes device connectivity, reminders, education content, and communication capabilities.

The European Commission announces interoperability plans that would cover the entire continent. I think they’re the folks behind the Euro.

E-mail me.

Readers Write 7/9/08

First-Hand KLAS Experience
By Jazzbo Depew

I work for a vendor. We crush everyone in our KLAS category, but we’re not happy with KLAS.

I firmly believe that they don’t cheat with their scores or comments. Some of their vendors might try really hard to get folks to fill out surveys, but KLAS tracks down every user they can and stops using them if they’ve milked that cow too much.

We are one of those "obscure" companies that gets the good scores. Why is ‘Spence Holmes’ surprised that agile, targeted companies will score better than the generic behemoths? Does it have to be a cheating conspiracy? Could it simply be that software written and supported for a specific speciality or service will make its users happier than those that aren’t? 

If the survey for KLAS is biased, the implication must be that my company has somehow cheated. As the KLAS contact, I assure you that I haven’t. We’re too small and have too little money, believe me.

But I do think KLAS is biased in another way – the opposite of what Holmes implies.

We got a call out of the blue one day saying, "Hey, we’re from KLAS and we’re going to start finding your clients whether you like it or not. You can help by giving us your client list." We waited the three months they told us it would take to get listed. Nothing. So, we called. "Well," they said, "when we see scores that are so out-of-line with the norm, we need more data." Huh? Good or bad? They wouldn’t tell us. 

So, we mentioned the survey to our clients. Eventually, after something like 12 months, we got listed. However, we had a BIG ASTERISK next to our name and were put among the other software vendors as "Component, Updated, or Replacement" software or something like that.

Why?  Because our scores were so good and we are a small specialty company. It’s that simple. They don’t want us listed next to our much larger competitors. Our specialist prospects will be misled to think the "Best in KLAS" folks are better for them than we are. I’ve been fighting with them about this for three years. We even see some well known vendors claiming to have the highest scores in more of the ~30 categories than anyone else – which is patently false – but because they are one of the big fish, they don’t have to pay attention to us.

So, some KLAS stories:

When our scores first came out, I was reading the comments section. One of our clients said something about us that isn’t true, but made us look better than we are ("they won’t hire anyone who hasn’t worked for three years already," when, in fact, we hire college kids every chance we get). I called them up to fix it and once the person on the phone said, "Wait, you’re the vendor?" she all but hung up on me. "We don’t talk to the vendors, period." Given that I wasn’t complaining about the bad comments, I was impressed.

We know our clients really well. When it’s a bad one (we have so few), I know EXACTLY who it is. And I can tell you that the comments are VERY real and are the GOLDMINE for KLAS users. We read them religiously and use them to direct our efforts. I could write you another five pages (I’ll spare you) about my efforts to get KLAS to understand their real value. My impression was that they are a nice little company with a family atmosphere and not the greatest sense of business.

We’ve had a number of clients tell us, "Oh, KLAS called me!" whose names we never provided and who hadn’t contacted KLAS. KLAS reads through web sites, checks out newsletters, and asks customers about other customers.

KLAS specifically reported to us more than once that our "degrees of confidence" were about to slip because they had been getting data from our same customers for almost too long. If some new customers didn’t report, we’d lose a checkmark or two.  Whether this is lip service or not, I’ll never know, but the information was delivered in a manner that I believed. We did what we always do: sent out a customer-wide e-mail saying, "Don’t forget to fill out your KLAS survey. P.S. Give us a good score or we cut off your support." [Kidding about that last part.]

KLAS made a BIG DEAL about needing a proper sample size. Ours represents a FAR greater section of our clients than from the big vendors. In fact, during the first discussion I had with them, it was clear that there was a BIG vendor bias, not the other way around. KLAS can’t have the little guys winning all the awards and driving the hospitals away from the GEs, etc. Plus, what kind of blackmail would I have to use to get KLAS to give us those scores? They hate me there – I call to complain all the time about our lack of recognition. They’d love nothing more than to have us be average.

There is probably a correlation between being publicly traded and scores. This is largely a service industry and being beholden to two masters (shareholders vs. customers) doesn’t work, as we know.

ED Software Seen First-Hand
By Lukas

[From Mr. HIStalk: I removed the vendor’s name from this writeup because I can’t verify the source or its accuracy, but it was claimed to be one of the biggest ones and it’s not Cerner, Epic, Eclipsys, or Siemens.]

During a busy couple of weeks taking parents and going myself to the local ER, I got very close to watching the ED system in action and had the opportunity to talk with my nursing and physician colleagues about what they thought of the [vendor] ED system.

The most common answer was that it was cumbersome and didn’t provide the level of documentation needed in the ED. All of the treatment rooms in the ED were equipped with wall mounted PCs, but in the four visits, no one even turned on the PCs in the treatment rooms.

What’s even more scary, when one of my parents was admitted and the information in the ED was supposedly sent to the inpatient system, the medication records were a mess. Doses were wrong, medications missing, assessments didn’t move to the inpatient system. The nurses were not happy since they are spending time on the floor updating the inpatient system with the correct information.

None of the nurses or physicians in the ED were involved in making the system selection. The nurses on the floor want to go back to manual charting.

This hospital invested heavily in COWs, but they are currently in storage. They are also cumbersome and not much help.

