HIStalk Interviews Denis Baker, VP/CIO, Sarasota Memorial Hospital

One of Denis Baker’s employees e-mailed and said I had to interview him, including a long list of reasons she enjoys working for him. I knew of Denis mostly because of Sarasota’s work with Eclipsys and CPOE and was happy to visit with him by telephone.

Tell me a little bit about yourself and about your job.

I started in healthcare during Vietnam as a Navy corpsman, thinking that I would end up on a ship or a Navy base someplace. Then, out of total ignorance, I realized that I was probably going to end up in the Marine Corps, which I did for short while, but fortunately stayed out of Vietnam.

I got into laboratory medicine and then became a med tech. I worked in a hospital in Portland, Oregon for ten years, in a chemistry department. They were implementing their self-developed lab system. So I got involved interfacing all of the instrumentation to the computer system. This would have been early eighties. Then they thought the computer system was going to support itself, so they were going send me back to the bench. So I jumped to another organization and supported an HBOC Star lab system for a couple of years there.

I ended up being the manager of the clinical systems. Then a new CIO came into the organization and created a new position of Office Automation and End-User Computing Manager, which is the worst title in the world that I can think of. Was it meant, basically, was supporting PCs. It was a four-hospital system back then. They had no centralized support. So I pulled together a good support group for training around PCs.

I left the organization in 1991 and then ended up working for an outsourcing company that has since disappeared, moved to Cincinnati, and worked as a director of IT at one of the suburban hospitals there. Then, ultimately became the CIO for the four suburban hospitals who were part of the system. The whole consulting company crashed. At about that time, the CIO that I worked with in Portland, Jim Turnbull, had since moved down here to Florida and there was a Director of IT position. So I moved down here in 1995. I was the Director of IS for five years. Jim left in 2000 to go to Denver Children’s. I was promoted to CIO.

Your background is as a clinical department end user. Do you think that’s a good background for a CIO to have?

I think it so, because I looked around early on at who the early CIOs were. It seemed to be most of them were promoted directly out of IT and really didn’t have any exposure to the clinical world. I think that has really helped me as the whole shift in the industry is gone to clinical information systems. I can talk the lingo with not only lab folks, but also nurses and other clinical folks. Physicians as well. I think that’s been a leg up.

I think the future for healthcare CIOs in particular is to have a clinical background, whether that’s nursing or one of the ancillaries. I think you really need to understand what happens in a hospital, not just producing bills.

Should the ultimate goal be to have a physician running IT or does it really require that?

I think that physicians bring a certain aspect to the job, but I don’t think they necessarily know how a hospital works. I think they know how their practice works and how they interact with the hospital, but I don’t think they absolutely know what nursing does, or any of the ancillary departments, and what they do.

What do you like most and least about being a CIO?

Most is seeing technology applied to operational improvement in the organization and moving healthcare out of the dark ages. We’ve been on paper for a hundred years and many people have said there are industries that are far beyond us in adoption of IT. With good systems and good implementations, it’s remarkable what you can change within healthcare with IT.

Do you think clinical systems are realizing their potential, or are those systems still a generation away?

My chief medical officer asked a similar question a couple of days ago. He compared it to the automobile industry, where the tires might last for five miles and then you’d have to replace them. He thought that maybe we’d moved now into maybe the thirties or forties as far as automobile technology in comparison.

But I think we’re really in the fifties. I think the systems work, but they don’t have all of the bells and whistles that the current car today would have. It’s going to be an evolving process. We’ve been at this, with the clinical information system, for twelve years and it seems like the work is never done. There’s always something changing and something new. New functionality or, typically, some new regulation or reporting that has to be generated out of your clinical system, so the work never stops.

You never stop implementing a clinical system once you start. That, I guess, one of the downsides. You asked me the pluses and the minuses. I think the downside is, it’d be nice to wrap up a project and move onto another one, but it just never goes away.

Nobody can afford to replace those systems every few years. How important is it for the CIO to establish a relationship with a vendor and stick with them?

Let me start from day one, with negotiations with the vendor. Obviously the vendor’s interested in sales, market value, and stock price, but I think you need to reach a common ground on what you’re trying to achieve. I’m not a big one for really tough, upfront negotiations. I don’t try to nickel and dime them, but I do want performance guarantees. I do want access to senior management. I do want them listening to us as a customer base as to where their systems need to go, and hopefully they’re listening to us. Because you’re right, this system we’ve had for twelve years — I would not want to be here to be the one to replace it. I would not want to go through that agony again.

A lot of places just trade Vendor A for Vendor B while the hospital down the street is trading Vendor B for Vendor A.

Once again, I think it comes down to personalities, and if you can develop a relationship with your vendor at a personal level and not slam your fist on the table every time there’s a hiccup, but thank them for when they help you solve problems … I think that’s the key to the partnership. I think some people get caught up in egos. They’ve negotiated some super-duper contract and the vendor, for whatever reason, is unable to deliver, and potentially the CIO or whoever negotiated is being held accountable for making it happen. So the knee-jerk reaction is, “Let’s go find Vendor B. That’ll work out much better than Vendor A did.”

How much are hospital executives involved in IT decisions?

Well, here, they’re pretty involved. The Chief Operating Officer, my new CEO that’s been here for about two and a half years – both of them have been involved in some pretty major IT implementations where they came from. I think they have a good understanding of technology and what the limits of technology are. Their caution to me and the organization is, “Just because you’ve got a problem doesn’t mean IT necessarily needs to solve it. We need to focus on our workflow and the operational improvement.” And then if there’s an opportunity for IT to get involved and ease that along, that’s probably the best course to take. I think all of my peers within the VP ranks have that same understanding.

How often is IT part of the strategic solution?

It’s hard for me to gauge at this point. We’ve had a new CEO for two and half years. Our Chief Operating Officer, he’s relatively new as well. I think the last thing they look for is an IT solution, but we’re still going through our version of Six Sigma or Lean Management or Process Control Management, whatever you want to call it. And then you take a look at, “OK,is there an opportunity for IT to get involved and help solve that problem?” So as we have a fairly new executive team, I think we’re still working our way through that.

Every CIO wants to run a world class IT operation, but hospitals don’t usually have large IT budgets. How do you choose your battles and stretch your dollars?

Number one, I’ve got a great staff. I have about a hundred people on staff. Being in Sarasota, Florida, it’s fairly easy to recruit good talent to this part of the world. We pay well. So I think that’s the first key, I guess, to making it a success.

I can only think of one project in twelve years that we’ve backed out of. Some of the projects may have taken us a little bit longer or cost us a little bit more than what we thought, but we’ve only had one complete failure in ten or twelve years, out of I don’t know how many projects we’ve been involved in. I think we’ve developed a reputation, as a division, for getting things done on time and relatively on budget. That lends some credibility, not only among my peers at the executive level, but also with staff; and also, even more importantly, with the physicians. If you get them involved in something and it turns out to be a success, you get less and less resistance as you move into other things to implement.,

If you look back two or three years, what projects gave you a lot of bang for the buck or made you glad you did them?

Probably the first one would have been what’s now the Eclipsys Sunrise Clinical Manger. It was created by a company called HealthVision, then called CareVision, the product. We were the first customer. We started to roll it out in 1998 to deal with nursing documentation and physician order entry.

At some point, the voluntary CPOE hovered at about 25%  and finally, nursing got tired of having to deal with the paper and electronic world. Our elected board then told our physicians, “OK, a year from now, it’s mandatory that you put your orders in.” Almost immediately, we saw the percentage starting to rise. We run probably about 80% entered by physicians, 10% verbal, and another 10% written or faxed in.

I think the whole CPOE and at least the beginning of the medication order process of transcription illegibility and so on – that went completely away. It created other problems, but at least it solved the illegibility and who actually ordered something.

Another project that took us a few years, but I think was ultimately a good decision … we needed an ERP system. We looked at Lawson and PeopleSoft and ultimately decided on PeopleSoft. That product has been rock-solid ever since we implemented it, even after the Oracle acquisition. In fact, we’re going through an upgrade to the HR side of this system right now. We had to engage some fairly expensive consultants to help us get it implemented and augment our staff. But I don’t lie awake at night worrying about PeopleSoft at all. It really helped with supply chain management, on the one side, and then we also had some issues with HR and payroll on the other. I think Peoplesoft solved both of those.

Anything on the infrastructure side that turned out to be a good investment of time and money?

Early on, as we implemented the electronic medical record, we were looking for a fairly robust network infrastructure. At the time, about the only thing was available was a technology called ATM. Implementation was good. It provided campus-wide network backbone capability up to gigabit speed. That served us well for a few years, until Cisco and the rest of the world got Ethernet up to speed.

Since then, we’ve gone with Cisco and that’s been rock-solid for us. Built in an awful lot of redundancy to make sure that the network never goes down and, knock on wood, it never goes down. Early on, the intent with the electronic medical record was to maintain all of the records on everybody forever. So we made an early investment with EMC and their technology. This would have been back in 1996 or 1997. We’ve been with EMC ever since. So from a storage perspective, expandability, once again, that’s worked out very well for us.

You made CPOE mandatory in 2003. What advice would you have for hospitals considering doing the same thing?

I‘ve looked at some of the organizations that have tried the voluntary route, but I think you can only do that for a certain period of time before you have to make it mandatory. Like I said, we coasted along for a few years with a 25% compliance and that was driving our nurses nuts. Having to check not only the paper chart, but the electronic chart for recent orders and so on. That’s going to cause quality and safety issues. So at some point, if you’re not making it with the voluntary, I think you better go mandatory.

You’re not going win them over with technology. They’re always going to complain about the time it takes to log on and how much longer it takes to place an order. But after a period of time, in our case ten years, they can look at patient information back to 1998. There’s nothing archived. Everything’s available and I really think they see that as a value in exchange for the whole CPOE piece, but it takes a while for you to build up that database for them to appreciate that.

Are you seeing any impact of the Stark relaxation and are you doing anything with physician office computing?

In a very minor way. We’ve had Siemens’ PACS system since 1996. I think three to four years ago, we implemented Siemens Magic Web, which is the online retrieval of images. They were able to do that within the organization. Obviously, they came to us and said , “OK, we want to see those images in our offices, and by the way, we don’t want to buy any equipment.”

So we were able to seed a few workstations out into some of our specialty physician offices; orthopedic surgeons and so on. That’s all they can do with them, look at our images. They can’t load it up with games and other stuff.

Physicians have the expectation that the hospital should provide them with an office EMR. We’re trying to figure out if our direction should be in that area. Obviously we’d have to charge some nominal fee. On the other hand, as my CEO reminds me, there’s a whole host of other companies out there like eClinicalWorks and so on that are offering ASP models that have relatively reasonable prices. They offer not only EMR, but also practice management.

So why, as an organization, should we get involved in that? The only challenge I have to that is that it would be nice to be able to have longitudinal medical history on our patients, whether they’re seen in an office or in the hospitals. I’m not sure how well some of those ASP offerings could be integrated into what we’ve got. So we’re kind of exploring that right now.

Are you seeing any impact of interoperability?

We’re the only not-for-profit hospital in four counties, surrounded by HCA, Universal, and HMA organizations,and they really have no desire to exchange data. I don’t think it makes sense, from a corporate perspective, for them to get into that. So we’ve really not been too successful in creating a RHIO environment here locally.

I tried to get some money out of the State of Florida. Jed Bush budgeted $10 million to get RHIOs off the ground. I made an application and one of the requirements was that it had to be with a competitor. I tried to make the argument that, in some cases, our physicians are competitors, but the state wasn’t going for that, so I didn’t get any of that money.

How would you say Sunrise is working compared to a year or two ago?

We did the 4.0 upgrade probably close to two years ago. That was probably some of the worst software I’ve ever seen. It took us probably eight months and I don’t know how many hundred patches and service packs to get all of that fixed. But finally, everything settled down and the performance came back.

Two months ago, we did the 4.5 upgrade. That’s was probably the easiest upgrade that we’ve ever experienced. That was real quality software. I think you could see the impact of John Gomez and his development team on the quality of the software they’ve produced.

With Andy Eckhert involved, do you think the direction of the company or its likelihood to success has changed?

Yes. Andy made a few visits here since we were one of the early adopters and I’ve liked the changes he’s made in the company. I’m not sure how successful offshore development is. I’ve never dealt with a vendor who has really relied on that quite a bit. I know they’re expanding their office in India to four or five hundred developers. So hopefully we’ll see, once again, a continued emphasis on quality software when that’s released.

Some of the other changes he’s made is decreasing sales staff and so on, and focusing more on support and development folks. The consultants that we’ve had involved in the 4.5 upgrade … the quality of the individuals, I think, has risen dramatically as well. As I understand it, they have to go through a three-month boot camp to learn the system before they’re ever turned loose on the customer base. I can remember years ago when a new hire would get hired on Friday and be assigned to us to fly in on Monday, knowing little to nothing about the system. They were just here as a body filler. But, like I said, the quality of individuals we’re dealing with now is much better.

Their future success in a having a broad clinical offering like the market wants is based on making Sunrise Pharmacy work. What are your thoughts on that?

I always thought that pharmacy really needed to be, not an interfaced system, but integral to the whole order entry process. Because they didn’t have that product five years ago, when we needed a pharmacy system, we went with McKesson’s Horizon Meds Manager. We had some transition issues with McKesson. So we implemented their system; we interfaced it with a bi-directional interface. That has its own uniqueness and causes its own problems. Now that Eclipsys has a pharmacy component, we’re going through an evaluation of, “OK, where’s McKesson right now? How would their new Meds Manager and Admin-RX compare to an integrated pharmacy module with Eclipsys?” So we’re going through that process this week, comparing and contrasting that.

One of the things I remembered about the hospital is you were one of the first, if not the first, to offer a turnaround time guaranteed time in the ED. Were there technology implications to that strategy?

Actually, no. That was all workflow. A new CEO came in two and a half years ago from Detroit. At least a couple of hospitals had implemented the thirty-minute guarantee. She walked in the door and said, “OK, we’re going to do that here” and turned to the ED folks and said, “Make it happen. Figure it out.” And it really had nothing to do with technology. It was all workflow and handoffs.

Now, somewhat after the thirty-minute guarantee was in place, we purchased the Eclipsys ED module, displaced boards and all that other stuff in there, and I think that helped. Now we’re on ED doing nursing documentation. And then finally, ten years later, asking the ED physicians to do order entry. Back in 1998, they screamed bloody murder, so we started someplace else. So it’s taken us ten years to get back to them. I’m anxious to get that piece wrapped up. But no, the thirty-minute guarantee had nothing to do with technology.

Tell me more about your department.

There’s actually three departments that report to me. I had more at one point, but right now I’ve got Information Systems, which is the pure technology stuff: the servers, the network, PCs, and all of that. There’s about sixty people there. The original project team that implemented SCM has been maintained as a separate department. They used to be all clinicians, with nurses, pharmacists, radiology techs, whatever. Perhaps less so today, but I wanted to maintain a real emphasis that there was a support department called clinical systems. It was responsible for, not only SCM, but now they’ve taken on the rest of the world: radiology, pharmacy, laboratory, all the ancillary systems as well. Their focus is more on the application side, with the IT department really worrying about the infrastructure piece.

We’re about 3.1 or 3.2% of the operating budget. Our routine capital is about $30 million a year and typically we get $5 to $7 million of that, This year, we’ve got $7 million, which is about a quarter of it. In fact, that was one of the attractions when I came down here. I came from an organization whose IT capital budget for four hospitals might be $1 million. When I came down here, my predecessor Jim Turnbull had gone through a planning process and gotten a commitment from the board to spend $50 to $60 million over seven or eight years. So that was a big attraction — being able to do things without scrimping on the basics. And I’ve been able to maintain that capital commitment board and administration. This is my third CEO. I’ve been able to continue the capital investment in IT for the last seven years since I’ve been CIO. So I feel pretty good about that.

With a large amount of money being invested, how do you decide where to spend it and how to justify the ROI that results?

I think I’ve been fortunate. We’ve really never been an ROI organization, which I appreciated as well when I first walked in here. It’s been focused more on what are the problems that the organization needs to solve. What’s the solution to it? How much does it cost? And then it goes into the budget.

I don’t have an IT steering committee. My IT steering committee is my CEO and she can be very direct at times. We had a JCAHO survey a couple of years ago. We ran into a couple of situations that IT could solve and she said, “Go make it happen.” And the real focus over the last eighteen months, if not more, has been on quality and safety. Now that we’re doing CPOE and eliminated the upfront transcription errors, how do we solve the problem of wrong meds, doses, and all that on the back end. That’s why we’re really focused on the barcode administration piece right now.

Are you worried that vendors seem to be moving toward hiring inexperienced employees right out of college?

I can’t say that I’ve seen that within Eclipsys. Most of the people that I’ve interacted with, all the way from implementation consultants to project managers, these people have got a number of years of experience behind them. I’ve seen the comments about Epic and the implementations and so on, but I cannot say I’ve ever seen that with Eclipsys. There always seems to be a requirement that either they have a clinical background and know something about how the department operates. And then they get educated in IT. And as I reflect on our original project team for SCM, that’s the approach we took. We attracted the best and brightest clinicians in the organizations and then took them through the IT training piece. That worked out very well for us. I think it would be very difficult to take some computer science graduate that just got out of school and teach them how a hospital works without a whole lot of supervision and good mentorship and/or project management.

Then we get into my concern about a company that is publicly traded is having to pay attention to what’s going on in Wall Street, and try to come up with, may be not the best model, but the most economical model, and hope that it actually works. I wish there were more healthcare IT companies that were privately owned. I see Wall Street as a huge distraction. A good example — I don’t know if you remember Transition Systems Inc.?

Yes. Eclipsys bought their decision support.

They missed the mark on one quarter. Their stock price dropped and then they got scooped up by Eclipsys. At the core, I think TSI was a good company. I think they had a Cadillac of decision support systems at that time. Through acquisition, good talent left.

That’s what I get tired of — the mergers and acquisitions. When we were looking for radiology systems, Siemens had a partnership with IDX at the time. They didn’t have their own good solution. So we went with IDX for radiology. Then that faded after about two to three years. IDX went to GE, and I can’t say I’ve seen a GE rep in the last two years since the acquisition. So this whole vendor churn and having vendors figure out how the new products that they’ve just acquired are going to integrate with what they’ve got seems like a huge distraction, not only on the front end of the acquisition, but on the back end on how are you going to make this stuff work.

What technologies do you see on the horizon?

I’m not sure I’ve got any original thoughts. I know there’s a lot of negative bias against it, but it occurred to me after Katrina, the paper records in New Orleans were gone and the only organization that seemingly did well at recovery was the VA. They took their backup tapes from their data center in New Orleans to Houston and, within a week, everybody in the nation had access to those records. I was trying to think, since I’m in the potential path of a hurricane as well, what would we do?

The whole idea with smart cards appealed to me. Downloading the CCR from our inpatient systems; providing read-write devices to our physician offices so they can populate it as well. The card isn’t so much the issue. The opportunity is having a redundant data center in Dallas or someplace where all the data is stored. But from a smart card perspective, not only has the core clinical data on that card to be read any place, its also available on some website somewhere. It provides a marketing opportunity for us with our logo all over the face of it. And then from an efficiency point of view, them walking in with their card, we swipe them, they’re registered, and they are done. Then they can go on to their appointment.

One of the issues that I’m not sure is unique to us is the length of time to identify the right patient, get them registered, and double check the insurance information. I believe that smart cards would solve that. Some of the discussions I’ve heard is, “Well, we should be downloading that to people’s cell phones.” Somebody’s always looking for the next technology and we’re really focused on trying to do smart cards this year, but we’ll see how well I do. It’s kind of a data concept, but I think it’s potentially could solve three problems for us.

One of your employees e-mailed me to suggest that I interview you and said, “As long as Denis is the big guy, I will work at SMH.” How do you command that kind of loyalty?

I’m honest with them, sometimes to the point of probably saying things that maybe I shouldn’t. Like most larger organizations, there’s rumor mills all over the place and I want to make sure that my folks hear from me what I think is going on and what the organization is actually doing. So I think, honesty and also being upfront and fair. We’ve had certain situations with employees that have not been popular decisions. So when I go back to explain, to the degree that I can, what the situation was and why that individual no longer works here, they appreciate the fact that I made the right decision. They understand it.

I give them quite a bit of latitude into the decision-making, particularly to my management group. An idea will be thrown out on the table, we’ll talk about it, and sometimes I’ve overridden the consensus decision from the management group, and I’ve tried to explain why I made that decision. I’ve had very little disgruntlement because of that.

Who do you admire in the industry?

I would say John Glaser at Partners. He was way ahead of his time when they started writing their own MUMPS software in, I think, 1988. They’ve always been ahead of the curve as far as development of their clinical systems and the fact that they self-develop them. They’ve got a staff of six hundred or something like that, but to take something massive like that on and be that successful at that large an organization is remarkable.

The same employee that e-mailed me that said that you’re a faithful HIStalk reader. Why is that?

I appreciate the insight. You’re one of my twice-weekly reads and the Brev-It e-mails as well. It gives me an insight into stuff that typically wouldn’t be available to me regarding acquisitions of vendors. Sometimes the rumors are interesting as well. I appreciate the fact that you wait for secondary validation that its true. It’s well written. I think you cover the industry pretty well. Obviously I think you have the trust of your readership. It’s a good read. I guess the other piece that I appreciate is that but you’ve always got the link. The article allows me to go out and find out more about it, so I don’t have to go someplace else.

Is there anything that you wanted to talk about?

I just received the invitation for the Most Wired survey again. I wish somebody would kill that. I’ve seen your comments. I share your sentiments about it.

I’ve talked to some of my peers that have been on the Most Wired list and asked them if they’re really doing some of that, and they said, “Of course not.” So I think somebody needs to audit some of this and put this to rest. Fortunately my CEO doesn’t have a whole lot of belief in it either, so she’s not holding me accountable to what some of the other organizations are doing. Not that there aren’t some good, innovative things going on out there, but having an unaudited survey of what you’re doing … the polling results are in from New Hampshire. Everybody thought they had the pulse on what they thought was going happen and then it changed overnight. So in that case, the pollsters were throwing out the numbers, but the voters really showed up and indicated what reality was. So I wish somebody would do that with the whole Most Wired survey as well.

Monday Morning Update 1/28/08

From Mitt Romney: “Re: Lowell. Lowell General Hospital is the only full Cerner site in Massachusetts and a fairly new install. They had a multi-day,system-wide downtime last month that has been kept very quiet. It would be good to hear from CIO John Goodrow what the outage was and its impact on clinicians.” Inga will make inquiries.

From Big Fan: “Re: Cerner. Lazlo has the Cerner health plan mostly correct, but we associates have always been told that the TPA processors are not Cerner employees. Cerner has received numerous Top 100 awards for Best Places to Work, citing the health club, onsite daycare, etc. but to me, it is not as good as it sounds. The health club/associate center is more costly than the local gym, the onsite daycare is convenient and nice but more expensive than nearby places, and the health care plans are expensive compared to most area employers. Three days paternity leave – hey, at least it is something. They offer an FMLA-like option for people employed less than one year, which isn’t a bad thing. If that makes one a Best Place to Work, then I guess just having those sorts of things exceeds what most other companies do for their employees.”

From Dan Tanna: “Re: progress notes. We are moving our inpatient progress notes online. An issue that has come up has been during a code or RRT situation, people have to leave the bedside to find a computer and look at the ‘chart’. I recommended using one of the nurse’s medication carts since they are wireless, portable, and hooked up to the EMR, but was wondering if there are any better ideas. We don’t want to print out notes.”

From Walt Ducati: “Re: Cerner in the Middle East. Cerner was chosen by the American Hospital in Dubai, but later lost because ‘management couldn’t deal with the arrogant Cerner salespeople, so we took our next choice – Meditech.’ The hospital did not look at Epic because ‘they didn’t have plans to sell internationally.'”

From NY Customer: “Re: QuadraMed. Could someone please confirm the departure of Christine Stanfield from QuadraMed? She was one of the few who really knew the CPR system.” I’ll defer to anyone who knows one way or the other.

Intercepted e-mail: Drexel DeFord has resigned as VP/CIO of Scripps Health, according to an internal memo dated January 22. His last day will be February 22, after which he’ll head off to be SVP/CIO of Seattle Children’s after two years at Scripps. You may know him from his Air Force hospital CIO days or his HIMSS involvement. The anonymous source sent the e-mail over by confidential Rumor Report.

Jobs: MUMPS Software Engineer, Centricity Consultant, SCM Project Manager (Contract), Allscripts Consultant.

McKesson joins the “vendors laying off” club, wiping out 79 IT jobs in Dubuque, IA and announcing plans to sell the old department store it occupies. Sounds like the end of the line for CyCare, the practice management and EDI vendor that HBOC bought for $287 million in 1996.

The Raleigh paper declares that Misys Healthcare is “on the mend,” although its numbers don’t seem quite that rosy and betting its future on a relabeled competitor’s physician system seems both risky and uninspired. Maybe it’s just me, but they’ve got a lot of train wreck baggage to unload before I’d project their success.

HHS recognizes three of HITSP’s interoperability specifications.

Calgary Health Region reveals that a problem with fax software held up delivery of radiology reports to doctors’ offices last year. I’m still amazed that anybody faxes anything. If someone e-mails me some document to be signed, I print it, sign it, scan it, and e-mail it back. Primitive, but way better than faxing.

This seems preordained: in Michigan, St. Mary Mercy Hospital will join St. Joseph Mercy Health System.

Investigators say that an electronic medical records system is partly to blame for the low productivity of its contracted prison doctors, calling the documentation function “achingly slow”. Their recommendation: get rid of it.

I’m puzzled: Sumter Regional didn’t win the MRI from Siemens, according to announcements that proclaimed Lockport Memorial Hospital (NY) to be the winner despite what looked like about a 2 to 1 Sumter victory based on the online vote counts. I’ve seen no mention of how or why the auditors overturned the tally, although the phrase “qualified votes” has been thrown around. Still, Siemens is giving them a free MRI anyway, saving themselves a PR headache in having to explain how, in the absence of an electoral college, the popular vote winner lost. I’m trying to hold back on the Siemens bribery jokes.

Physician billing company MTBC is named a Microsoft Gold Partner, which I don’t care much about, but I did look at the company’s site since I’ve never heard of them. Looks pretty good and the management team has great credentials. Says they take care of all physician office billing for 4%. You can download their free EMR in case it’s a slow weekend.

Big problems at $3.8 billion insurance company WellCare Health Plans, which probably thought they’d bottomed after state and federal investigations and a stock price freefall. Well, maybe: the CEO, CFO, and general counsel all quit Friday. At least the CEO has an impressive resume to take job-hunting; he was also CEO of a subsidiary of Oxford Health Plans, which had a similar meltdown.

Nice reporting by an Idaho reporter: researching the governor’s claim that the RHIO he wants to start will be self-supporting after the grants run out, she dug up several sources from our industry citing how hard it is to wean off RHIO grant money. Both the writing and the research behind it are better than what most of the industry rags put out.

John Dvorak says Sun’s aquisition of open source database vendor MySQL is such a bad idea that surely Sun is trying to kill MySQL off to benefit Oracle. Evidence: Sun’s terrible acquisition track record and its willingness to pay $1 billion for a company whose annual revenue is only $60 million. I’ve also heard that the price was really too low and that the stalwart Swedes who run MySQL should have shopped it around before simply handing over the keys to Sun. Since its database runs most of the Internet (mostly because it’s free), it’s surely got a footprint.

Bizarre hospital lawsuit: an Illinois hospital will pay a $100,000 EPA fine but still faces a civil suit from a man who says he saw a hospital employee toss a cardboard box of body parts into the open grave of his father and stomp on it, explaining that the hospital contracted with the cemetery for such disposal.

E-mail me.

News 1/25/08

From Kevin Gnapoor: “Re: HIMSS Analytics mention of HIStalk. It came off better than you reported. Of surveyed healthcare IT execs, 65% reported reading a technology blog in the last year. When asked to mention specific blogs read, 13% identified HIStalk, whereas no other blog was mentioned more than once.” Glad to hear that, although I’d like think I can compete well with mainstream publications and not just blogs. It makes Inga happy to be anonymously famous.

From Cady Heron: “Re: Misys. Misys will have a big roll-out of an SaaS solution. athenahealth may start feeling some heat if Misys can overcome its current dismal perception in the market. As my contact stated, athenahealth is nothing more than a service operation for handling billing with a software front-end.”

From Broadway Joe: “Re: Keane. We run their RCM product and some clinical apps and we were happy to see there recent press releases with some new deals. I know they are actively installing new business in the NY/NJ area.  I think the CHS move was a provider acquisition that is causing the move away from Keane.”

From Gretchen Wieners: “Re: Leapfrog. I agree Leapfrog has become irrelevant, but they started with the realization that employers held the purse strings in many cases and had motive for lower cost and better quality of care and better negotiating power given their role. So they analytically looked at what would have the biggest impact on medication errors and chose them. That included CPOE, which can play a key role if the system is designed for clinical decision support. The others were also no-brainers, e.g. the intensivists. But, they never used their clout and their demands were unfunded. Once the MDs balked, they caved.” 

From The PACS Designer: “Re: Oracle VM. Virtualization has been mentioned in past posts by TPD. Oracle has a new software offering called Oracle VM, which makes it easier to implement virtualization within the institution at a relative low cost for both Oracle and non-Oracle applications. Edward Screven, Oracle’s chief corporate architect, states ‘Oracle is the only software vendor that combines the benefits of server clustering and server virtualization technologies to deliver integrated clustering, virtualization, storage, and management for grid computing’.” Link.

From Cliff Pantone: “Re: AMIA. This job posting on the American Medical Informatics Association website nearlymade me spurt my morning coffee over the screen: ‘Applicants should have experienced first-hand the creation and rollout of a commercial software product, or else should possess a good sense of humor.’ Too true, too true…”

From Jerry Aldini: “Re: Cerner in the Middle East. I wonder if Cerner will sue IBA since the hospital IBA supposedly took from them was never in the Cerner-Health Authority contract? Also, I have heard that the delayed go-live is mainly due to data center delays. In the Middle East, there is NO experience on the client side when it comes to projects of this magnitude. If a data center is not ready, PCs are not ordered, or end users are not trained, it’s the vendor’s default.”

From Lazlo Hollyfield: “Re: Cerner. It’s funny how an organization supposedly trying to improve healthcare treats its own employees poorly in health benefits and policies. Cerner offers only high-deductible health plans. It created its own TPA (whose medical director was a Cerner associate) to handle employee healthcare claims and Cerner employees manage precertifications, claims, and medical records, meaning the company is looking at the medical records of its own employees. HealtheExchange uses a second-tier provider network that leaves major metro areas uncovered, so if an associate falls seriously ill while working at a client site where the plan has no in-network providers, the associate gets stuck with the bill for any charges over the usual and customary amount, typically 60-75% of the provider’s claim.” I’ll just jump in to disclaim that I don’t know this officially, so you’ll have to take Lazlo’s word for it unless somebody wants to second his emotion.

From Charles Bronson: “Re: RevolutionHealth. They already have a PHR, soon to be CCD-structured.”

From Dr. Lisa Cutty: “Re: Cerner. We get rumors from Asia about Oracle buying Cerner. I know they are interested in the company since 2004 and Cerner is using Oracle’s platform, but are there any new developments?” None I’ve heard. The floor is yours if you have.

MedStar Health, the Baltimore/Washington system in which Azyxxi was created, chooses Cerner Millennium for all seven of its hospitals, although not all apps. A couple of people e-mailed me wondering if that means anything beyond the obvious. I’m guessing no. From Art Vandelay: “I wonder if they used the funds from the sale of Azyxxi to pay for Cerner? Ironic … at least there was no mention of replacing the ED module. Do you really still need your own CDR/Viewer if you are going away from a best-of-breed strategy?”

This must have been embarrassing. HealthTrio is working with CMS in a PHR pilot, which requires going through a security audit. Auditors connected their equipment to power in a server rack and blew a power circuit. That was fixed, but somehow the connector on the server’s RAID controller card was broken. They failed over and were up again within a couple of hours, but this morning went down again due to DNS problems. It’s running, although not very well, and another outage this evening is needed to catch up the primary server.

I’m guessing that Sumter Regional Hospital won the MRI since the Sumter folks sent me an invitation to attend a joint Siemens-SRH announcement tomorrow morning. Good for them. Unusually smart marketing by Siemens, too.

Inga and I finished the first of several new HIStech Report interviews, this one with Stratus Technologies. Pretty interesting stuff. We’re proud of how cool our reprint format (warning: PDF) looks considering we’re moonlighting amateurs.

Jobs in cities: Nashville, Chicago, Denver, Los Angeles. I see we now have 230 jobs listed.

Meditech’s Magic 5.6 is now CCHIT certified.

Premise had a 260% increase in revenue in 2007 (2,265% over five years). I interviewed CEO Eric Rosow in November about hospital throughput.

Ann Carey of St. Vincent’s HealthCare (FL) is promoted to VP/CIO.

Suffolk RHIO in New York chooses HealthUnity.

Last chance for HISsies voting.

Former State of California CIO J. Clark Kelso replaces the receiver of the state’s prison system. I had to look up what that meant: California’s prisons provided such bad medical care that the federal government seized the system in 2005, calling conditions deplorable despite annual medical costs of over $1 billion. The guy in charge is the receiver.