The PACS Designer’s Web Software Review – Adobe Acrobat.com
By The PACS Designer

Adobe has launched a new website called Acrobat.com to provide new collaborative features for Internet users. The features are:

(1) Adobe Buzzword® – online word processor
(2) Adobe® ConnectNow – web meeting platform
(3) Create PDF – convert up to five documents to PDFs for e-mailing
(4) Share – work online with others, sharing large files without  e-mailing
(5) MyFiles – ability to store up to 5 gigabytes of files for sharing with others

You can use Acrobat.com to create and share documents, communicate in real time, and simplify working with others.

The First Real Web-Based Word Processor, Adobe Buzzword®, is a key feature of the new Acrobat.com website. Adobe has promised to keep adding new features into the future as users get more experience using their new site.

Create PDF is something new that Adobe has decided to give us in an online format. Since TPD has been posting about the new PDF/H for healthcare it would be good for HIStalkers to try to record their medical information securely in a PHR on their hard drive or USB drive and then using Acrobat.com Share to e-mail their PHR as a PDF/H. Adobe is permitting up to five different PDFs for free.

Adobe Acrobat.com is a nice addition to the Adobe portfolio of products and should attract new users with its free online word processor, Create PDF capability, and its sharing function.

TPD Usefulness Rating:  9.

http://www.adobe.com/acom/

News 7/9/08

From Ben Kenobi: "Re: Eclipsys. Eclipsys announced today that their emergency department module is really taking off. Seems like damage control to me as I talk with a lot of sites that are losing their hair and their patience with it. From a clinician’s perspective, I’ve been told it’s unusable. Kudos for CPOE, but the ED is much, much more than that. Is the press release intended to direct attention away from the internal strife reported earlier (Frank Stearns)?" ECLP announced several go-lives, although shrouding them with some fuzzy numbers that sound great without being specific, like doubling the number of live sites and a 70% increase in patients served by the end of 2008. All of that’s truthful, so I don’t see any negatives there. They named Children’s Hospital of Eastern Ontario and Springhill Medical Center as newly live, so I’m sure someone from there could provide a first-person report (it makes sense to talk to those who made it work instead of those who didn’t). Besides, they announce earnings on July 30 and always start paving the road with some positive press right before (and, if history is any indication, they’re sitting on a couple of announcements that will go out along with the numbers). Seems to me that the company’s announcements have gotten a lot more substantive since the current management team came on board.

From Gigi: "Re: Siemens. Siemens reduces 12,600 jobs worldwide, including 1,550 in healthcare, mostly in the U.S. Imaging & IT and Workflow & Solutions Division." Link. An additional 4,150 restructured jobs hits the 17,000 total that was rumored and reported here last week. That’s what stinks about working for a company that a conglomerate buys – if they struggle in one area, they cut all over the place. Times are a little lean, so I don’t imagine this will be the last time a vendor cuts back.

From Murray Slaughter: "Re: TEPR+. They’re a private business, so they can do whatever they want. You did know that the Medical Records Institute is a for-profit company, right?" I did not, actually, and they certainly don’t seem to shout that fact loudly since I can find no mention of it on their site. They have a noble-sounding mission and Executive Director (doesn’t that sound non-profit?) Peter Waegemann is always involved in non-profit activities, so I never dreamed that MRI was just a private business. Admit it: who is surprised by that? HIMSS not only runs a far better conference, they’re a non-profit member organization, of course.

From The PACS Designer: "Re: future CIO role. TPD admires the accomplishments of C. Martin Harris, MD, MBA, CIO of The Cleveland Clinic Foundation who had an interesting mini-interview in the July issue of Health Management Technology magazine. He was asked about how the role of CIO will change and said, ‘I think we’re in a transition period from a physical integrated delivery system to a virtual integrated delivery system that’s capable of serving and meeting the needs of patients and physicians on a regional, national or international basis. The CIO has to develop a skill set that’s consumer/customer oriented versus being operations oriented. These are the new responsibilities that are going to be required of a successful CIO over the next five years.’ On the IT skills of a CIO, he commented, ‘although their IT skills will be very important, understanding the concepts and principals of operations in the current model of healthcare delivery inside the hospital and physician’s office is equally important, as well as learning what it means to a doctor to care for patients when they’re not physically present.’" Link.

From Jim Turnbull: "Re: $1,000 reward. Well, what can I say. You clearly know a lot more about HIS stuff than I do … but not very much about the world of petty thieves and their friends. Yes, Mr. Talk, with all due respect … $1,000 is more than enough for these people to turn in their ‘buddies’. I can’t say enough about the guidance we received from the local sheriff, the fraud folks at USPS, and the FBI. In addition, several of my good CIO friends in the industry were incredibly supportive in terms of sharing the lessons learned from their own experiences in similar situations." Jim’s the CIO at University of Utah Hospitals and Clinics, although I still think of him at Children’s Denver. Glad to hear it, but I still would have put a little more cash on the line just in case $1,000 wasn’t tempting enough to risk arrest. I still think the university should pay and drop charges since they promised "no questions asked" for the return of the tapes and no harm was done (other than the courier got fired and had his car window broken). The idiots could have just trashed the tape, in which case someone smarter might have found it, or they could have chucked it in a river, requiring the university to fret and apologize for years since its disposition would have been unknown.