Cleveland Clinic is a big sponsor of Arab Health Congress and CIO Martin Harris will speak. Mr. HIStalk was not invited to attend as a guest of the countries he so richly supports through his regular gasoline purchases, so he sends his regrets. Dubai seems pretty cool.

MedAvant’s shareholders approve the sale of its preferred provider network for $23.5 million.

Wal-Mart starts an employee pilot of its Dossia PHR system, a quick rollout considering it wasn’t long ago (September 2007) that Omnimedix was replaced with Children’s Boston as the technology supplier.

Busted: a Massachusetts doctor is reprimanded for reviewing the electronic medical records of a nurse he was dating. The hospital caught him in an audit and gave him a written warning, but the medical board fined him. Another employee found that the doctor had checked out her OB/GYN records, so she’s suing the him and hospital for $250,000.

The Massachusetts Attorney General is investigating the $16.4 million parting gift that “nonprofit” (despite a $157 million “surplus” in one year) BCBS of Massachusetts gave its retiring CEO this month.

Varian Medical Systems announces Q1 numbers: revenue up 18%, EPS $0.43 vs. $0.37.

The government is anguishing over those five acronyms that are holding the industry at bay due to imprecise definitions, but there’s another mammoth problem that’s keeping Uncle Sam awake at night: the job descriptions of HIT employees. HHS secretary Mike Leavitt asks AHIC to come up with job descriptions and their required credentials in the next year. It is mentioned that the shortage of trained HIT experts is getting critical and not just in the US.

E-mail me.

Inga’s Update

Misys PLC announces its interim results from the first six months of their fiscal year. While overall revenue for the company (including banking and financial services) was up about 3%, healthcare saw only a slight revenue rise and order intake was up only 1% over the same period last year. One of the most painful numbers has to be the 34% decrease in initial license fees. No doubt they are hoping MyWay will turn things around for the rest of the year.

Medcomsoft signs a $750K agreement to put EMR in Puerto Rico’s largest owned drug store chain. The deal includes licenses for 100 physicians.

Just the other day I was wondering if I should consider a health savings account and if anyone really used them. Well, according to HSA Bank (warning: PDF), quite a few folks are using them, given the bank’s status as the first HSA administrator to surpass $500K in HSA deposits.

Revenue cycle management provider Accuro Healthcare Solutions files a registration for an IPO to raise up to $144M.

McKesson adds Intel executive Andy Bryant to their board. Bryant is an Intel executive vice president and chief administrative officer.

HIMSS announces that registration for this year’s conference is up 17% over this time last year and more top-level execs than ever are attending. Mr. H swears it’s because I’ll be at the Healthia/HIStalk soiree, but I think he’s just saying that to get me to wear some fancy ball gown.

Read about Meriter Hospital and details on its $30 million all-digital hospital in Madison, WI. Epic is called the “centerpiece” of their showcase for the latest in healthcare technology for patients with cardiovascular disease.

E-mail Inga.

Leapfrog’s Big Leap Into Irrelevance

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in October 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

I remember sitting in a hotel ballroom back in 2001 or 2002 hearing about The Leapfrog Group for the first time. I was both energized and worried. I liked their idea of pushing a short list of evidence-based quality measures for hospitals to follow. However, I was worried that my own hospital employer might not be able to meet their expectations, thereby raising the ire of the big-employer healthcare dollars behind Leapfrog.

Leapfrog didn’t sound like someone to mess with. The post-dot com era would be bleak, with too many hospital beds competing for the business of the newly savvy baby boomer consumers, capable of making shrewd healthcare decisions because they’d ordered books from Amazon.com.

If the IOM’s “To Err is Human” was embarrassing, Leapfrog was threatening. Their changes were downright prescriptive, encouraging no debate or deviation, and backed by the folks who pay the bills. Experts in their individual Leaps howled to see the evidence behind their choices, but it was not forthcoming.

Somewhere along the line, Leapfrog fizzled. Nowadays, they’re a quaint anachronism. Their role seems mainly to trumpet the accomplishments of other groups on their website.

In fact, I just compared their Members webpage with an archived version from 2004. Today’s count: 44 members. 2004’s count: 152 members. Among the missing: Allscripts, Cerner, Eclipsys, McKesson, Misys, Siemens. I hope no one got hurt in the mass exodus.

A new Leapfrog press release illustrates how little influence they have. They did a study that found over 90% of hospitals have ignored their CPOE mandate. Over 90% don’t meet their standards for two surgical procedures. 70% don’t use intensivists in the ICU as Leapfrog demands. Are they suffering from the financial retaliation of Leapfrog’s few remaining members? Not that I can tell.

Also unfortunate was their inclusion of Indianapolis’s Methodist Hospital as one of their Top Hospitals of 2006, fresh off headlines detailing the deaths of three newborns there due to a medication error. That could have happened anywhere, but the timing was terrible for Leapfrog. To cynics like me, that was yet another indicator of their irrelevance.

I’ll leave other experts to comment on some of the widely ignored Leapfrog standards, but I’m not about to pass up the chance to point out how ridiculous their CPOE requirement is.

CPOE prevents few patient errors. It prevents mistakes, but mostly those that would have been caught anyway by skilled professionals, such as transcription errors and clinically questionable orders. Just about every study done by AHRQ and others have said exactly that: there’s nothing wrong with CPOE, but just don’t expect it to make much of a difference in patient outcomes, particularly considering its immense cost and failure rate.

Leapfrog should have been smart enough to steer clear of the CPOE bandwagon. Maybe they didn’t look around at the available products, small in number and large in functional deficiencies. Maybe their healthcare IT members twisted their arms to sell a few CPOE systems by mandate. At any rate, Leapfrog’s urgings probably sold a lot of CPOE systems, but their own survey shows they aren’t being used. Millions spent with little to show for it, apparently.

It isn’t that healthcare won’t change, it was just that Leapfrog didn’t do it. For those making it happen, check out Don Berwick’s Institute for Healthcare Improvement. If you want to see research in action, look at AHRQ. If you want to see cutting-edge informatics, consider Kaiser or Intermountain Healthcare. For mass market mandates, even JCAHO’s core measures are getting the word out. And if you want to see a group living in its own formerly large shadow, check out Leapfrog.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 1/23/08

From Neal’s Pizza Guy: “Re: Cerner. 21 June 2005: Cerner wins a seven-hospital Abu Dhabi contract and no doubt promises the world. Arab pizza futures soar on the news. 14 June 2007: Cerner opens a new office in Dubai to supplement efforts in Abu Dhabi. The smile on Doug Krebs face says the parking lot is full and the pizza is yummy. The other Cernerbots smile pretty for Neal. 22 January 2008: Doh! What do you mean we had to deliver?!? IBA Health boots Cerner from Abu Dhabi hospital after ‘lengthy delays.’ Abu Dhabi pizza futures are down …way down. No word on whether Krebs is still smiling. Also: Computer Weekly reports that Fujitsu is ready to pull the plug on NPfIT program. UK pizza futures are rocketing on the news.” Link.

From Rich Davis: “Re: Cerner layoffs. Go back and check your lists of healthcare IT employers in KC. There are several pharmacy tech vendors of size and lots of other niche players. Other IT only places are Garmin, Yellow Freight, etc. Don’t cry too hard for these folks. If they have any skills at all they will easily find work.”

From Kenny Crawdad: “Re: Keane. What is up with Keane? I hear they are imploding because of the new acquisition and the loss of CHS business. No real new sales in over six months, and the only thing going is some offshoot deals with MedSphere. Sounds pretty scary.” Unverified, assumed inaccurate unless someone wants to confirm.

A sponsor tells me (via Inga) that HIStalk was mentioned in a recent HIMSS Analytics webinar, with 13% of surveyed healthcare CIOs saying they read here regularly. I’m a glass-half-empty kind of guy, so I’m thinking that having 87% who don’t is a terrible disappointment, but I guess that’s pretty good.

My editorial this week: Cerner Layoffs in Review: Why Marching People Out Makes Sense, but Sickouts Don’t. A short teaser: “Personally, I’m blaming Meditech.” Want to guess the connection?

Houskeeping issues: the search box to your right plows through millions (literally) of words of HIStalk going back to 2003, so Google yourself or a company for fun. That Rumor Report button to your right lets you send me anonymous, secure messages (including attachments if you’re so inclined), so give me some good dirt and I can write about. Sign up for e-mail updates when I write something new here or for the Brev+IT weekly e-mail. Try HIStalk Discussion or the stock page. Our friends at Healthcare IT Transition Group have a text ad to your right for their 2008 Health IT Grant Resource Directory (you can check out sample pages and full details). And please take a moment to do a little click-visiting to the sponsors whose ads grace the left margin and thereby keep my keyboard clacking until all hours of the night like Design Clinicals (HIStech Report coming soon), SCI Solutions (ditto), high availability architecture gurus Stratus Technologies (ditto again), and patient flow experts Premise.

Speaking of Google search, I was scouring HIStalk for something yesterday and ran across this post from May 2006, when Electronic Slide laid on some heavily sarcastic criticism of my skepticism about the rumor that Allina was bailing out on Epic, saying I play Epic favorites and have no journalistic standards. Since then, Allina’s live on Epic and, in fact, won the Davies Award. So there.

Jobs: Account Executive Sales (note: it’s in KC!), Physician Liaison, Information Architect, Sales Executive. Signup is quick for a weekly jobs update.

Stocks started out in meltdown mode this morning, then rebounded, with the Dow down 1% and Nasdaq down 2%. Most HIT stocks did a little but worse than that, but Eclipsys and Perot Systems were up.

Jim Wilson is promoted to president of Craneware’s US subsidiary, which sells charge master software.

Philips had a big Q4, doubling profits to $2 billion on a 3.8% revenue increase, but US sales were down 10%. Healthcare is right up there with shaving and grooming for US investment, the company president says.

King’s Daughters Medical Center (KY) names Cathy Cooper-Weidner as VP/CIO. I think she used to be CIO at Memorial at IU South Bend.

West Georgia Health System is bringing up a $12 million Meditech system. It wasn’t clear what it is from the newspaper article, but C/S 6.0 is mentioned.

If you have to make a medication error, make sure no celebrities are involved. Dennis Quaid criticizes Cedars-Sinai in a Sundance Film Festival interview, something the average patient isn’t often asked to do.

Looking for a laptop deal? Best Buy has a Gateway with Pentium Dual Core 1.6 GHz, 2 gig memory, 160 gig SATA, DVD/CDRW, 15.4″ display, and Vista Home Premium for $549. I got one and it’s sweet, even to the laptop-indifferent like me.

GE Healthcare will exhibit at Arab Health 2008 in Dubai next week. So will just about everybody else in HIT, according to the conference page. Which reminds me: if you’re an HIStalk sponsor, Inga will be contacting you about some cool HIMSS benefits: a free sign for your booth (autographed by her, no less!) and a mention in the upcoming “Mr. HIStalk Goes to HIMSS” guide. Thanks to the companies who volunteered to help out with our little giveaways there. We’ll name them soon.

Siemens will announce the MRI winner in a live webcast Friday morning at 8:00 Eastern. Sumter says they haven’t heard anything.

The Ann Arbor Area Health Information Exchange gets a Detroit mention. Its annual budget is only $140K, which is darned good. NextGen is mentioned because all the partners use it.

An embarrassing NHS glitch: a server crashes at midnight, the primary on-call tech forgot to turn his cell phone on, and the backup support tech didn’t have a data center key. The ED and results inquiry function were offline for 12 hours. Maybe not as embarrassing as this NHS gaffe: a patient’s newly transplanted kidney has to be removed when caregivers notice that the patient’s blood type was recorded wrong in the computer.

E-mail me.

Inga’s Update

The country’s oldest visiting nurse association, VNA of Western NY is partnering with Cardiocom Multi-Disease Management to provide home telemonitoring technology.

Cerner Millennium PowerChart 2007 and MEDITECH MAGIC 5.6 just gained 2007 CCHIT EHR certification. INVISION Clinicals Version 27.0 with Siemens Pharmacy and MAK Version 24.0 is conditionally certified, pending a “verifiable customer reference.”

Awarepoint and Skytron announce a new integrated active RFID asset management and information resource solution.

McKesson pats itself on the back a bit for having 18 solutions ranked in the top three in the recent KLAS rankings. Not shabby at all.

Greenway Medical Technologies was another strong KLAS performer, named Best in KLAS for ambulatory EMR in the 6-25 physician practice. Greenway’s also making headway into the RHIO/IDN/IPA segment since the Stark laws were modified and has signed on 10 community healthcare organizations since July.

Fujitsu announces a more secure and powerful mobile device targeted for healthcare (and some other industries.) The newest design of the P1620 includes such features as a biometric fingerprint sensor, secure asset tracking software, and a weight of just 2.2 lbs.

Is it tougher than ever to be in healthcare sales? Out of 180,000 surveyed docs, 19% said they refuse to see drug and device sales reps at any time and 23% make the reps to set an appointment. However, 73% of the physicians said they’ll take details from reps at any time of the day or week. A couple of curious observations here: first, the numbers add up to greater than 100 (what is up with that?) and second, this study by SK&A Healthcare Information Solutions (who sell physician databases) claims they reached all 180,000 doctors by phone. Why would a doctor take a phone call from a marketing company but not see a sales rep in their office? Are there perhaps no restrictions on paying physicians for their time to answer surveys?

E-mail Inga.

Art Vandelay on Social Networking in Healthcare

The spigot is opening. Another Web 2.0 company, IMedix, is stepping onto the scene to take social networking and apply it to healthcare. This company offers a virtual gathering place for patients to share their experience and search for useful health info.

This is one of those trends I follow from outside of our industry and try to figure out when it will make inroads into our strategy. I have seen small communities arise around support groups on Yahoo Groups, FaceBook, and MySpace. These venues aren’t tailored to health information. CarePages offers a somewhat similar concept but is usually offered through a specific health care institution. WebMD offer this service but it can be a challenge to navigate. Revolution Health (RH) seems to be the player with the most momentum. They offer the communities and health info, but also aim to link in information about physicians (typical find-a-doc search), insurance companies, and health risk appraisals. Like RH, IMedix makes money by selling targeted ads.

What does all this mean for us? Other than “never a dull moment”, I see four blips on the radar. First, these sites are yet another logical platform for personal health records (PHRs). Second, they are a platform for physician and insurer report cards. Third, we will be monitoring content sources to provide a list of approved sources for patients. Lastly, our media awareness requirements will evolve.

For PHRs, start brushing up on your HL7 Continuity of Care Document (CCD) specification and quizzing your vendors. Then, start tracing the data sources that feed the CCD. The CCD content in a PHR will be just like a patient receiving a bill and questioning the details (“Did I see Dr. ‘A’? I don’t remember her coming in.). In the PHR scenario, it will be patients questioning diagnoses, procedural descriptions, and results they see. Decoding the trail of consumer terminology versus medical and billing terminology and norms will be the challenge.

For report cards and content sources, the responses of our organizations are pretty clear. We will be asked to either try and compile the same report card info or develop systems to align with or challenge the scores. For content sources, we will be asked to provide a place where our clinical content managers or librarians can add or remove approved sites while also educating our physicians about the sites where we usually direct patients.

Media awareness, outside of health care, is a niche service. There are services that scour the public sources of information (ex: Internet, publications, radio, TV) for mentions of a company and sell the transcripts to the company. We may soon be in this challenging situation – finding all the mentions of our organizations and attempting to validate that what was said was correct.

HIStalk Interviews Mark Zielazinski, CIO of Children’s Hospital of Central California

You may remember Mark Zielazinski from his days as CIO at El Camino Hospital. He responded in 2006 to a reader comment about that hospital’s problems with its Eclipsys Sunrise implementation, which caused great organizational upheaval and nearly got the hospital shut down, according to newspaper accounts. We agreed to do an interview at some point. It’s taken awhile, but we finally had a chance to talk. Mark’s now CIO at Children’s Hospital of Central California. He was trying to get out of the office for a long Friday commute home when we connected, but was gracious enough to spend time with me.

Tell me a little bit about yourself and your job.

I am CIO at Children’s Hospital of Central California, which is the only rural children’s hospital in the United States. It’s actually a pretty big facility. We’re located just outside of Fresno, California, the central valley of California. I think we’re going to be 320-something beds next month. We’re opening up 28 more beds.

Describe your IT shop and how it’s structured.

We’re primarily a Meditech shop. We’ve been a Meditech hospital for 20+ years, so we were an early adapter of the Meditech system back in the mid-eighties, I think.