From Spence Holmes: "Re: your most recent Inside Healthcare Computing editorial called Conduct a Survey, Game the Results: If the Results are Important, Somebody’s Cheating. The KLAS survey is anything but unbiased and statistical relevance is difficult to find. A vendor with a few survey responses has the scores weighted equally as one with many. That’s why it seems that obscure vendors win the Best in KLAS all the time. The other major shortcoming I found was the fact that significant figures were not utilized. When a survey response rating is based on a single whole number, the average results cannot be reported with two-decimal precision, yet, KLAS reports to two-decimal precision. It does, of course, help one sell reports to vendors if their competitor receives a score that is 0.25 higher than theirs. Since many hospital personnel rely on these reports to make multi-million dollar, once-in-a-career decisions, it is in their best interest to have the reports accurately reflect the differences between vendors for the same product."

Thanks to Michael Nissenbaum from iMedica for a fun interview. Also, thanks to the HIStalk readers who e-mailed me about a Google warning concerning an exploit it had detected on iMedica’s site (it’s pretty cool that Google can do that!) I e-mailed Michael first thing this morning to let him know and he appreciates the heads-up. The problem is resolved and Google will eventually update itself about the issue it found on July 4. Michael sent over the network engineer’s explanation and it’s interesting, but over my head (bottom line: make sure your anti-virus checks browser pages). Anyway, the site is fine and was never penetrated, so click away.

Lots of folks e-mailed to mention that Sage Healthcare had layoffs today, as several rumor reporters had (accurately) predicted last week. Our Sage contact promised to let us know if anything changed and did, sending over the announcement at 8:30 this morning with this note: "I’m sharing this with you before I share with the industry media, and I do hope you’ll honor the embargo [4:30 p.m. Eastern] so that individual employees can have the courtesy of hearing from their managers first." That’s fair and we appreciate it – it’s hard enough to lose a job without hearing impersonally without a chance to react privately. Bottom line: 235 folks were laid off and some restructuring done to improve the company’s competitive position. As I always say, it sucks for everyone involved (I’ve been on both ends of that situation) and nobody enjoys it. Condolences to those affected. if you want to use the Jobs Offered/Positions Wanted section of HIStalk Discussion to look for a new job or to recruit those impacted today, please feel free.

I don’t see that the Sage announcement is online yet, so here’s a snip: "To address these issues, the company in April implemented a new Account Management model, allying customers with a single Sage Software resource to service most of their needs. Today’s realignment continues the focus on addressing client priorities and service. As part of the restructuring, many cross-functional, internal electronic data interchange (EDI) positions – including support and clearinghouse development – will consolidate under a single business leader to spur innovation, increase speed to market and coordinate faster response in support. To ensure that meeting client needs remains the company’s top priority, all efforts have been made to minimize the impact of resource realignment on customer-facing groups. As part of the restructuring, the company has reduced its workforce by approximately 235 employees. Services and support are being offered to those employees affected by the restructuring."

Speaking of layoffs, Cardinal Health cuts 600 jobs.

Novo Innovations brings on Mark Hanna, formerly of Patient Care Technologies and Meditech, as VP of sales.

Some folks wanted to read the writeup I mentioned about Trinity Health’s SurgiNet implementation. Alex Scarlat, MD will send a PDF if you e-mail him. 

RTLS vendor CenTrak gets a patent for a dual IR/RF location technology that’s claimed to be more accurate than RF/WiFi systems.

Tokyo-based Mitsui pays $61 million for a 47% share of MED3000, which offers a variety of healthcare services and technologies. I believe I’ve predicted foreign investment in US HIT companies now that the dollar’s worth so little, so there you go.

I quoted a credible story from some wacky publication last week about Medicare fraud, and now the wacky publication is retracting most of it. The bottom line is that the author, while well-credentialed, didn’t have factual information to back some of his statements. From the wording of the retraction and the yanking of the original story, I’m guessing the consulting firm the author named howled since they settled without admitting guilt. I still think it was probably accurate, other than the parts about that company specifically.

Unrelated and Nerd Alert: if you need a PC benchmarking and diagnostic tool that’s free, I tried PC Wizard and it’s very cool.

Dr. Molly weighs in on e-MDs and hanging out in Austin for training. She likes both.

Industry long-timer Alan Portela is named COO of CliniComp, where he formerly worked.

Providence Health (OR) is cutting back on Internet radio streaming to conserve bandwidth after offsite transcriptionists couldn’t get in remotely. Usage dropped from 90% of capacity to 60%, although that means no one can listen to HIStalk Radio (the horrors!)

Cerner moves Rich Berner to VP/GM of its Middle East operation.

QuadraMed announces GA of QCPR on Cache’. CTO Jim Klein talked about that when I interviewed him in February.

Jobs: Epic Resolute Consultants, Sales Executive – Workflow Solutions, Implementation Consultant, Principal Pharmacy Systems Analyst.

A Milwaukee business blog sides with Judy: "Instead of deriding Epic and dismissing Faulkner as a meddling ‘computer lady,’ WMC and its members might do well to ask her for advice on creating jobs and attracting talent in a tough economic climate without the benefit of out-of-state tax shelters or hand-picked judges." The Madison newspaper doesn’t.

Misys MyWay (nee iMedica) earns CCHIT 2007 certification. It’s creepy to read Vern’s quote, in which it sounds like he really believes that Misys created it and didn’t just pay the company that did: "Both Misys and the Commission are committed to improving patient safety and enhancing operational efficiency through the use of EHRs. With CCHIT certification for Misys MyWay, we have taken another step to remove barriers to healthcare technology adoption." iMedica PRM was already certified under CCHIT Ambulatory EHR 2006.

The Athens, OH paper covers the new Appalachian Health Information Exchange, eliciting this concerning comment from one participant: "It’s a very expensive proposition. Most monies put toward it so far are grants. Multiple millions of dollars have already been spent." Red flag.

E-mail me.

Inga’s Update

Hi from Vacationville! As expected, my days are filled with lots of sightseeing. I saw a great 4th of July fireworks display and have seen a few great American landmarks. I’ve also eaten a lot of food – some of it really great! Hoping the extensive walking will help me maintain my girlish figure.

Anyway, if you missed Mr. H’s interview of iMedica’s Michael Nissenbaum, I would say it is a must-read for anyone in the ambulatory EMR space. I hear that the iMedica’s sales force in particular enjoyed the interview.

I have concluded (yet again) that between the iMedica interview and the recent Sage re-alignment announcements that I am so very happy to not be in that market. There are so many uncertainties in the EMR world today (so few doctors adopting, so many questions still about who will foot the bill, who will offer be able to offer the interconnectivity required, who will last long term, etc.) that I think it may be one of the hardest sales in HIT today.

I did a bit of checking into JJ Wild’s possible layoffs. So far, some “in the know” folks don’t know anything and the “official” folks won’t/haven’t yet replied. Anyone?

Now that my vacation is almost over, that means Mr. H is about to leave. If you are a brilliant author (named John or otherwise) then I am counting on you! Send in your posts to ensure Mr. H doesn’t come back to a reader-less blog!

I heard from a reader who suggested the “AC Awards are for sale.” We’ve repeated such comments before and I’m not certain of the truth, but here is my two cents. I know that the AC Group provides consulting to companies that want Mark Anderson to look under the hood. The more the AC Group knows of a particular product, the more likely the company will earn a five-star rating. A five-star rating, by the way, has more to do with how valid the AC Group thinks the findings are and less to do with the quality of the product itself. Anderson has denied the “for sale” accusations numerous times, and in personally talking to him, I believe him. From the vendor perspective, I hear his survey is outrageously cumbersome, but yet another hoop companies must jump through if they want to play the EMR game.

See ya guys next week!

E-mail Inga.

HIStalk Interviews Michael Nissenbaum, President and CEO, iMedica

 

Many folks probably heard of PM/EMR vendor iMedica when Misys announced that it had licensed iMedica’s product and would sell it under the Misys MyWay nameplate. That put the company on the map, but it seems go be gaining visibility on its own. CEO Michael Nissenbaum has the reputation for being able to deliver and for being a straight shooter, so when a reader suggested interviewing him, I asked and he agreed.

Let’s start with a little bit about yourself and about iMedica.

I’ve been in the industry for 10 years, going back to my days at Millbrook Corporation back in 1998. They had a great product, but it had been driven off the cliff financially. It took about three to six months to put it back together, and then we enjoyed five consecutive years of 85% compounded revenue growth, profitability, best-of-breed selection in the marketplace.

The end of that story was GE came in and offered my directors a price. They were interested in exiting. They made good money. It migrated the Millbrook team to GE. Most of us stayed there for a year, year and a half, and then started looking around. GE was not the entrepreneurial environment that we had at Millbrook. GE had a different culture than we had.

I was contacted by two investors who had a significant equity interest in the iMedica Corporation. iMedica, at that time in 2004, was already a six-year-old company. Charlie Koo, the founder, had, during his PhD dissertation, convinced 18 physicians at Stanford to, instead of building a template-driven EHR, to build a chief complaint-driven EHR. Those Stanford physicians compiled about 1,000 chief complaints and then associated 400,000 clinical terms with those complaints. That provided the unique speed into the application.

Charlie and his team built the product out for EHR. It was very fast. It had the replication features which are now the patient record to cache onto the tablet. Not only the single record, but you can determine every record for everyone I’ve seen in the last 90 days and will see in the next 30. You set the parameter. It gave the physician incredible mobility on the tablet PC.

Charlie’s target market, though, was the 50-doctor and larger groups. As you and I both know, two things are required to claim that market. The first is the capital to sustain yourself through the committees, the consultants, and the “we’re not sure if we want to do anything right now” decisions. The second is having another 50-doctor group so that you have a reference account.

Charlie was able to get one account up and running, a 62-doctor practice in California, but it was late in the game and he ran out of money as well. Good product, good technology – at least the investors saw that. They decided to look around for a different management team, which got to me.

I had some individuals take a look at it on my behalf. I’m not technologist; I’m a finance guy. They came back and said, “It’s Microsoft-based.” They thought it had a lot of potential. On June 13, 2004, I came over to iMedica and was followed over the ensuing months by some others who joined me from Millbrook and at GE: Neil Simon, Daniel Popp, Lonnie Cordell.

We were very fortunate that, in September 2004, literally on our doorstep, Sanofi Aventis wanted to get out of the practice management business. They had a team of developers right there in San Jose. We were in Mountain View, California at the time, which is just a stone’s throw away. They were willing to give us the code if we would just support their existing client base, which I think were eight practices. So it wasn’t any type of bonanza.

So, all of a sudden, we had an EHR team and a PM team and were able to begin the integration of those products into a single database application offering both PM and EHR in a .NET environment. As any other software development goes, the first 90% of the time, the last 10% took the other 90% of the time. We found ourselves about a year behind in getting the product to market from our original date.