Beyond Meditech, we have the typical gaggle of supporting systems. We’ve got Picis in the OR. We have Kronos for time and attendance. We’ve got a couple of ancillary systems and KaufmanHall  products for budget and capital. This year we’re going to be replacing our Meditech ERP modules with the Lawson system for ERP. We’ll start implementation this summer and then go live sometime in ‘09. And then for the Meditech products, we’re just starting to do nursing documentation. We’re on the old Magic platform.

We’re doing some things with physicians in ambulatory order management and pharmacy in prescription writing. We’ll upgrade to Client Server in the fall. We’ll start the process this fall. I think that will be done just about the time we go live with the ERP system.

Most readers will remember you from El Camino Hospital. You had problems there with the Sunrise go live and pharmacy department problems on top of that. What lessons did you learn personally from that and what should other vendors and the industry learn?

We did a lot of things right there. I think we were on track with being very successful. I think they’re going to very successful right now. I know Eric Pifer’s there. I think that’s going to go well for him. He’s got a good environment to go from.

We went live in the first part of March 2006. I don’t remember the exact dates, but it was sometime in early 2006. We had missed our initial go-live, which would have been the middle of November 2005. The primary reason for missing was the fact that we couldn’t get our doctors educated. I think the training we had set up for them was about four hours total, in two-hour segments. We actually did it, but we could have done it a little better. We started paying the physicians to attend those classes. We paid them a fixed fee for the two classes. To get the payment, they had to go through and demonstrate proficiency. The lesson is that you have to pay them.

You get so much momentum. We had gone almost three years. We were in the process of building, creating, and moving when we missed our November date. So it was three and half years by the time we went live. I think one of things that’s got to happen is it can’t take that long. You’ve got to find a way to get that stuff to work in such a way that it doesn’t take three years to build a product and get it ready.

This was a place where we had the experience. El Camino had been doing physician-based order entry. They’d been doing nursing charting and documentation. We were doing all that stuff and it still took us a hell of a long time. The products vendors have, and I don’t believe Eclipsys has a monopoly on this problem, are really a tool set. They don’t have a very good set of schematics and plans and starting places for you, as an organization, to be able to drive with that tool set quickly to using it.

You hit the third thing on the head when you said we had department issues in pharmacy.  We really needed to have dealt with that prior to that change. That was a major league change for pharmacy. Even though we were using the pharmacy product, the old E7000 product, it was a pretty manual process without any kind of real automation to it. Even though it was SCM 4.0 and I know everyone talks about the fact that it was an interfaced product versus an integrated product, people have been using interfaced pharmacy products for years and years.

That wasn’t what the issue was there. We had a very serious problem and the pharmacy didn’t do a very good job of managing that. I take some of the hit for that, but I think the organization takes some of the hit for that as well. We ended up actually outsourcing the whole pharmacy management. Once that was done and in place, the vast majority of the issues that were affecting us at the time of go-live and about five months later when we actually did the outsourcing, it kind of disappeared. Not to say that there’s not still learning that’s going on.

Somewhere, I have documents from the original Lockheed-Martin system that ultimately became TDS. It went live in 1971 at El Camino. There was study done in ’75 and another in ’77. They’re really good studies talking about adoption. In six years post go-live of that system, they only had about a 40% participation by physicians. So it’s not something that happened fast back then.

Looking back now, with the benefit of 20:20 hindsight, should the plug have been pulled at El Camino because it wasn’t ready?

I think if we would’ve had the issues in pharmacy fixed, I’m not sure that would have had such a negative impact that it had. I don’t know that the system wasn’t ready at that point. I don’t know if we had made some of the pharmacy outsourcing decisions prior to go live; would we have said at go live, “We aren’t ready”, and would we have experienced the same problems. I don’t think we would have, so I think that was where that all ended.

But I think you’re right. We had a committee, a very large group that included the chief nursing officer, myself, and the chief financial officer, looking at that, making the decision and recommending to the board of directors whether we went live. The three of us made that decision. Primarily myself and the chief nursing officer made the decision to pull the plug on the November go live because we didn’t think we were ready. We had physician input on that committee. The committee was basically a group of 28 people that met as we were getting ready to go live on a very regular basis. Not just weekly, but multiple times per week. We made the decision and took it to the board of directors.

When you left El Camino, you went to Sensitron as the COO there. What did you like and dislike about working in that environment as opposed to a hospital?

I’ve been in the private sector and consulting or working for small companies before. I was employee sixteen with Superior. I was very early on with DAOU systems. I actually went through taking DAOU systems public. So I looked at the opportunity with Sensitron as, here was a start-up company. I’m at that time in my life — I’m fifty today — where I thought, “I could try that one more time”.

They were pretty good folks. They were a service provider for us at El Camino. I knew their technology. The CEO had left the hospital. The guys from Sensitron had come to me and offered me an opportunity to participate in that small company start-up thing. To me, it was one more opportunity for me to do that. I’m not sure how many time you can jump in, try to take something and see where it goes. So it looked like a great opportunity.

We never really got our funding set up appropriately. So for them to continue to carry me would have really put an undue burden on their ability to the R&D kind of work. While I was there, we were able to put out a new product. Sensitron does the wireless automation and collection of vital signs from the devices that you move around from room to room in the hospital. While I was there, we also came up with an ICU product that took information off of the stationary monitors in the ICU. So I was able to get a new product out and help them develop a new version of their existing product, and do some alignments with companies

We struck up a partnership relationship with a portable monitoring company. Then our money dried up. We didn’t have any more money coming in, in terms of investment money. And our sales weren’t keeping up with the payroll. I said, “Look, what we really need to do is continue to build our engineering group and our customer services group. Carrying my salary doesn’t make any sense, guys.” So I told them I was going to go off and do some other things, which is what I did. I went off and did my own consulting and then landed a job here at Children’s.

How would you compare your Meditech shop versus being at El Camino?

It is a little bit different. It’s a little tighter system. Looking at the Client Server version of the product we’re looking to go to and looking at the documentation features, there’s a lot of stuff that … quite frankly, I was surprised at how similar it was to some of the capacities in the SCM that I’d put out there. They’ve come a long way.

The last time I had ever worked on anything at all with Meditech was when I was back with Superior in the late eighties. So I’d been away from it for a pretty long time, but they are still pretty rigid in their product. Quite frankly, they’re pretty rigid in their relationship with their clients. When I got here, we didn’t have a plan to go to Client Server, but we had a strong desire to get to doing a lot more electronic documentation, and ultimately of getting CPOE. As I did my research for the first couple of months I was here, it was pretty clear to me that, in order to do that in a very reasoned fashion on a Meditech platform, you really have to be on a Client Server environment, not on a Magic environment. All of the big groups like St Joe’s and Christus and the guys who just went live in Colorado — they’re all on the Client Server platform.

It’s part of the vendor dilemma, where they’ve got an old legacy product on the Magic side that they’re saying ain’t gonna go away for a while. The reality is that it’s really hard for a vendor to maintain multiple products like that. They’ve got to really get on board with something. I think ultimately they will get to that Client Server platform. I don’t know what’s going on in that market yet to see why they feel they’re going to keep managing both Magic and Client Server, but it’s a pretty bulletproof product set for us.

I think, on the ERP side, it’s pretty darned weak. In this organization, before I’d even got here, they had made the decision they wanted to get off of the Meditech ERP products. On the clinical side and the billing and accounts receivable side, I think it’s a really good product. The market share that they have speaks a little bit to that.

Tell me about your department’s operating statistics.

Historically, the budget runs at about 2.6 or 2.7%. Our fiscal year starts October 1. I came on board just in time to finish up the budget process. We are budgeted to be at about 3.2% this year. As I took the position, one of the things we talked about with the executive team coming on board was that I thought that an organization this size should be nearer 4% of the operating budget in terms of the group. At El Camino I was at 4.7% of the operating budget. So that seems right to me.

I have a director of applications, a director of technology, and the director of HIM reporting to me. I’ve also just hired a director for project management and a director … well, I haven’t hired it, but it’ll be an executive director role, physician liaison. I’ll probably to that either late this fiscal year or the beginning of next fiscal year.

In total FTEs in the applications and technology area right now, we’re about 44. By the end of this year, we’ll be at around 48. Into next fiscal year, we’ll probably be into the mid fifties. I don’t see us being larger than 60 people at the top end.

We’re pretty straightforward in terms of the capital budget. We haven’t done a very good job managing the replenishment of the physical infrastructure. So this year, we were about half of the equipment budget for the hospital on a capital basis, and the lion’s share of that is going into replenishing the physical infrastructure. We’re putting in new networking, new wireless, and getting us onto a program that says we’ll replenish the desktops and all that stuff.

We’ll start to roll out some mobile devices. We really haven’t had much mobile device work here, but we’ve got to get that in place if we’re going to electronic documentation. So we’re going add the C5s and some mechanism for putting up some other type of cards. I think that stuff is all happening.

The other part of the capital budget this year is for the Lawson project. I suspect we’ll be somewhere between 20 and 40% of the capital budget for equipment for the next two or three years. And then we’ll get to a point were we’re between 15 and 20% on an annualized basis. We’ll have a real serious replenishment program in place so that we don’t get stuck in this kind of environment again. The board is aware of and has bought into that process.

We’ve had our first IT steering committee earlier this week. They haven’t had an IT steering committee in about nine years here. The last IT plan was done in 1996. But there’s just some bread and butter kind of things that we have to get done and we’re working on.

You were a mobile device advocate at El Camino. How would you say overall the industry is doing in that whole mobile workforce area?

From what I can see overall, we’re typical healthcare — we’re behind the curve. Lots of other industries have taken over mobility a lot faster than we have in healthcare. I think the idea of a specific medical mobile device, like the C5 … I got to participate in that in a very big way, from the conceptual design phase. We were involved in that at El Camino. So I understand it, I believe in it firmly, but I also believe that there’s not silver bullet solution.

Some people are going to want to use mobile tablets. Some people are going to want to use mobile carts. That’s just a fact of life that we’re going to have to deal with here. I believe its true for about every hospital. But, I think, if you were to look out five or ten years from now, I think mobile computing will be the rule for the way access happens in a hospital. Whereas today, even at El Camino, where we deployed it very, very extensively, we still hadn’t gotten to 50% of the devices being mobile devices. El Camino will be one of the places that gets there the fastest, but it will probably be three or four years more where half or more of the devices are mobile devices. But I believe that is going to happen.

You mentioned voice over IP. We did the Vocera stuff. Here, we use VoIP phones. We don’t have a VoIP infrastructure fully deployed. We’re going to do that. I think that concept of personal communications is going to expand in hospitals. I’m a firm believer that and I think it’s got to happen in hospitals relatively soon, and that is, that we have to issue all of our employees some kind of communications access device.

I use the example of this. My youngest child just went to college. He was at California Polytechnic. In order for him to register for class at Cal Poly, he had to prove to them that he had a computing device that he was going to use. He couldn’t register for class until he’d gone through this process of proving to them that he had this computing device. We hire employees here at the hospital, we don’t have that same approach.

I think, at some point, that’s going to happen at hospitals. We are information providers. That’s what we do as an organization. When you really get down to it, we’re really information dependent workers. At some point, just like when we give you your badge, we’re going to give you some kind of computing device. You’ll be responsible for it and use it for all the interactions you have while you’re at work. I don’t know how far off that is, but I think its something that’s coming.

You were at a great location at El Camino for watching technologies develop. When you look across the technologies that might be promising for healthcare, what things do you like?

I like some of the devices that are bringing everything together. My phone, whether it’s a cell phone or a VoIP phone … that same device is going to be my computer. I think that’s happening. I think, in that device, its going to have this concept of personal recognition. So it’s a personal device. Rather than dialing a telephone number, you’ll just type in my name and it’ll get me via voice or via message. However you want to get me.

We’re going get more and more into monitoring people’s conditions. Do you remember Goldsmith’s book Digital Medicine? If you remember that first chapter, where he writes about a scenario, I guess it was the year 2015. The thing that was the most vivid to me out of that whole chapter that he wrote was the fact the guy who was the patient received his treatment diagnosis and everything without ever being either in a physician office or in a hospital. Pretty impressive. I think there are technologies that are coalescing to allow us to do that. They’re going to happen pretty soon. We’re at that tipping point for that stuff to happen. Its a combination of being able to monitor inputs and get information out of folks, without it being necessarily an invasive process, in terms of diagnosing things. Then having a mobile workforce that gets out to deliver care to the patients or the people, wherever they are.

Do you see that as a growing role for a CIO?

I think so. It’s really got to be more upstream and visionary. I haven’t done day-to-day operations for a long, long time. In fact, I’m not sure I’d be qualified to do day-to-day operations. It’s more of a vision, planning and really working with the executive team and the board to get a sense of what’s out there.

A lot of folks say we’re supposed to manage our vendors. One of the main roles of the CIO is to work and manage vendors and vendor relationships. I don’t think that’s a part of my job, but a bigger part of my job, I think, is kind of like what I did when I was with El Camino and Intel … building a partnership where we do interesting things together and bring that to the organization.

That process is what we went through to conceptually design the C5 and see it come out. I was pretty non-involved with the process and outcomes. I worked with the nurses and doctors, but I got them to work with designers and engineers and watch the output. I kind of guided it. I wouldn’t say I was completely out of it, but I wasn’t into the integral processes of that.

Nurses and doctors were just jazzed. There’s no other way to describe it. They were really jazzed that there was someone listening to them and trying to figure out things that they could do. I think that’s the role the CIO needs to play to facilitate those types of activities. Because once those people are jazzed like that about the technology and what’s happening, they start to think about how to change processes to make that stuff allow them to give better care, deliver quality and those type of things. Otherwise, if they’re not involved and jazzed by that process that way, they look at it as just another set of changes coming down on top of them.

When you think about how busy and how difficult it is for the clinicians with increasing activity and increasing volumes, they’re just getting creamed. The last thing they want is another set of changes. So somehow, you’ve got get them jazzed about that in order for them to say, “OK. I can see how this fits in. I can see how I can modify my normal work process to do it this way which will be better. It’ll be better for the patient. It’ll be better for me. Everyone will benefit.” You’ve got to figure out how to get them into that. That’s the role the CIO’s got to play.

What are the biggest problems and opportunities that CIOs face?

Trying to compete for what I believe is going to be a shrinking capital dollar. That’s going to be a huge challenge for them. Secondly, it’s going to be the political challenge of trying to change from simple vendor relationships to partnerships that allow real change to occur. The technology changes are not going be done from within the hospital. You’re going to have to bring technologies from outside the hospital, more likely from outside of healthcare, and apply them in a hospital setting and in a healthcare setting in such a way that brings success to the organization. These are huge challenges for a CIO.

Let’s get to know you better. I’ll give you an item and you tell me what you favorite of that item is. TV show: I watch football. I don’t watch TV other than sports. Sports team: Chicago Bears. Food: Veal chops. City: Verona, Italy. Music: Chuck Mangione. I’m a jazz guy, but I like his horn. Vacation destination: The Orient. I married a Chinese woman. My wife is Taiwanese. I love the Orient. HIMSS conference event: The keynote. Hobby: Bicycling.

Who do you admire in the industry?

Dave Garets. I’ve known him for a long time. Bill Childs and Bill Bria. Those are guys I really admire.

Is there anything that you wanted to talk about that I didn’t ask you?

I know there are a lot of folks I’ve talked with recently. The folks from McKesson are like, ‘What’s going on with Eclipsys?” I did a lot of work before Eclipsys was formed, I did a lot of work when I was at Superior with TDS. So I had a long experience with that company. When I was at Superior, each of the executives had a vendor they were responsible for. I’ve also had a lot of stuff that I’ve done with Cardinal. I guess the one thing that I would tell you about me that people probably don’t know; when I was at El Camino, IT was a big part of my job, but we were completely outsourced there. I was the only non-outsourced employee at El Camino in IT. IT, while it was a big thing, it probably only took about 35-45% of my time.

The remainder of my time there, I was responsible for materials management, all of our purchasing, central distribution, central sterilization. I did a lot of other stuff, which was very intriguing to me. I learned more about hospital management in 5-6 years I was at El Camino by having direct responsibility for that stuff. That was a lot of fun. I did some neat stuff and I learned about logistics distribution. I actually did some work with MIT. We had two graduate students with their teams come out to do work on our logistics stuff. I think we did a lot of neat things in information technology at El Camino. On the supply side, I think we did some even crazier and neater things. As far as I know, we were the first hospital in the United States to go from a six- or seven-day supply delivery schedule to a three-day supply delivery schedule. We did some neat stuff around that. I learned a lot of that stuff that I didn’t know that I’d ever get a chance to do. I really enjoyed that.

Monday Morning Update 1/21/08

Francisco Partners acquires practice management software vendor AdvancedMD, a pretty good billing and scheduling performer in KLAS.

Charges against a suspect in the 2003 murder of a Cerner sales associate are dropped for police misconduct but will be re-filed, the prosecutor says. The 25-year-old Connecticut-based rep was in Kansas City for a Cerner sales conference, went to a bar and strip club, left to buy cocaine and methamphetamine, and was later shot dead in a prostitute’s bed in a crack house during a robbery attempt, according to testimony.

ZDnet says Misys is one of the “biggest open source health care outfits.” For making one tiny, zero-demand niche connectivity product available, sort of? Either ZDnet drank some purple Kool-Aid or it only takes one product to reach the Big Outfit list in healthcare.

Richard Temple, CIO of Saint Clare’s Health System (NJ) is profiled in Information Week.

GE Healthcare’s Q4 numbers: revenue up 6% to $5 billion, earnings $1.04 billion, down from $1.08 billion. Immelt blames Medicare for lower profits. I’m sure Medicare blames GE for higher costs to taxpayers.

Memorial Health of Savannah will lay off 130 employees in its elimination of 180 positions. They’re combining RT and PT, which seems odd. The president says the level of care won’t change, they’ll just become more efficient. If that’s the case, I’d lay off the management team who waited until now to make it so.

SMDC Health System (MN) bans drug company gifts and hauls off 20 shopping carts of mugs, pens, and notepads. The drug company trade organization, naturally, is horrified at the terrible misunderstanding in which they were cast as anything less than noble. “It’s a bit draconian. But the onus is on us now to do a better job of explaining the job and the importance of marketing representatives. Unfortunately there are a lot of cynics in America who want to think the worst.” Unfortunately, a lot of those cynics are right.

A new CHCF report reviews federal HIT initiatives. Summary: the President’s agenda hasn’t improved HIT/EHR adoption, NHIN is wasted money because it won’t work, EHR certification efforts turned out to be the easiest project, state and federal privacy laws need to be merged into something usable, the government isn’t exerting its purchasing influence to encourage HIT adoption, and ONCHIT isn’t doing enough to get federal support.

MedPlus is chosen as the preferred LIS for the Canadian healthcare system.

Green Bay (WI) hospitals get a mention in the local newspaper for their physician portal project, for which Medicity is the vendor.

NAHIT’s still working on defining those five acronyms (HIE, RHIO, EHR, EMR, PHR) so they’re holding two-hour work group sessions at HIMSS. The press release quotes the chief marketing officer (!) of NAHIT (which they insist on calling The Alliance, which sounds sinister and mysterious) who says the definitions “will remove a major barrier to HIT adoption.” Say, what does HIT mean since she used that acronym? Healthcare or hospital? Is healthcare one word or two? I smell more BearingPoint contracts! And maybe a follow-up study on how the HIT floodgates will open once these five pesky acronyms that confuse no one are put in their grammatical place by big government contractors more than happy to undertake fool’s work as long as it pays well.

E-mail me.

Inga’s Update

Add a couple more products to the 2007 CCHIT certification list. Intergy by Sage and Noteworthy EHR 6.0 by Noteworthy Medical Systems gain approval this week.

The current issue of The Annals of Family Medicine has a report on the state of EHR adoption for FPs in academic facilities. A survey showed that 72% have implemented an EHR and another 18% plan to do so in the next 12 months.

E-mail Inga.

Art Vandelay on Patient Command Centers

I share Jim Stalder‘s vision of a patient command center. I never considered using SNMP and Zenoss as a core engine for communication of information from the devices. Merging Jim’s concept with what I have been thinking for some time, the patient command center is similar to the air traffic control center at a busy airport. The air traffic control center knows who is arriving, when and where they are leaving, and they share status with all the others on the ground and in planes.

My vision is that the patient command center will be a physical or virtual department where traditional admissions, financial folio, bed, transport and discharge management are handled. It will manage service desks for IT, facilities, clinical engineering, and equipment, as well as clinical alerts and data from medical devices and the computerized patient record for singular issues and trended problems. It will monitor throughput bottlenecks, such as ED, OR, and patients ready for discharge.

I had envisioned using real-time location tracking systems (RTLS) integrated with a real-time data store of ADT, orders, billing, enterprise scheduling and results data. Large screens with various real-time reports would be available. Think of this like the status boards for the Emergency Department on steroids. With a complex event processing (CEP) engine monitoring the information, the proper resources could be alerted to the status of the facility, patients, and staff at any point in time via visual queues on the big board, a user-specific screen, or various reports. Alerts could also be sent to the device of choice, i.e., PC, handheld, Crackberry, local mobile phone. Sorry nurses, it looks like there is another job for you to consider – Command Center Czar.

SNMP isn’t that complex. What are the chances of getting the medical device vendors to add this to their devices? It already runs on the private networks and servers they use. In my opinion, the companies to watch in this space are Cerner, with their medical device push, and Philips, with their recent acquisitions. All-in-one vendors like Epic and Meditech are also well positioned with the data their systems have – in theory.

News 1/18/08

From Latka Gravas: “Re: Cerner layoffs. Interesting that this subject was broached prior to Thanksgiving, when the internal job site was taken down for ‘construction,’ not allowing anyone to review possible openings and make a move prior to being escorted out the door. None of this has been handled with dignity and grace by Cerner, as ‘associates,’ rather ’employees,’ were escorted out the door by HR and security. This is from someone who is still employed by Cerner, but observing the action from my office.”

Speaking of Cerner’s layoffs, the Kansas City paper’s website has several pages of interesting comments from readers on that story, including one ripping the company by an Indian associate (you know you’ve stirred people up when the offshore employees are livid). Those severed are planning to connect at Ameristar Casino Friday night at 5:00 for a “We’re Finally Free – No Pity Party” to which all former and current associates are invited. They’re even planning a dramatic reading of Neal’s infamous “tick tock” e-mail (YouTube it and send me the link) which I’m sure all this will give him a few more Pie votes. With the big price drop yesterday, he’s down to $294 million worth of CERN.

From Shiftcycle: “Re: RemedyMD. Anyone every worked for them? Thinking about a job with them, but wanted to hear anyone’s experiences.”

From The PACS Designer: “Re: Web x.0 hysteria. What brings up the Web x.0 headline is TPD recently noticed a website touting Web 3.0. There has been a lot of Web 2.0 stuff, some valid and some not, but we are years away from even beginning to consider Web 3.0 solutions. Since we are only in the first inning of this new Web 2.0 era, be skeptical about anything purporting to be Web 3.0 ready. Instead, HIStalk readers may want to peruse the Oracle website and their Oracle WebCenter offering for Web 2.0.” Oracle WebCenter. PC Magazine’s Web 3.0 overview.

From Curious: “Re: RPP. Anatomical Pathology standards question – does anyone know how commonly RPP is used these days? Is it still in test phase? Will it be commonly used in the visible future?”

From Hillary Flammond: “Re: HISsies. I’m a little surprised that you only placed Picis on positively stated questions within your HISies poll. I’d bet that, had they been a candidate on some of the more negatively phrased questions, you’d have received some more votes for them. I do remain hopeful, however, that their performance and our experience with them will improve over time.” A couple of folks commented that certain vendors showed up only in positive categories. It’s important to note that I didn’t choose the nominees – you did. They’re exactly as nominated by HIStalk readers, with no intervention by me. Good to remember next year, especially for the folks who didn’t nominate but now are unhappy with the nominees of those who did. I re-checked the nominations and Picis got one vote in the “stupidest move” category and one in “worst vendor.” That’s certainly no groundswell among those doing the nominating, considering that companies nobody’s heard of got more than that and still didn’t make the ballot.

Jobs: Manager Corporate Systems, Sales Executive, Data Center Technologies Analyst.

Your opinion: for the HIMSS get-together, would you like to see any particular agenda item? I may have the HISsies announced there. I could maybe get a CEO or two to say a few words, although there’s no guarantee since anonymous bloggers are low on the food chain. Or, we could just eat, drink, gossip, and admire how smart and attractive we all are. I’m picturing Inga like in one of those old movies, wearing a fabulous gown and smiling suggestively as 10 tuxedoed guys eagerly thrust out lighters, jostling to be the one who gets to light her cigarette in its gaudy holder while she throws back her head in self-indulgent laughter at the silly boys who adore her.

For those who care (not me), the Most Wired Survey is open, with a new appendage “& Benchmarking” tacked on, most likely to appease survey co-sponsor and outsourcer Accenture. If you can buy the shaky premise of such a survey, the questions are vastly better than those from years ago, although subject to the same overly generous respondent interpretation. There’s a PDF link at the bottom of the page if you want a look.

Elsevier acquires Florida predictive analysis company MED-ai, finally putting an end to its years of struggling.

Alex Rodriguez, CIO of Ohio’s Health Alliance, leaves to become VP/CIO of St. Elizabeth Medical Center (KY) in a ten-year, $252 million deal. Maybe I’m confusing him with someone else.

Scott McMullen, formerly Misys, joins Medsphere as VP of engineering. From one open source evangelist company to the next, eh?

Sonitor Technologies says it gained more than a dozen new real-time location system hospital customers recently, with 20% of its sales replacing dysfunctional RFID tracking systems. That’s what RTLS stands for, I keep reminding myself, since that’s an acronym on the rise.

Eight Ohio hospitals will use Premier’s SafetySurveillor infection control system. Premier bought Cereplex and that product along with it in 2006, if I recall.

ClinicComp gets an Essentris electronic medical records contract for Landstuhl Army Medical Center in Germany. One interim step is to generate PDFs for inpatient records to share with the VA.

Defense and aerospace contractor Harris Corporation announces the formation of Harris Healthcare Solutions. Bart Harmon, formerly of DoD, was announced as CMO.

Forgot to mention: thanks to AT&T Healthcare and eScription, both of which just upgraded their HIStalk sponsorships to Platinum. Thanks to both companies for supporting HIStalk and, by doing so, supporting its readers. Sponsors provide the money I need to hire fabulous colleagues like Inga, pay server and software bills, give stuff away at HIMSS, and support a worthy cause every now and then. Give the ads a look and click over to those with interesting stuff. It really helps. I was far less jolly when it was coming out of my day job paycheck with mumbled excuses to Mrs. HIStalk about the odd expenditures.

Information Week looks at the cost of health IT projects touted by presidential candidates. Clinton wants $3 billion, Obama says $50 billion. See Harris Corporation item above.

UPMC pilots an internally developed “smart room” program in which patient rooms are equipped with monitors that display medical information.

Arizona surgeons are developing simulated surgery trainers for the Nintendo Wii. Surgical residents who warmed up with a Wii training tool scored better on tool control and performance.

Sun Microsystems will acquire open source database vendor MySQL for $1 billion.

A SureScripts analysis finds that 50 times the number of prescriptions were transmitted electronically in 2007 as in 2004. Allscripts was the most used e-prescribing system.

Bizarre hospital lawsuit: an injured construction worker is told by ED docs that he needs a rectal exam to rule out spinal cord injury. He refuses and hits a doctor who orders him held down so he can do the exam. The patient is arrested afterward on assault charges that are later dropped, but he’s suing the hospital because “he has absolutely no trust in the system at all”, “has post-traumatic stress syndrome”, and is unable to work.

E-mail me.

Inga’s Update

Opus Health Care Solutions names Brad Karagin VP of sales. He previously worked as a sales executive for T-System and, before that, Cerner.

Medicity gets some press in Green Bay, WI, home of Packers’ cutie Brett Favre as well as St. Vincent’s and St. Mary’s Hospitals. The hospitals, along with 11 others in the Hospital Sisters Health System, are implementing Medicity’s centralized medical record repository and physician portal.

Hayes Management Consulting announces their new Technology Solutions business division, along with the appointment of two new VPs. Former IBM associate partner Peter Zazzara is Hayes’ new VP of client services, while Andrew Treanor is the new technology solutions VP. Treanor comes from GE/IDX, where he served as VP of client support and operations.

I went to Sears a couple of weeks ago to buy a dryer (one of those “incidentals” that is never part of the budget.) Who knew that Sears also sells a loaded Linux desktop PC for under $200? Definitely less than my dryer.

Allscripts partners with billing company CHMB Solutions to provide an outsourced EHR and PM solution to CHMB’s 500 clients. CHMB will provide the hosting, support, and implementation services.

The state of Maine is jumping into the IHE arena. More than $4 million has been raised to begin the nonprofit HealthInfoNet. 3M Health Information Systems and Orion Health have been retained to build and operate the program.

Survey update: glad to see most readers are like me and prefer free stuff (you can never have too many pens or bags) and invites to an event (I still have some open spots on my dance card) over attractive reps. Also tied for the lead is cool demo technology.

E-mail Inga.

Clinical vs. Clerical Systems – Why FDA Software Regulation is Inevitable

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in December 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Most hospital information systems are old. Faded pictures of the original system architects feature bushy-haired guys wearing plaid pants, wide ties, and CPO jackets. Given their unfortunate fashion sense, it’s not surprising that their precognition of today’s healthcare environment didn’t include having physicians and other clinicians use their creations directly. The goals of information technology were simple: capture charges, batch-bill the heck out of Medicare and Medicaid, and maybe provide a simple order entry function.

Today’s so-called “clinical” systems mostly sit on that antique and unsuitable foundation, outdated not because of old programming languages and hardware platforms, but because their original design mindset is now hopelessly obsolete. Clinical applications are really just green-screen type data entry forms that happen to accept clinical information. It’s the mainframe mentality at its worst – the all-knowing system that requires regular data feedings from subservient users who, despite their occupational disposition, are relegated to data entry clerks.

Eventually, some company will actually design a new system from the ground up. We can fervently hope that when they do, they’ll start with a blank slate and not simply port outdated, monolithic thinking to a newer technology platform. With that innovation, though, will come the crossing of a huge chasm: the no-man’s land between “information systems” and FDA-approved systems.

Clinicians gripe that clinical systems are user unfriendly, do little to help them perform their jobs, and add little value to personal productivity or patient outcomes. They’re just accounting systems dealing with clinical widgets. One reason: HIT vendors are terrified of FDA regulation. It’s easier to make sure systems are too dumb to require it than risk exposing sometimes bad software practices to government oversight. No wonder our clinical systems are substandard.

Clinicians are overwhelmed by too much raw data whose presentation can’t be individualized, i.e. don’t insult bone marrow docs with low platelet warnings. That picture that’s worth 1,000 words can’t be included because 1980s-era programmers didn’t see cheap multimedia and storage coming. Systems deliver data like an obedient mailroom clerk, with equally unimpressive value added.

It’s like Lucy working on that candy assembly line – reams of often irrelevant information is unceremoniously dumped in the laps of physicians and nurses, who are expected to manually figure out what’s relevant and then “process” it, often by entering even more on-screen information. Eventually, the administrivia buries someone who ought to be making patient care decisions instead of romancing a keyboard.

IT vendors have good reason to fear the FDA, who won’t be happy to hear about buggy code, poor testing practices, slow updates for known defects that have clinical implications, and head-scratching user interfaces that merited no more than an afterthought. Maybe that level of scrutiny would slow development and increase costs, but accepting possibly dangerous software as long as it’s fast and cheap (both debatable) doesn’t seem like much of a bargain.

A smart clinical systems vendor would build FDA approval into their long-term plans and build killer applications around it, thereby scooping their competition by years. Redesign the first-generation systems, step boldly into the FDA-regulated space before the device vendors instead step over into the IT space, and build systems that improve patient care, not just caregiver data processing skills.

Today’s software was designed around old constraints and its design shows it. Clinicians should get together with no programmers in the room and design the systems of tomorrow. Clinical systems need to interrupt the care process less and enhance it more. Doing that right will require FDA approval.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission.  To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 1/16/08

From Stanley Twanger: “Re: career move. If anyone has advice on moving from academic medicine to the corporate world, I’d be happy to hear it.”

From Neal’s Dog: “Re: Cerner. Cerner is letting VPs and directors go in an effort to trim the executive level roles and put more associates on the front line.” It’s hard to be against that action unless you’re one of those axed. Unlike some companies, Cerner at least waited until after the holidays (they surely planned this well before). The stock’s down 8% on a day when the market dropped 2.5%. Earnings are out in a couple of weeks. The Kansas City Star reports 97 jobs cut, with a total of 152 positions eliminated. In my experience, you can’t fault a company for a one-time layoff, as long as they handle it professionally, with dignity and sensitivity toward those let go, and after exhausting other options. In other words, it needs to be as distasteful to management as it is to employees, to the point that no one wants to do it again. Condolences to those affected, for whom it’s a cold, frightening winter’s night.

Julie Wilson, Cerner’s Chief People Officer, sent this to me through a high-ranking Cerner friend of HIStalk: “As HIStalk readers will see from my comments in the attached coverage, ‘Cerner continues to anticipate growth at our locations worldwide’ and is ‘actively recruiting and hiring at this time.’ We currently have dozens of roles posted on cerner.com. We have 45 new hires in orientation classes this week alone. Ultimately, these new associates will share the same goal as our more than 7,500 current associates: value creation for our clients. And as we deliver, it will have positive implications for ongoing growth and future job creation here at Cerner.”