We came to market and the company we took over, iMedica, had, I think, 12 clients. Today we have well over 300 practices ranging from single doc to over 62; from single sites to over 17 sites; multiple specialities. The only thing we really don’t do are oncology and ophthalmology, but everything else is in our portfolio. We’ve continue to grow over the last three years at over 100% per year.

So you joined iMedica and they had the existing EHR product?

They had an EHR engine. It was a great documentation engine, but there were other parts of the EHR product that weren’t in the product. It was an incomplete EHR, at least when you look backwards from today. At the time it was pretty complete, but as we are seeing with CCHIT and other requirements in the industry … things that we didn’t even think are required by the EHR and we now have in the application.

Why do you think Misys decided to license your product and how to you think that decision has worked out for them so far?

They represented to us that they decided to license our product because of the underlying technological architecture upon which our product is built. For Misys, they looked around in this marketplace and nobody had the structure that was as flexible and as strong as what our development team had built. They believed they could take that and continue to leverage it into their market. So, that was the differentiator up front.

Misys is many multiples the size of iMedica, so the obvious question would be why wouldn’t they build their own? Usually you buy someone else’s technology because the market won’t wait for you or you don’t have the capability.

Their EHR has some traction in the marketplace, but it’s not a single database application with either their Tiger or Vision application. So yes, they saw the time-to-market being a hurdle in front of them if they tried to build.

Second, they had purchased Amicore. They bought the remnants of that product, if I recall correctly, in 2005-6. They were supposed to come to market in late 2006 or 2007 with this single database application. They missed that date. Just anecdotally, from what I heard, it was going to take a significantly longer period that they anticipated to bring that product to market. Then they had the change of management and I’m sure the new management had different objectives and different strategies.

I  know there was some equity consideration as part of your licensing arrangement, but I think most people said, "Why didn’t Misys just buy the company outright?"

We weren’t for sale outright. We had no desire to sell the company at the time.

Everything is for sale at the right price and Misys certainly has the deep pockets.

They do. Again, we think our value will continue to accrete. Again, we’re growing at 100%+ per year. We will continue to grow 100%+ this year even without any Misys involvement. With the Misys involvement, the numbers go up considerably.

Why didn’t they buy us at the time? At Millbrook, we think we left money on the table by selling too early. And while we have no plans of selling presently, when the time is right, we want to make sure that we get full value for our investors. They’ve been very good to us.

Is there any agreement that gives them the right to purchase more of the company?

There’s absolutely no agreement which allows them to buy any more of the company in any preferred mode. If we went out to raise capital at any time, they would have the same rights as any other shareholder.

Is the version they sell under the MyWay nameplate the same product or did they fork it off?

It’s the same source code. The source code is ours. If you go to the About button on Misys MyWay, you’ll see iMedica.

Then what value is Misys adding, other than they’ve got a big footprint and a lot of sales people?

They claim they have 110,000 physicians. They claim 85% of those do not have an EMR. That’s a heck of a business right now, going back and getting your existing installed base captured with an EMR. I don’t think any of us in the business have 85,000 EHR sites and or EHR physicians today.

Wasn’t that the same argument for their hooking up with Allscripts? Now they’ve got products from two competitors confusing their own customer base. How do you think it will shake out?

I haven’t been privy to the conversations in Raleigh. They are having discussions between Misys and Allscripts. We’ve been talked to once or twice. The MyWay product has been exhibited at their analyst day in Raleigh and got a great reception. They continue to sell it aggressively and we think it’s part of the portfolio going forward.

How it plays into the Allscripts portfolio, I really don’t know. I heard that they were supposed to bring an application to market and that’s, anecdotally, in the fall on a single database. They still had their challenges with Version 11 on their TouchWorks, their HealthMatics product. It looks like a single database is really still two different products integrated together.

You’re fully competing with both companies and will continue to do so with the combined company?

Tooth and nail until somebody notifies me otherwise.

Why would prospects buy the product from Misys instead of the company that develops and supports it?

You’d probably have to ask the few that I know that have bought it from Misys. Usually it’s continuity. They have an existing Misys contract and maybe Misys is having special deals. When we go toe-to-toe with them, we’ve been very aggressive, they‘ve been very aggressive, and fortunately, knock on wood, we’ve prevailed and we plan to continue doing so, even in light of the Allscripts acquisition.

Surely Misys will have to make a bunch of sales to get back the millions of dollars they paid.

I think they are well on their way of reaching the numbers they need. From all reports we’ve seen and heard, they continue to do very well with Misys MyWay and the product in the marketplace. They had their fiscal year end. I read the press release. They talked nicely about the Misys traction which they received. I don’t have the figures or number of units and other distribution channels. It seems like they’re meeting their plans.

Were you the only company they approached, or are there others they would have struck a deal with?

We understand that they approached a great number prior to coming to see us. Whether they did as deep a dive as they did in our house, I’m not sure, but we had Misys people camped out for the better art of a week or week and a half.

I promise that’s the end of the Misys discussion. We had to get that out of the way.

It’s not an issue. I’m very comfortable speaking about it.

In the KLAS reports, the iMedica PRM product is not listed. Why is that and does it impact your marketing?

Sure, it impacts our marketing. Our PRM 2008 product went generally available in April. It’s the product we’ll come to KLAS with in December. We did not have it installed in enough locations in time to qualify for the June book. You need 14 sites for each different group in KLAS and we were just getting all those up and running and getting their interfaces tuned.