From Danny Noonan: “Re: HHC. I can verify that they’re looking for a QuadraMed CPR replacement. They’ve hired a guy to evaluate vendors. There’s a big disconnect between management and users. They’ve built some cool stuff that’s better than the mess that they paid Misys to develop. The customizability is a plus and the back end is stable. Instead of paying $10 million to bring in some programmers, they’ll spend $500 million (at least) to buy a new product. Almost every CMIO and CIO in the corporation wants to stay the course, but the central office seems to be set on the new vendor route. They’ll lose the local control that has led to many impressive applications.”

From GE Insider: “Re: interview. Wow! Not sure how I missed this interview initially, but what a crock! I used to work on the IHC project. When it ‘goes live’ in a few months (and I hear it’s not even code-complete with a go-live date of March 08), it will be attached to the IHC back end (the HELP system). So, for all of their investment, all IHC will have to show for it is a new UI. Just now are they starting to plan for the new infrastructure and in the future, you’ll completely have to throw away your IDX solution and drink the new Kool-Aid. Already IHC is getting tired as they have instructed employees to discontinue some of their content work until they can reevaluate. Eventually GE will get tired of all of this, and when they’re not getting new sales, and they’ll bow out, leaving IHC holding the bag.” Just to be clear, this isn’t verified (but it’s interesting).

New text ad to your right: Medziva, which has an SaaS-based clinical lab collaboration platform, is seeking companies interested in making a cash or equity offer.

I see a company or two is encouraging employees to stuff the HISsies ballot box. That’s OK – that happens ever year. Since I can’t stop it, I have fun with it. There could be some surprising results (who’ll be wearing The Pie in a few weeks?) Statistically valid or not, it’s fun. I’m still considering making the official announcements at the HIMSS get-together, putting them online nearly simultaneously. Please vote just once because I have to pay by the response if it goes over 1,000.

Listening: L7, foul-mouthed, all-female punk metal, now disbanded. The second video down shreds it. My new favorite drummer.

David Starr joins Queen’s Health System (HI) as CIO, coming from BearingPoint.

The Fort Myers, FL paper has a good article on Lee Memorial’s implementation of Epic for its physician group.

Dennis Quaid goes public with his complaints about Cedars-Sinai, saying family members didn’t hear anything until a gossip website broke the story on their heparin overdose, which he believes a hospital employee leaked. The hospital’s now going after presumed HIPAA violators.

Jobs: Director of Outpatient Clinical Systems, Manager of Clinical Support Systems, Director of Sales, HL7 Integration Expert.

This seems like a really bad idea: a Pennsylvania start-up records the examining room conversations between physicians and consenting patients, transcribes and de-identifies them, then sells the recordings and transcripts over the Web to drug companies. The docs get paid and the patients are told the recordings support “medical research.”

For the other side of the coin, see No Free Lunch: Just Say No to Drug Reps, a non-profit started by a New York doctor. ” … the doctor-patient relationship … is a fiduciary relationship … Patients rightly expect their physician to act in their (the patient’s) best interest. Patients do not enter the examining room caveat emptor. Patients should be confident that the drug being is prescribed is the best, the most cost-effective, not the best promoted.”

The Houston Fire Department is implementing software that will direct ambulances to the least busy hospitals.

E-mail me. It makes my day, even though I’m just buried and may not e-mail you back anything other than gibberish. It’s interview season, so look for new ones soon.

Inga’s Update

I think Mr. H has found an even better give-away option than rejected vendor trinkets for the Healthia-sponsored HIStalk party. In light of Hollywood writer’s strike and canceled Golden Globes bash, he worked his connections to get all those extra swag bags donated for our faithful readers. I personally can’t wait to get my eyelash-strengthening serum, pearl necklace and Croton watch.

Special note to Pokenoke who suggested I might not (!) be female. Be assured, this cougar is all woman!

CSC is told to pay the NHS £5m in penalties for late delivery of patient administration software.

Quest Diagnostics HIT subsidiary MedPlus wins a contract to implement a clinical portal and information exchange for the Brooklyn Health Information Exchange.

I think I may be in love. Peter sent me this lovely note: “Booth babes are like when they give away free key chains. Initially they are attractive, but you find out later that they aren’t really useful and they get in the way. Spoken like a true fan of the mature woman …”

CSC’s acquisition of First Consulting is now complete. All $365 million of the purchase was in cash.

Beth Israel Deaconess selects Concordant to assist them with building and managing their EHR infrastructure for up to 300 practices.

Aetna donates $500K to UC Davis Children’s Hospital to expand its PICU and telemedicine functions.

Dublin Methodist Hospital opened its doors last week with an all-digital setup with McKesson’s Horizon Clinicals throughout.

Emerging healthcare market trend: cellulite treatment. Since 85% of women have cellulite, it’s no wonder that medical device companies are scrambling to enter into this estimated $3 billion (!) “cosmeceutical” market. (I personally blame it on booth babes! OK, I admit I’m obsessed with them, but not in the same way you guys are!)

Fallon Community Health Plan in Massachusetts selects Trizetto’s QNXT enterprise admin system and application hosting services.

SureScripts announces that Allscripts eRX NOW and TouchWorks have achieved GoldRX advanced product certification for 2007, meaning they really work. More specifically they have “gone beyond SureScripts baseline product certification to establish a proven track record in pharmacy interoperability.”

Health Affairs announces the results of new study of ED wait times and documents increases of more than 4% a year from 1997 to 2004. It’s really bad news if you had an acute MI because your waits increased over 11%. Blacks, Hispanics, women, and patients seen in urban EDs waited longer than other patients did.

Docusys signs a letter of intent to buy surgical planning software vendor Prompte. Docusys has had an exclusive marketing agreement with Prompte for the last two years.

A reader sent me a note saying he’d heard that athenahealth might have performance issues with a high number of users. I checked with the folks there, who gave this response. “We have the same stacking architecture as eBay and Amazon and have thousands of providers billing, ordering labs, and prescribing on the system daily with approx 35k daily users on athenaNet. There is only one instance of the application and we put out new versions 6-8 times a year automatically. The athena network is supported by hundreds of people that are athena’s virtual back office. Our infrastructure can currently exceed 4x its current volume and will increase when we open our new operations center in Maine.”

E-mail Inga.

CIO Unplugged – 1/15/08

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

Faces: The Toughest Aspect of Being CIO
By Ed Marx

In answering an often asked question—what is the most challenging part of being CIO?—several dated situations came to mind. Losing a data center when the electric grid went down in the northeast. Personnel matters. Providing champagne service and applications on a beer budget. The weight of my responsibilities while knowing patient lives are at risk. Facing down angry physicians. A multi-million dollar project gone bad. These situations ranked as tough, but not toughest.

I think back to Zarema, a woman on the staff interview panel when I came through as a candidate. While her peers tossed softball questions at me, she played fast pitch. I loved it! I respected her glasnost approach and assertiveness. A recent immigrant from Russia, Zarema spoke with a thick accent and held to cultural mannerisms that sometimes clashed with our health system’s progressive environment. Nevertheless, as a tireless and productive employee, she evolved into the go-to person of our division.

Before I left that division and eventually became CIO, Zarema confided in me that she was ill. I stayed abreast of her condition. She was very private, but over time, she received my prayers and support. Then, one day, I got the call. Disease had stolen her life. I lost an exemplar employee. Despite being sick, she had demonstrated how to strive for excellence, for she never settled for less than 100% on her yearly review.

“I still see your face, Zarema.”

A couple of years later, our IS Division underwent an incredible transformation, and much of the progress was attributable to our Field Engineering Team. We suffered “ticket tennis” issues, meaning service requests were lobbed between internal teams while the customer’s needs remained unmet. By combining the silos of Desktop Support, LAN Admin, and Network, we adopted a Field Engineering concept that encouraged and rewarded collaboration, which resulted in higher velocity and customer satisfaction. Dale was one of our young field engineers and a solid performer. Outside of work, he engaged in another passion: his motorcycle. One morning, tragedy came at him fast, and he was killed while riding his cycle to work. That week, the funeral was packed, and the majority of our field engineers joined me in attendance. Listening to them share words of support to the grieving family I gathered morsels of this man’s passion and added them to my treasury on life.

“I still see your face, Dale.”

I recall “Bill,” the husband of one of my direct reports, taking ill. After a few days in the hospital, his wife told me that he had tired of cafeteria food. (Imagine that!) My son and I snuck tastier cuisine past the nurse station then hung out for a little bit and prayed with him. His death devastated me, as he left behind an infant daughter and a young wife. He was brave; he fought hard. And he reminded me how life was too short to not live it abundantly.

“I still see your face, Bill.”

Most recently, another member of my division passed away suddenly. I regret, given my short tenure, that I did not have the time to get to know “Maggie.” Co-workers shared that she was a dedicated employee and a wonderful person, someone I would have appreciated. During a moment of silence at an all-staff meeting, I studied this woman in a picture on power point. I imagined visiting her at her desk, and I wondered what wealth of character I might have gained from knowing her.

“I still see your face, Maggie.”

So what is the most challenging experience as CIO? Identifying with tragedies that befall my department: lives taken prematurely; the impact of death and disease on families and communities. A good leader will morn with those who morn and rejoice with those who rejoice. I have attended many wakes and funerals to console grieving staff who lost children, parents, grandparents, spouses, and other loved ones. I have kept some in my contacts and scheduled their birthdates to chime annually on those bitter yet beautiful days.

I still see their faces.

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.”

Monday Morning Update 1/14/08

From Kim Chi: “Re: QuadraMed. They are losing people by attrition, layoffs, and cutting CPR development. Word has it Health and Hospitals in NYC decided to look for another solution.” Unconfirmed and assumed incorrect unless someone wants to go on record (anonymously is OK). I’m always cautious about specific rumors involving publicly traded companies, although this one comes from a good and historically reliable source.

From Abigail Papshmir: “Re: Is this El Camino story highway robbery or what? They screw it up with a flawed and now-defunct system, then offer to evaluate the mess for millions.” Link. Eclipsys, which sold El Camino Hospital an interfaced Sunrise to Meta Pharmacy solution since abandoned in favor of Sunrise Pharmacy, says they’ll evaluate the hospital’s medication ordering situation for $3.4 million, requiring 16,000 consulting hours to do so. The end result will be “recommendations and training.” The original implementation, along with some underlying process issues, nearly caused the state to shut the hospital down when its medication error rate tripled. The hospital had outsourced the entire IT department to Eclipsys, I believe, with only the CIO as a hospital employee. The hospital says it needs another $6.6 million for pharmacy system upgrades this year. That’s $10 million, plus the original $8 million that Sunrise cost, plus a previous $2 million in upgrades planned in 2006, plus the cost of outsourcing the pharmacy to Cardinal that was required to keep CMS from padlocking the doors. That’s one expensive medication management system for a 400-bed hospital, especially considering that it still seems dysfunctional judging from this latest decision.

From Wilma Nordberg: “Re: One Laptop Per Child initiative. Intel has pulled its financial support.” Link. Intel joins Microsoft in boycotting the project, which hopes to give the world’s poorest children inexpensive laptop PCs. An Intel salesperson tried to talk Peruvian officials out of buying the nonprofit’s cheaper PCs, which come with AMD chips and open source software, in favor of the company’s own proprietary product. Maybe Craig Barrett can get involved since he thinks he’s already got healthcare figured out.

From Inside Outsider: “Re: Dennis Quaid. All I can say is – NO WAY! He has every right to be outraged and he should be outraged. The simple fact that hospital errors kill people all the time is not a good enough reason to say that the damage done to his kids should not be considered a bad thing. Yes, death is worse than maiming or brain damage or temporary damage, but the day that we look at it as acceptable is the day that we should get into another business. Just my two cents.”

From The PACS Designer: “Re: WiserWiki. TPD has discovered a new free wiki called WiserWiki by Elsevier. Only board-certified physicians can post. TPD browsed cardiovascular disease,diabetes, and COPD and found significant detail. It would be a nice complement to a PHR that would give it precise health information from prominent physicians.” Link.

HISsies voting is open. Thanks for your nominations. Time to vote … now git. I was serious when I said that Inga led the nominations for industry figure of the year, so you can congratulate her even though I didn’t include her on the ballot.

Listening: Big Elf. Black Sabbath meets the Beatles.

eScription earns 2007 Best in KLAS for its #1 ranking in Transcription and Back-End Speech Recognition for the fourth consecutive year.

Jobs: IT Manager, Product Manager, Web Developer. We’re getting lots of hits at HealthcareITJobs.com, so sign up for weekly e-mail updates of new listings.

Speaking of job listings, HIStalk sponsor Intellect Resources has quite a few their site. They’re also listing on HealthcareITJobs.

Delano Regional Medical Center (CA) and Sentillion get mentioned for the hospital’s single sign-on implementation, which it says boosted business because doctors are now willing to use its Meditech, Dictaphone, Cerner, and GE systems instead of sending patients elsewhere because of complexity and the myriad of passwords formerly required.

A former St. Cloud Hospital (MN) programmer pleads guilty to putting a logic bomb in a training program he wrote for the hospital. The code activated after he quit in June 2006 and trashed his program. He probably thought he was pretty darned clever until the FBI’s cybercrime unit came knocking on his door, for which he’s now facing 10 years in federal prison and a $250,000 fine. Doh!

Stratus Technologies is offering (warning: PDF) a free “Fault Tolerance for Dummies” book.

CraneWare announces software that links pharmacy purchasing to CDM pricing.

Missouri’s governor wants $15 million for a Web-based electronic health records system for MO HealthNet, which I think is a cute marketing name for Missouri’s welfare program.

Odd lawsuit: a Canadian drug addict wins a negligence lawsuit against her former drug dealer for getting her hooked on crystal meth and causing her hospitalization for an overdose. “”I sued him for negligence … for selling me (illegal) drugs and getting me hooked when I was vulnerable”. The dealer’s defense said the woman “voluntarily consumed illegal drugs, thus contributing to her own condition. She assumed the risks.”

Sutter Medical Center lays off 49 employees and cuts back on housekeeping services after its divisional profit drops to $111 million. It blamed that financial crisis on salaries and technology investments. Why didn’t they invest in technology that pays for itself instead of laying off janitors? You may recall that its Epic implementation will price out at $500 million or more. They even hired a “transformation vice president.” (Note to providers: any time anyone mentions the word “transformation”, do that little “make a cross with your fingers to repel vampires” thing and run for the hills. All that will be transformed is your money into someone else’s.)

An HHS/OIG report blasts the capability of physician-owned specialty hospitals to handle medical emergencies. The investigation came after two patients died following elective surgery complications when no physicians were in the building. Both hospitals called 911. Findings: less than one-third of specialty hospitals have a physician on site at all times, some had neither physicians or nurses present on some days, and two-thirds include calling 911 as part of their emergency procedures.

San Antonio Community Hospital (CA) gets local coverage for its use of scribes to follow physicians and do their paperwork. It’s the anti-CPOE solution, variants of which I’ve advocated here on occasion.

E-mail me. I’m a busy boy, but I read every e-mail even though I can’t always respond. Thank you for reading.

Inga’s Update

Special thanks to the (female) reader who sent me a note with her opinion on booth babes. “While I’m not a fan of putting a younger, thinner, cuter version of myself in my booth to draw traffic, I’m not proud.” It was such a spot-on comment! While the guys might love the eye candy, it serves as too much of a reminder for us “former” 22-year-old babes that perhaps we’re past our prime! (This is when all you mature guys can send me notes telling me how you much prefer your women to be worldly and a bit more mature).

Meanwhile I have been glued to the latest survey to see what attracts you to HIMSS booths. I’ve been happy to see “free stuff” and “cool technology” pull ahead of “attractive representatives,” proving that not all our readers are as shallow as Mr. H predicted.

As Mr. H noted earlier this week, we have some great new interviews on tap for HIStech Report, just in time to pique your interest about some of the more innovative companies exhibiting at HIMSS. Coming soon: chats with McKesson, Sage, and QuadraMed, to name a few.

E-mail Inga.