We wanted to have, not just 14 in each … I’d like to have enough in each that it gives us a representative sample, because you only get the first level of confidence at 14. By August 15, every one of our practices will be on the newest version. We’re migrating practices every night now.

It will be the first time since we took over that we’re going to have all practices singing off the same song sheet with regard to versions. That’s going to give us the ability to address issues more effectively; to bring featuring functions to market that will enhance their environments. Up until this point, there were practices still sitting on the PRM 2006, 2007, and 2008 release candidate. That was a really hard environment to bring to KLAS. So now we’re going to have one product in a universe that will be highly satisfied. We think we can be a very competitive in KLAS.

I meant to ask you about the number of employees.

We have just about 105 employees today. The bulk of them are in Carrollton, Texas, I would say 55 to 60. The rest are sales people and training personnel and they are scattered geographically around the United Sates. If anybody is looking to come to Carrollton, Texas in a support role or to become a trainer, we’re looking for them. That’s a plug. Can they send resumes to HIStalk?

Sure, why not? We’ll hook you up.

I think we actually found a trainer recently through you. You didn’t know you had that feature, did you?

I didn’t.

We continue to grow. We continue to be selective as to who we bring on board. Interestingly enough, about 40 ex-Millbrook people have joined us around the United States in development, implementation, and sales. Somebody actually said we’re putting the band back together, but this time we’re playing a different tune – EHR and PM.

This is slightly off topic but I can’t resist asking the question. You’re someone who was entrepreneurial and went to GE. Now you’re back out of that environment. For you and those 40 people who bailed, what made you not want to stick around?

You know, that has been raised to us a number of times. While GE is a phenomenal institution, many of us felt that we spent more time fighting internally than we did fighting our competitors. Whether it was resources, product direction, technologies, getting contracts done – the bars that were set internally by the different functions sometimes made it more difficult to do work internally than getting done internally than getting contracts done externally.

In an entrepreneurial environment, everybody is focused on “Let’s take this to the next level.” You have payroll to make; you have commitments. There’s just a nice, healthy tension in an entrepreneurial environment, whereas at GE, there would be people who could live in that house for an extremely long time not having to make a payroll; not having to make the commitments; and it made it very frustrating for those of us that came out of the entrepreneurial environment.

I always say that GE is the place where good products go to die. Would you say that, in general, your direction with the product would have been different from theirs?

You know, that’s five or six years of hindsight, so I really don’t know. We had been looking at a skunkworks on EHR. At the time that we sold Millbrook, we had over 50 partners and 18 of them were EHRs. It would have been very easy to reach out and embrace one of them to come to a point where we are today, but that’s speculative at best.

Even at GE, the product and the market continued to grow, so we had a very viable business. I think if you’re in a nice trajectory, don’t walk away from it. Again, it was more the board that did this than anyone on the management team.

So we’re enjoying it. The company comes to work each day with a passion of getting out a great product. We maintain our Millbrook mantras of never letting a physician office fail and hugging the physician — God knows they’re being beaten up by everybody else in the market — and to make sure at the end of the day they have an excellent experience.

I think everybody recognizes that the EHR part of iMedica is really strong. Would you say the practice management aspect of your system is equally competitive?

You know, that’s a question that’s been raised over the last 45 days. Up until our 2008 release, our 2007 product lagged, I would say, the same level performance of performance as our EHR. But with our 2008 product, we will go toe to toe with anybody in the industry on the PM side. In fact, we will bury most of them.

The product has a tremendous report portfolio. It has great claims processing. My PM is doing what the PM is supposed to you. It has front-end claims and demographic activity, scanner capability. There are a few features that we’re going to continue to add, but as we’ve always said about our product, it’s a work in progress. It’ll never be done. We will have an upgrade coming out during the third quarter of this year, a service pack, and we’re already working on the 2009 product as we speak, which will have additional features and functionality and meet the CCHIT 2008 requirements.

Who would you say your strongest competitors are?

I would say we probably are looking at three significant competitors out there, the first being the Allscripts portfolio. Mainly on the lower end, which I think is the HealthMatics product. We run into them regularly. We have eClinicalWorks, although over the last four months, we have not seen them quite as much as we had previously. And then we see e-MDs in certain geographies.

Sometimes I list competitors and ask for some adjectives. Would you be willing to do that?

I’m not going to sit here and diss someone, but I’ll be glad to give it my best shot.

One that you probably don’t run across too often – Epic.

We don’t run across Epic too often. We see them in some environments where physicians have been offered Epic by a hospital. The interesting thing is that they are perceived as being a bit kludgy for a small physician office — overkill. That’s not surprising, because when you try to bring a large practice application down to the small market, sometimes there’s too much in it and it’s very difficult to maneuver with that product.

One of the marketing initiatives we have going on right now is called “Take a Tablet.” It’s different from anything else in the market. When you take a demonstration of our product, we put a tablet in your hand for a week, load it with the application; load it with 200 patients in a demo database, and give you an hour and a half of training and say, “Go play and here’s a number you can call if you have questions.” The application is so intuitive and the physicians get it so fast that they can look at an Epic, which is rather cumbersome for them, and with the nimbleness and the ease of use of our application, they tend to migrate more to ours.

I want to ask you a question about that a little bit later. What about Sage?