News 1/11/08

From Rogue: “Re: HIStalk get-together. Thanks, Healthia. I propose the price of admission be a wrapped/bagged trinket from your vendor company or organization —  a go-live t-shirt, hat, pen, stress ball, Post-It pad, or whatever logo item you have lots of. (And Mr. HIStalk can get rid of the bag of last year’s leftover buttons, too). Drop yours in as you arrive, take one home as you leave. Something fun to talk about later. Maybe a couple vendors will seed the grab bag with a neat MP3 player or two. BTW, the Communities open house is Monday night until 6.30 pm, so I’ll be late. And isn’t the Chapters Open House night on Monday traditionally since Tuesday is the awards dinner and Wednesday is the Universal Studios event? Stagger from one open house to another. Maybe I’ll be lucky and they’re all in the Peabody. Do we use our real names when we RSVP to keep our blog pseudonyms secret?” I like the swag idea, a modified Christmas party idea where you bring a wrapped toy. Would anyone do that? I know there will be conflicts with the time since every HIMSS event is either Monday or Tuesday night, so we figured making it 6:00 to 8:00 would allow hitting the big blowouts afterward (we know our place in the universe). I think you’ll want to use your real name on the RSVP, but we can try to guess each other’s secret HIStalk identity. Inga and I will be undercover most likely, so we can all play.

From Animal Mother: “Re: temper your envy. There is certainly a happy McK rep – or reps, actually – but no one is retiring. McK has a 27-page comp plan: one page on how to earn the money and 26 on how to actually get it. There’s a cap of around $300K on the commission will be paid out in total for any one contract, even if there are three, four, or five reps on the deal. Then you start the clocks on what will be paid when, based on the deal. The result is that the McK retention plan holds around $50-100K from the performing rep. The comp plan is the #1 reason reps leave and leave the money behind. It’s a monthly slap in the face to see that the largest number on the commission statement is the money you don’t get.”

From Willem Seminole: “Re: your free research. I got an e-mail update from [magazine] and it’s obvious they’re just writing up the news you’ve found. Some of your links from Tuesday were obscure and, what do you know, they covered those stories like they found them themselves.” I know. Adds to my legend.

From Leonard Pratt: “Re: ECG. I heard a rumor that ECG, the company that owns CHIMES, shut its doors yesterday. This is third-hand info, but I thought I would see if you heard anything about it.” I assume this is the contract worker firm. If so, yep, they’re toast. Ensemble Chimes Global was a subsidiary of Hollywood payroll services Axium International, which filed bankruptcy and tied up lots of payroll deposits this week when it defaulted on a $140 million loan.

From Lumpy Rutherford: “Re: Allscripts. This was posted on the MDRX message board: ‘Allscripts announced to customers yesterday that they’re halting all further upgrades and installations of version 11.0 and waiting until 11.1 can be released. This is in response to massive technical problems in v11.’ Any truth to this rumor?” According to my internal source, it’s not true. Lots of folks are already live on v11 (some upgraders, some net news) and v11.1 will GA in a few weeks.

From Eightball: “Re: athenahealth. Word is athena’s big win at Harbin was an IDX install and Allscripts lost out.” Here’s an announcement of their 2002 TouchWorks intentions, anyway, so it seems likely.

I’m not naming names, but a reader was looking for some help and someone from HIMSS stepped forward. Enough said, other than thanks.

Listening: Maeder. Also: Zebrahead.

Last chance for HISsies nominations. We have a couple of frontrunner disqualifications already, namely me in the “HIS industry figure with whom you’d most like to have a few beers” category and Inga in “HIStalk HIT Industry Figure of the Year.” We appreciate the support, but we’ll keep it honest. And to think I had my beer alone today while watching a Gilmore Girls rerun and waiting for Mrs. HIStalk to get home. We’ll have no remarks about Inga’s figure, please.

Jobs: Web Developer, PathNet Architect, Senior Account Executive, Epic Consultants.

McKesson claims to be the first vendor to GA software for the Intel C5 tablet PC. Says it will support Admin-RX barcoding, which could use some improvement.

Verispan announces availability of a database of retail clinics.

Jay Miller, president and CEO of Vital Images, resigns (with someone else’s hand firmly forcing his signature on the resignation letter, no doubt.) The guy he hired as COO will take his job.

I haven’t mentioned them in awhile, so here’s a plug for The Revere Group, a big hitter in providing Microsoft services to healthcare providers. Thanks for sponsoring. Ditto for MedMatica Consulting Associates, a fine source for experienced healthcare consultants.

Midwest Regional Regional Medical Center (OK) goes live with SafeScan medication barcoding.

And speaking of a potential SafeScan client, Dennis Quaid is really peeved at Cedars-Sinai now. He found that his twins got two heparin overdoses each, not just the one the hospital told him about. Not to belittle DQ since I’m a fan of his Right Stuff work, but Dennis … hospital mistakes kill patients all the time, unfortunately. Your kids got protamine and are fine, with no lasting consequences. I know actors are self-centered and all, but leave the outrage for someone looking at a headstone instead of healthy, happy babies. Go ahead and sue since that’s the American way, but remember how it could have turned out. Start a foundation or something for those not so lucky.

Speaking of positive ID technologies, Mercy Medical Center (AR) will implement a state-of-the-art RFID scanning system. In its gift shop, along with Camille Beckman lotions.

FCG’s shareholder merger vote on its CSC acquisition forges ahead. The court told a couple of legal firms that always file shareholder class action suits to stick it. Surely no one with any shred of sanity thinks FCG could do better.

Washington Hospital Center, fresh off selling Azyxxi to Microsoft, apparently will turn its ED into a mini-HIMSS, with its technology vendors running around with reporters for the launch party … errr,  “unveiling,” as the press release says. Somebody keep those unsavory patients out of the camera shots, please.

In the UK, a passer-by finds a bicycle courier bag in the street that contains sensitive lab results. He turns them over to the local newspaper, of course, since people who find medical records always seek a media outlet instead of just giving them back.

The remains of shuttered practice managment vendor AcerMed are bought for $500,000 by a newly formed subsidiary of an ophthalmic sofware vendor. Former AcerMed CEO Michael Bina is brought on as CEO of the new Abraxas Medical Solutions, Inc., along with seven other former employees. Could be good news for practices who figured they were stuck with an albatross.

Elekta AB is negotiating to buy CMS, Inc., a St. Louis radiation treatment planning software vendor, from its private equity owner.

Former Summit Medical Systems execs form clinical trials software vendor MedNet Solutions.

Mayo Clinic and IBM announce formation of The Medical Imaging Informatics Innovation Center, whose bulky and voluntarily chosen name is helpfully pushed as MI3C, which they might have picked upfront if it tickled them so darned much that they immediately started using it instead of the real name.

Cleveland is a healthcare investing hotbed, although the local paper doesn’t mention Cleveland Clinic’s doctors who have been caught running up patient tabs for medical devices and treatments produced by companies in which they have a financial interest.

Sounds interesting: a new documentary investigates the massive doping of American children with ADHD drugs. “Ethics, or as Miller reveals, the lack of such, is a central theme of the film. As he investigated the culture of medicine, the producer was shocked to learn that a vast majority of psychiatric drugs being prescribed to millions of children worldwide have never been proven safe and/or effective for the very conditions they are purported to treat. In fact, he uncovered a pattern of collusion between drug manufacturers and their regulatory watchdogs at the FDA, who literally hid evidence of suicidal thoughts and violent acts long before these drugs were approved for the marketplace.” Maybe he should offer CME and a free lunch.

The new drug benefit increased Medicare’s costs by 18.7% in 2006, now up to over $400 billion. Demanding boomers should be able to bankrupt the entire country in a few years at that rate of increase.

If you read this snip out of context, would you guess the article is about EMR software developed by a doctor in Viet Nam? “Medisoft makes things too explicit. Even one dong cannot be concealed. Perhaps that bothers some people.” Maybe it’s just me.

E-mail me.

Happy New Year – Now Get Back to Work

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in January 2007. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Happy New Year! Considering the alternative, be glad that you were alive and well enough to eat and drink too much over the past couple of weeks. Now get back to work!

You’ll notice your local newspaper, having slyly given many of the real news staff time off for the holidays, is padding out their already-slim editions with time-insensitive material written in advance or copied off the wire services: witless phony New Year’s resolutions for local politicians, tired rosters of the biggest local stories and celebrity deaths of 2006, and pleas for donations to community causes.

I can see why. Healthcare IT news is sparse this time of year. No one wants to bring out new products, start implementations, hire or fire people, or make changes in the strategic plan when no one is paying attention (hmm: that would actually be good time to announce bad news, wouldn’t it?)

If our industry was a sport, the season would actually begin at the HIMSS conference in late February. It sets the tone for the year to follow, as everyone saves up positive announcements to coincide with the annual bacchanal. Vendors who make a bad impression at HIMSS will find it difficult to recover throughout the year, with attendees critically evaluating their demonstrations, booth size, staff attire, and cheery spirit or lack thereof. Even those companies in imminent danger of collapse spend the equivalent of a small country’s gross domestic product on one glorious, go-for-broke HIMSS splash, hoping against odds to get their money’s worth in new business.

Hospitals, too, get busy after months of letting IT projects lie fallow. No wonder ROI is hard to come by when projects come to a screeching halt because of non-IT staff refusal to get involved during (a) the November to January holiday block; (b) summer vacations; (c) school spring breaks; (d) impending JCAHO or state inspection visits; and (e) local, state, or national conferences involving anyone remotely involved. No wonder implementations take forever – they’re on hiatus half the year.

CIOs have plenty of work to do. All those clinical systems projects still need to be finished. Celebrate the completion of major phases with some downtime and reflection, don’t forget to keep pushing at needed process changes and system improvements, and then jump into the next round of work. Clinical systems projects are like painting the Golden Gate Bridge: they’re never finished.

Speaking of clinical systems, if you haven’t yet made a commitment to bedside barcode verification of medications, then now’s the time. Same, too, with tightening up your Pyxis access with biometric security, override vigilance, and double-checked stocking procedures.

Microsoft has a new operating system and Office version – yay! Users will be upgrading at home, scornfully wondering why your IT department is holding them back in the Stone Age with systems they shamefully underuse anyway. You needed that non-strategic headache, right? At least PC hardware keeps getting cheaper, right about the time Vista will eat up more of it.

RHIOs will want your attention in 2007. Your data, too. Maybe now’s the time to catalog all the electronic data elements you have available and to develop a plan to move important paper-based ones to electronic formats.

If you haven’t already, let one of your computer geeks play around (officially) with Linux, both server and desktop. If you aren’t running it at all now, you will be soon.

Stark relaxation means you may need to support a new class of impatient, computer-illiterate users: doctors in private practice and the inconsistent employees they hire. Keep stats to get budget dollars since those support hours have to come from somewhere.

Lastly, if you’re in management, please make sure to recognize and reward those who work for you. When you get too full of yourself, make a list of which essential personnel would be needed in case of system failure, natural disaster, or clinical emergency. You’re probably not on it.

I hope our industry and all of us working in it have an excellent 2007. If in doubt about a particular course of action, remember WWIWAAP (which you may pronounce WEE-WEE-WAP, since I just made it up): what would I want as a patient?

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 1/9/08

From James Ballard: “Re: checklists. HHS’s ruling on the checklist issue is a perfect example of the loss of common sense caused by excessive regulation. If we call the documentation of the checklist a ‘Nursing Intervention’ and we then call the study a ‘Chart Review’, the Joint Commission would be singing our praises for an effective quality improvement initiative. I can’t help but wonder if I was breaking the law during most of the chart reviews I was asked to take part in.”

From Mac MacGuff: “Re: checklists. Check the credentials of the person the Bush Administration put in charge of the Office for HUMAN research protection (Acting Director). You’ll find he is a veterinarian. Apparently human protection has gone to the dogs. It appears there’s a new acting director now, but I don’t know his background.” Bet he’s driving improvement guru Peter Provonost through the woof. Sorry.

From Sam: “Re: Greenway. I was contact by Greenway Medical about a position. Do you know anyone who worked there or anything about the company?” I’ll need some reader help here since I know next to nothing.

I heard from Mike Quinto and others with clarifications about a reader’s comment involving Mike’s new CIO job at Applachian Regional Healthcare System. Mike says he’s not the only one who sold Affinity deals during his time there, although he was the big gun (he didn’t say it like that, but I spiced up the wording since I always picture sales guys as swaggering former jocks who talk that way). He also mentions that this particular ARH is not the one I was thinking of in KY and  WV — it’s a three-hospital group in Boone, NC (I gave him a barbeque joint tip since that’s one of my core competencies, but he’d just been there the night before).

From The Shelton Shadow: “Re: PACS in NPfIT. Word has come that the PACS installation in the UK has reached conclusion. The positive responses from users are starting to roll in, with many reporting faster processing of patients and quicker access to image files, thus saving money. Another key decision was made by Philips Medical to exit the installing of any further PACS for radiology in the UK, leaving the potential future business for Sectra and others to pursue.”

Mark your HIMSS calendar for Monday evening, February 25, from 6:00 to 8:00 at the Peabody Orlando, right at the convention center. It’s the first ever HIStalk get-together, unbelievably sponsored by the cool folks at Healthia Consulting. This will be first class in every respect — food, drinks, and who knows what else. I just about fell out of my chair when Shawna from Healthia sent me the menus, which just happened to include costs (I’m parsimonious), but they graciously volunteered to make the arrangements and spend the bucks to support HIStalk’s readers. Details to follow (including an online RSVP page so we can reserve those $7 Peabody shrimp, which is about what I pay for one of those barbeque dinners I mentioned). If you’re an outgoing sort, I may need some “ambassadors” to mingle on HIStalk’s behalf (I’m considering hiring cheery booth babes and boys, which even Inga thinks would be fun, although I’d be too embarrassed to have Healthia pay for them).

Speaking of booth candy: I put up a new poll to your right, playing off Inga’s earlier question. What would draw you into a vendor’s booth if you otherwise had no particular interest? I se that “attractive representatives” is doing well, so it’s not just me.

Houskeeping stuff: check the Healthcare IT Stocks page, which displays current (well, delayed 15 minutes, anyway) stock prices of some bit HIT vendors. Also, the Best Practices question is still open, with good feedback from readers about their choice of project tracking and communications tools. There are new text ads to your right — thanks to Dragon Medical, CodeMap, and Patient Placement Systems for supporting HIStalk. And, time is slipping away to get your HISsies nominations submitted, joining 137 of your colleagues so far in deciding who will be on the ballot shortly. I was thinking of unveiling the HISies winners at our Orlando soiree, although that may take more organizational skills than I can muster. Wouldn’t it be cool to have The Pie winner show up to accept? Unlikely.

Nearly 200 jobs are listed on HealthcareITJobs.com, including listings from QuadraMed, Partners Healthcare System, Intellect Resources, and DocuSys. Employers can post jobs at no charge for a few more days.

Listening: Chevelle.

My editorial in tomorrow’s Inside Healthcare Computing electronic update: “RHIOs 2.0 Dying Uglier Deaths than 1.0,  but Hardy Survivors Guarantee Another Round.” I might surprise you with my tiny, guarded RHIO optimism, including this comment about my previous posture: “I was a real buzz-kill, raining rational thinking onto the frenetic, obedient parade of RHIO trough-lappers.” I notice today that Marc Overhage has an editorial in the Indianapolis paper, although he isn’t unbiased like I am since he runs a RHIO.

American Radiology Services Inc. will be sold by its buyout owners for $151 million to CML HealthCare Income Fund. Johns Hopkins owns a big chunk.

Cerner, Microsoft, and Spectrum Health (MI) will partner to develop the Cerner Care Console, one of those combination clinical/entertainment systems that companies keep trying to sell. Cerner’s version will include an Xbox 360, patient-physician communication, patient schedules, surveys, and hospital propaganda.

McKesson signs a big deal with Community Health Systems (TN) that includes its physician portal, EMR, and clinical systems in over 40 hospitals. There’s one happy salesperson out there somewhere who will eventually pocket a fat commission check (How much, since I’m an incentive-free provider sider? A million?)

Provena Health signs up for Misys EMR, Tiger, and Homecare.

Lonnie Johnson joins Zotec Partners as COO.

Goldman Sachs puts money into portable clinical information vendor Epocrates.

The DoD wastes so much money that another $4 million and over 100 employees for a “Military Interoperable Digital Hospital Testbed” doesn’t register, even when it’s in that high-tech haven of Johnstown, PA and paid out to Northrop Grumman. Still, you have to guess this announcement is a lot more about federal pork than technology.

Former Amicore president Richard Noffsinger is named CEO of SafeMed. I couldn’t figure out what they sell from the lofty-sounding press release, but it’s something to do with health analysis and it brims with buzzwords: actionable, empower, architect, etc. According to my trustworthy Bullfighter software, “Diagnosis: You like to hear yourself write. Despairing of the thought of bringing a sentence to a close with something as demeaningly ordinary as a simple period, you shower readers with gratuitous, interminable and often weighty if not impossibly labyrinthine prose. Meaning lingers, albeit awash in a thick tide of metaphor and exposition that threatens to drown the writer’s message. Seek help.” I didn’t think it was that bad, but I don’t question BF.

Sage Software announces go-lives of its Intergy Practice Portal for patient-physician communication.