I really haven’t worked against them. Sage is the old Medical Manager. They have a tremendous installed base. The one deal I remember losing against them was because the nurses like the colors on the vitals screen. I’m going to have a hard time fighting that, but I really don’t know too much about their features and functions and haven’t seen them go head to head against us.

This might be a tough one: GE.

GE, we don’t really see that much in the EHR any more. We have started to replace them on the PM. We’re thinking that there’s an opportunity there for us. I don’t think GE has taken care of their customers to the extent that we’re able to.

And next on my list was Misys, but let’s separate that out as the non-MyWay Misys.

Well, I’m not sure what the non-MyWay Misys is. I know they just announced a big deal where they had their EHR and their non-MyWay EHR accepted at a very large practice. But I haven’t seen anybody buying Vision and Tiger lately. They’re buying MyWay.

What about Allscripts?

Allscripts is tough. They have a nice portfolio of products and they do a great job of marketing it. We think, on a functional basis, we can compete with them, but they are tough in the sandbox.

e-MDs.

David Winn has done a great job of putting that company together over the last few years. They’re tough. They have a good product. I don’t think they have as big a footprint, although David is very imaginative and a good leader. We go toe-to-toe with them. Sometimes we win; sometimes we don’t.

What about eClinicalWorks?

They were tough early on. We’ve understood what they’re selling, how they’re selling it, to whom they’re selling it. They’re formidable, but I think when physicians drill down feature by feature; when they understand what they’re getting and what they’re going to be required to get, I think our total cost of ownership is equal to theirs and I think our product dynamic is better than theirs.

What about athenahealth?

We’ve only come up against athena once or twice. I’m an accountant by trade, a CPA. I find in a small practice with what they charge, it’s almost irrational to go with them. If you look at the total cost of ownership over five years, the physician could probably pay for his kids’ college education. If you look at the cost between our application and athena, obviously their business model is working well in some of the hospital environments, but I think long term, we will continue to grow our company and be able to go toe-to-toe with them.

NextGen.

We don’t see a whole lot of NextGen. We’re in the 1-to-10 market, primarily. NextGen, even though they play down there form time to time, really isn’t that big of a footprint and they’ve said that publicly. They do well in the larger practices and more sophisticated enterprise situations.

They’ve built a hell of a product and they’re a tough competitor. They are very expensive. If we can get to a practice to look at what we have versus what they’re looking at with NextGen, and you look at a total cost of ownership, the ability to modify our application on the fly versus requiring programming, help for templates and other items with the NextGens and the GEs of the world, I think we walk away looking very good.

Some of those that are very competitive on price. I’m thinking specifically of eClinicalWorks and e-MDs. Is it tough to compete with them on price?

I don’t think it’s tough. I mean, we’re all in the same ballpark. I can’t remember losing a deal because of price. You usually you lose a deal because of features and functions.

The market seems to be polarizing around two extremes, the doc buying a simple, functional system with his own money and hoping not to kill productivity, vs. the hospitals who will provide the systems, but who pick big, traditional applications. Will that continue?

I see a cycle that’s been in healthcare for years. Right now, it’s hospitals providing software to physicians under the Stark exemption. A year from now, when we have a new administration, God knows what the new rules are going to be. You and I both have seen it. We have seen centralization and de-centralization.

I think in our market, which is the 1-10 physician group, those physicians realize that owning their patient records, being able to touch that patient record on their server, is the biggest asset they have and that’s their livelihood. To stick it at or through a hospital is problematic. It could compromise their existence and, long term, bring their livelihood into jeopardy.

I think physicians are more independent than that. They’re seeing that. Hardware has come down so much and is so easy to use that you can stick a server in a closet, essentially. You don’t need an IT department when you’ve got five or six physicians. The only thing you probably need to do is change the tape once a day. So I don’t know whether that division continues, but I’d be surprised if we didn’t see something in the next 24 months to turn it around.

The New England Journal of Medicine article reinforced what everyone already knew, that physicians aren’t using EMRs. What will it take to get them to?

I can only attack this from two sides. Putting my CPA hat on, for a physician who wants it, it’s not an expense, it’s an investment. Yes, it’s disruptive. I like to tell physicians, “Go home tonight. Turn off the lights in your bathroom. Stand on one leg and brush your teeth with your left hand. That’s what it’s going to be like using EHR for the first 20 days. It’s doing something differently that you’ve done for the last 20 years, but you will come around to it.”

We have physicians older than 60 who have adopted and become the leaders in their practice on our applications. So it’s disruptive, but once you get through that disruption, it makes your life better. And there are really economic benefits to the practice, whether it’s PQRI or whether it’s higher average reimbursements because you’re getting higher E&M scores. At least in our system, we score out the E&M points. We do a recommendation of the level visit and all the physician has to do is concur and it’s supported. We’ve repeatedly seen throughout our installed base a significantly high single-digit increase in revenue per average visit.

You add PQRI to that, you add health and maintenance reminders that are established in the clinical environment, but then go to the front desk at the time of scheduling. If I’m calling in, I think I have a sore throat, and it comes up that I have not had my PSA in a year, it reminds me to schedule my PSA at the same time. That creates more revenue opportunities for the office.

You add those together, those are the hard dollars based on revenue streams. You suddenly aren’t looking for charts. I was at a practice in Baltimore who said 60 to 70% of one head count was utilized looking for charts in a five-doctor group. That’s insane. That goes away. So the economics very much are there.

People think of electronic medical records as something you just have or you don’t, but products obviously differ. What differentiates them today and what will that be five years from now?

This goes to the previous question: what is going to make life easier for a physician? It’s the ability to use an EHR to the extent they want. In that New England Journal article, it was interesting to see that some physician use it for documenting history; some use it for e-prescribing; some use it for orders.

One of the features we are bringing to market is, in fact, the ability to structure the EHR to the extent that the individual physician in a practice wants to use it. If I don’t want to do the histories or the physical exams on the EHRs but want to continue to do it by paper, I can do that, but I’ll do the labs, the health maintenance, the prescribing, the follow-up, all on the EHR system. I don’t think any of us to date have been terribly flexible to the requirements of the physician. I think we’re going to be taking a large step very shortly in that direction.

Could products could be improved to give physicians more information as opposed to capturing more information from them?

I think it’s very important. I don’t how familiar you are with our EHR, but it’s highly customizable, starting out with the one-page summary that the physician looks at before going into a room. There are many fields on it, but they set the hierarchy and they set what they want to see. It’s by physician, care team, or practice, depending on rights. That allows individual physicians to modify the entire knowledge base. It’s not template-driven.

This is what’s different. You can modify in four or five key strokes in about 8-10 seconds virtually anything in our system and therefore customize it to your needs. Up front, we put together common problem palettes. We have adaptive learning, so that once a physician sees a bronchitis patient; if they see them again it will say, “This is what you’ve done for bronchitis in the past.” The adaptive learning continues to grow and it becomes dynamic with the physicians’ use.

I think too many of the EHRs out there, as you said, are too rigidized in templates of, “This is what you have to do and this is how you have to do it.” And if a patient walks out the door and sticks there head back in and says, “By the way, I was playing softball this weekend I heard a pop in my elbow” after you’ve seen them for an upper respiratory infection, you suddenly have to scramble and start the examination all over again.

But when you’re chief complaint-driven, you just add the chief complaint and it will pull through all the pertinent items for a sore elbow. Again, we need to adapt the applications to the physician’s reality as opposed to expecting the physicians to stick themselves inside of the template. These guys are thinkers. They went to med school to become thinkers.

You emphasize in your marketing material that physicians don’t have to put a computer and monitor between themselves and the patient. What are your thoughts on that?

Our application was designed primarily for a tablet. There are no double clicks, there are no right clicks – it’s all tablet-driven. So our physicians do some of the work in the exam room and then, as any other physician, when it’s done, walk out and finish the note off to the side.

I know, from my personal experience, last time I saw my physician, she had three inches of paper sitting on her lap and while she’s talking to me. She’s leafing through 20 years’ of paper. How that is different from sitting down looking at a computer screen or a tablet? We may not like it because its not a personal and as warm as paper, but it’s the same thing.

That leads to an interesting question. Your physician doesn’t use electronic medical records, yet you still see that physician. How strongly should someone consider whether or not their own physician uses EMRs?

My physician’s practice purchased GE’s medical record before we had a product to show them. It has taken over three years for them to implement this application. When they implemented it, it lasted two weeks and then they were back on paper in her practice. So I didn’t have a chance to get into that one. I may have a chance, depending on GE’s future success or lack thereof.

Let’s talk about the Take a Tablet test drive program. What’s the response to that and how many folks make a decision based on that one-week trial?

It’s been phenomenal. It was predicated on the fact that we had about eight physicians in the last year that looked at us and said, ‘If I could try this, I could probably give you an answer.” Of the eight that tried it, seven of them bought it.

We were able to work a promotional deal with Fujitsu. Remember, our application is fully functional on a tablet because of the caching mechanism. This is not a partial; it’s not different application; it is the exact same application when you buy the program.

What we did is we put it out there with our demo database and we teach them how to chart. If they want to chart another 1,000 patients, we warn them not to do real patients because of HIPAA considerations. But if they just want to play and create patients, it can stand alone for the physician.

One of the beauties of that is our physicians are able to take their tablet with them — whether it’s to a nursing home, to the hospital, or anywhere else — and document the full patient encounter. Take a Tablet is nothing more than an extension of that. We’ve given them skeletal training, an hour and a half to two hours, and they get it in that time frame.

I’ve seen old physicians grab tablets out of our salespeople’s hands during demonstrations saying, “I can do this” and begin to document. It’s highly intuitive; it follows logic which they were taught in med school; it’s easily modifiable; and when they look at it and play with it, they adapt to it very quickly.

We have quite a few machines in the field. We have a waiting list for our machines and we expect it to continue to see success through this promotion.

What are your goals for the company for the next five years?

We just want to continue to grow this company and develop a world class product. We were able to do it at Millbrook with practice management. We were able to do it under the radar against 4,500 competitors. We continue to do it here. We have the resources. We’ve been able to attract great talent and we continue to attract talent. We think that we will evolve to be the market leader in the single database EMR space.

You go to work everyday, you do the best you can, and you hope somebody takes notice. We got some traction and as long as it keeps growing, I’m happy and so are my investors. They have a medical background. They’re not in this just for, “Let’s make a dollar.” I hate to use the words, but they don’t need it.

They’ve been very active since the 1970s in enhancing the quality of healthcare in the United States, so this is not something new for them. They see the ability to put a great EMR in the marketplace that enables the physician, empowers the physician, and allows then to practice better medicine. It’s their life’s work. It’s not just, “This is another investment we can make a dollar on.” Having that type of philosophy behind you allows you to do the right thing as opposed to the expedient thing.