CalRHIO announces that Cisco will join Medicity, Perot, and HP in developing its information exchange.

InterSystems announces that partner Oleen will provide its Cache’-powered SurgiDat system to the VA.

E-mail me. Inga’s working on some HIStech Report stuff tonight, trying to catch up for HIMSS, so it’s just me.

Monday Morning Update 1/7/08

From Christine Slater: “Re: HIMSS legislative success. HIMSS sponsored 92 healthcare IT bills. Zero passed. Anything wrong? Nah.” And in more bad news for EMRs, fading presidential candidate Hillary Clinton says she’s all for them.

From Is CCHIT Irrelevant?: “Re: CCHIT. The CCHIT home page lists Epic as the only vendor with a certified ambulatory EHR and inpatient EHR system. Is the baseline functionality that CCHIT requires really missing from other enterprise vendors, or have vendors just stopped caring about CCHIT certification and the advantages that it is supposed to bring their customers?”

From Patrick Ayephbee: “Re: new vendors. I’m seeing more get rich schemes and dirty tactics from the usual greedy vendors plus companies new to HIT. Greed, inexperience, and arrogance – great combo. Most of the IT world seems to think that poor industry performance can be explained because we’re in the pioneering stages. No, THEY are in the pioneering stages. The industry is 40 years old and they have not stopped to learn one damn thing. In fact, they don’t even ask. If you heard some of what the [vendor name removed] folks are saying, it would bring a tear to your eye.”

From Gail Pileggi: “Re: real time location systems. The area of RTLS is suddenly the ‘next new thing’. We fail with overhyped CPOE, so turn to nursing documentation and BCMA. Oops, that’s not easy either, so let’s focus on supplies since they can’t gripe. Not a bad thing, just another detour and hype cycle to deal with.”

From The PACS Designer: “Re: 2008 outlook. The outlook for 2008 is rosy for some new software applications. We will be hearing about successes and failures of PHR efforts and implementations of thin client applications Another innovation that will begin to find a home is the ASTM International Continuity of Care Record (CCR). Since TPD was a participant in its creation, it would be gratifying for me to hear that it’s in use and working to improve the information flow of healthcare!”

From Stratto Cumulus: “Re: cloud computing. Reminds me of the late, unlamented ASP model, where clients wanted to outsource everything, lay off staff, and make huge profits. In real life, the vendors were running cloud servers with vanilla COTS applications that they would not modify, which killed the business since enterprise apps always need customization and interfacing. Questions to ask: who’s handling authentication and security? Will the cloud vendor tell you if someone snoops in George Clooney’s records, or if you suspect someone is, how fast will they look into it? How will COTS licensing be handled, or will only open source stuff be in the clouds? Will the cloud be a data repository with local data marts or will local systems collect the data and batch it up to the cloud? Will it be transaction driven and Web-based, and if so, how many critical clinical apps are really Web-enabled? How will APIs and web services be handled? Are you sure you have the bandwidth? Clouds could be great for research repositories, provided authentication and architecture is adequate to handle the multiple query services. It would be great if we could integrate research findings across multiple studies to increase statistical power or see relationships across organizations, genes, etc.”

My editorial in last week’s Inside Healthcare Computing: “How the Layoff Grinch Stole Christmas: Clueless Management 101.” I gave myself some love (is that immoral?) for this line about how suits pick layoff targets: “Extra points are assigned if the victim doesn’t seem like the sort to argue, sue for discrimination, or return with armament (the worst part of being laid off is realizing that management put you in the same league as those losers who got axed with you.)” I’m not claiming it’s Tolstoy, but it sounds like me.

Heard: Lucida Healthcare IT has been acquired by Vitalize Consulting Solutions. Lucida’s execs have taken key roles (CEO, CFO, and CIO) in the new entity, which has the financial backing of some big players that include Bank of America and SV Life Sciences. Vitalize’s Mary Pat Fralick will stay on as COO.

Jobs: Manager of Clinical Informatics, LIS Director, HRIS experts, Sunquest lab consultant. Employers can list jobs free for a couple of more weeks.

Make your HISsies nominations now. Surely you have thoughts on the best and worst HIT vendors, the smartest and stupidest vendor strategic move of 2007, and the HIStalk Industry Figure of the Year. There’s about 100 nomination votes so far and the top nominees will go on the ballot. Maybe the obvious choices haven’t been named, so why take the chance?

I’ve got a few giveaway items for the HIMSS conference and need vendors to make them available to attendees. If you want a little extra booth traffic, drop me a line. These are small items, so they won’t be hard to handle in the convention center. Unlike those damned “I Am Mr. HIStalk” buttons from two years ago, which I can’t believe I found a forgotten sackful of while cleaning out my computer closet this weekend. Maybe they’re reproducing like Tribbles. Unless someone saved theirs, I could wear one myself and have an exclusive (plus they say “I Am Mr. HIStalk”, so I’d be telling the truth).

Former QuadraMed sales guy and HIStalk reader Mike Quinto has joined Appalachian Regional Health System in Boone County, NC as CIO. Fun fact somebody told me: he sold the only Affinity deal made in the last three years and his customer was … Appalachian Regional Health System. He must be persuasive.

Kelly Barland, formerly of GE Healthcare, has joined InfoLogix as senior director of professional services.

Somebody sent me a Medicity Christmas letter of sorts (I always appreciate forwarding!) Revenue doubled again for the third year in a row (notable considering the obvious floundering of their interoperability competitors). They also signed a big deal with HSHS. I always harp on idiotic RHIO business models and Medicity’s customers seem to be a lot smarter about theirs (including CalRHIO, which is hush-hush about their arrangement but promises to spill it someday).

Remember that glowing article about Peter Provonost’s reminder checklists that were saving tons of lives and money, just like a pilot’s pre-flight checklist? They were cheap, easy, and set to roll out in the US and in other countries. Well, make that just “other countries” now because the geniuses at HHS’s Office for Human Research Protections, apparently in need of a moment of bureaucratic limelight, have declared the use of such lists unethical and have shut the program down. They decided that using a safety checklist and tracking the results violates IRB requirements, claiming that using a list is no different than injecting a patient with an experimental drug (huh?) Knowing that patients will die otherwise, that seems like a puzzling decision (who wouldn’t want their caregivers to use a list that could save their lives?) I’m not one to advocate storming the castle with pitchforks, but you could e-mail acting director Ivor Pritchard (ivor.pritchard@hhs.gov) your courteous, well-informed opinion if you agree with me that this seems ludicrous. Peter Provonost (of Johns Hopkins) agreed earlier to be interviewed here once we work out details, so I’m sure he’ll have plenty to say.

Former Navy hospital CIO David Yovanno has been named COO of Internet advertising firm ValueClick.

UK researches think Google’s PageRank technology can be used to identify MRSA hotspots in hospitals.

California’s data breach law, which previously covered only financial information, now requires patients to be notified if their medical information has been exposed.

ONCHIT’s 2008 budget will be the same as 2007’s, about half of what President Bush wanted. Rob Kolodner says they’re on track to meet Bush’s goal of EHRs for every American in the next six years. If Vegas gives odds, go the other way.

KLAS has announced its year-end Best in KLAS report. Since vendors aren’t shy in telling you when they’re #1, I like to focus on those products that are dead last in their respective categories: GE Centricity CDR, Siemens Invision ADT, Cerner FirstNet ED, Cerner Scheduling Management, GE Centricity LIS, Siemens SIENET PACS, Cerner PharmNet Pharmacy, Sunquest RIS, and GE Centricity Perioperative.

Bizarre medical lawsuit: a strip club owner whose penis is tattooed with the words “Hot Rod” is suing Mayo Clinic’s chief surgery resident, who admits taking a photo of it while catheterizing the man and showing it to other doctors.

E-mail me.

Inga’s Update

An Arkansas neurosurgeon pleads guilty to soliciting and accepting kickbacks from a surgical device company. The doctor has agreed to pay $1.5 million, of which $1.1 million will go to the state and to the whistleblower (who happened to work for a competitor.)

Overheard: two Misys operational superstars with over 30 years of combined tenure say goodbye to Misys to work for former Misys VP’s Marc Winchester and Scott Sanner at Digital Healthcare, a retinal risk assessment company. Their resignations come on the heels of at least a couple of senior sales superstars over the last month or so. Guess they’re all choosing the highway over Misys MyWay.

Mr. H and I have had a few conversations about what attracts people to booths at big shows like HIMSS. Let’s say you are only mildly interested in the company’s offering, or perhaps have no clue what the company does. Does a free latte or margarita get you to step into the booth? (my favorite). A beautiful young female with a bit of exposed skin? (Mr. H’s favorite). Pictures of Mr. H and me? (that was what our friends at The White Stone Group want to give away). Or, various trinkets and chances to win some exciting prize? Let me know.

Apparently the bean counters at PricewaterhouseCoopers will begin performing a new type of audit: PwC has been hired by CMS to perform 10 to 20 HIPAA “compliance reviews” of organizations facing complaints.

After an “independent strategic reviews,” MedcomSoft announces an overhaul to its board of directors. They are also looking for a new US-based CEO, if anyone is interested.

Barnes-Jewish Hospital in St. Louis is partnering with iMDsoft to implement MetaVision anesthesia information management system.

Reminder: our new “Best Practices” section of the Forum is up and running with this week’s question: what software or forms do you use to track an active project … tasks, percent complete, assignments, due dates, etc.? Add to your list of New Year’s resolutions to post a message or two to share your wisdom.

At the top of my personal resolutions is regular exercise, especially since I don’t seem to be too good at skipping cocktails or carbs. Happy New Year, by the way!

E-mail Inga.

News 1/3/08

From Lazlo Hollyfield: “Re: AHRQ. It amuses me how some of the health news outlets are highlighting the AHRQ focus groups on how consumers perceive health IT. Besides an area that several market research companies already cover, this is a complete non-story at best and lazy journalism at its worst. NIH budgets have dwindled/been flat and so has AHRQ’s budget. Most of the bureaucracy is leaving before the end of this presidential term and decisions to award money have gone astray. This is probably a case officer at AHRQ who basically had some extra money to throw around. Nothing more. I would be shocked if something truly interesting gets published from it. Probably just verifies existing customer data out there from the various market research firms.”

From The PACS Designer: “Re: Cloudy 2008. TPD took a well-deserved vacation and a break from HIStalk, but is now back in the groove as we approach 2008. Speaking of ‘Cloudy 2008’, it’s not weather or financial predictions, but refers to the emergence of more ‘Cloud’ offerings in the healthcare space, with Clouds being bundled software services which include  automatic upgrades from time to time which will remove the burden and worry from institutions. Since hospital budgets are tight due to reduced Medicare expenditures, you can expect more C-level execs to consider outsourcing many of the more laborious tasks to vendors who offer their services as ‘Clouds,’ which will expand the size and number of clouds employed to get the jobs done in 2008 and beyond. Short term, it will mean lower software revenues for vendors, but longer term will provide stable monthly/yearly business revenue volumes for companies offering this option. Happy 2008 from TPD to all HIStalk readers!”

From Nasty Parts: “Re: rumor. I can confirm your rumor of a British EMR company’s SVP of sales leaving. He came from outside of healthcare, a decision I never understood. Morale is high with his departure.”

From Marge N. Alperformer: “Re: HIMSS. Do you know of any inexpensive way to to attend?” Registration’s going to set you back $740 if you get it in by the 28th and there’s not much way to avoid that unless you: (a) “share” a badge with someone else and split your time; (b) find a vendor to comp you, which isn’t likely; (c) do something for HIMSS that will get you a free reg, but it’s probably too late for that; (d) skip the educational sessions (or assume credentials won’t be checked closely) and buy just an exhibit hall badge for $175. You can save on flight and lodging by using Priceline (I’ve done that), especially since rental cars are cheap in Orlando so you can stay further out and off the shuttle line. Anybody else have ideas?

From Kiera Whitlock: “Re: MGMA. They are very visible in the Medical Group Practice world; their founding fathers practically invented the large multi-specialty group practice. Most of the big groups are members, but MGMA is catering more and more to the smaller practices. Their sectional and national conferences are big, though not as big as HIMSS; but also don’t have HIMSS’ price tag, for vendors or for members. If you don’t know much about medical groups (or even if you do),their training and publications are a good value. If you want to hang around exclusively with the bigger (50+ MDs) groups, you’ll probably want to check out AMGA; their conference is smaller, but the biggest groups and the best vendors are there. AMGA does not (as far as I know) have individual memberships; so if you’re looking for a personal (as opposed to organizational) membership, MGMA is the place to go.”

From Techman: “Re: HL7. I work for a software vendor and I am interested in the way HL7 is used in practice by healthcare providers, like which parts of the HL7 messages are used. Anyone have suggestions for information sources?”

From Grizzled Veteran: “Re: Alteer. The California-based EMR/PM company is being acquired by VisionaryMED, a Florida EMR/PM company.” I saw nothing in the news or on either company’s site, but I’m not doubting you.

From Porchean Cantrall: “Re: HISsies. athena’s insane IPO and ongoing industry buzz around their disruptive SaaS model have got to make it for biggest industry event. Loved Beers with Bush last year in any event – thought that was pretty cool.” Beers with Bush was fun, especially since athenahealth brought out the good stuff right on the exhibit hall floor for HIStalk readers who dropped by. We need another fundraiser for a worthy cause, if anyone has ideas.

And speaking of HISsies, it’s that time again: your nominations for “The Brutally Honest Healthcare Information Systems Awards” in 18 categories are now welcome. Among them: who’s the worst vendor, what’s the biggest HIT news story of the year, who is the HIS industry figure in whose face you’d most like to throw a pie, and who gets the biggest award: the “HIStalk HIT Industry Figure of the Year.” Nominations will run until the end of next week, then voting begins. Don’t discount the importance of voting now: only the top handful of nomination vote-getters appear on the final ballot. If you’re new, don’t think this is a joke just because the categories are cheeky: it draws 1,000 or more voters each time, some vendor always tries to rig the voting by urging employees to vote for them as Best Vendor, and the number of people who read the results announcement is off the scale.

Cardinal Health recalls another 200,000 of its Alaris Medley smart IV pumps. Springs inside the pump were assembled incorrectly, leading to the potential for overinfusion.

Pennsylvania get its usual abundance of federal pork barrel money, including $86,000 each for clinical IT projects at Mercy Hospital Scranton, Moses Taylor Hospital, and Mid Valley Hospital.

Inga mentions her Christmas presents below. Mine: the rest of the Gilmore Girls DVDs (so femme, I know, but I’m addicted); Call of Duty 4; a couple of books, including How Doctors Think; and some Boy Scout popcorn from Mrs. HIStalk’s batty but adorable 90-something aunt.

Let’s get this Best Practices thing going! What software or forms do you use to track an active project … tasks, percent complete, assignments, due dates, etc.? An HIStalk reader has asked, so share your thoughts in this new HIStalk Forum topic. Register to post if you haven’t already.

If you found the Rose Bowl coverage annoying (nearly assured since Brent Musburger was involved), you’ll find this funny.

CPSI signs a deal with NeoTool to use its NeoIntegrate interface engine.

Listening: Blonde Redhead.

Merge Healthcare did some restating and reporting, but I just can’t get interested in their ongoing troubles any more.

Sumter Regional Hospital wins the Siemens MRI with over 260,000 votes, 101,000 more than the second-place finisher. The official announcement will come in a couple of weeks. Congratulations to them and thanks to the HIStalk readers who voted for them.

A Malaysian hospital has developed its own information system using free Oracle software. It includes ADT, ED, surgery, HIM, case mix, and patient accounting, with CPOE and HL7/DICOM integration planned for 2009. Says it costs millions of ringgits to implement (a ringgit is around 30 cents US) and that distributors are interested in selling it.

A former GE Healthcare bigwig, soon to be CEO of a small medical data analysis company, says he wants to sell clinical-genetic information systems to vendors like Cerner and GE.

Jobs: Pharmacy Application Specialist, Epic Trainers, Director of Global Training & Education.

A doctor creates a video e-mail for each patient to explain their lab results.

Allscripts acquires discharge referral system vendor Extended Care Information Network for $90 million in cash.

E-mail me. It’s time to get back in the swing of things.

Inga’s Update

I am back from a week in the land of no Internet access. I loved my time with the extended family, but truly, how does one survive in a world with no Wall Street Journal, one FM radio station, and 20 miles from the nearest manicurist? The highlight was driving into “town” one day and seeing a plethora of beefy country boys in their nice-fitting jeans. They all looked like they spent a lot of time hauling things around all day, though I bet none knew anything about healthcare IT. Next year I am voting for a Four Seasons somewhere (I love their towel boys.)

My best Christmas present is my 320GB external disk drive that I haven’t hooked up yet. Probably next was the 1000-page “World Without End” by Ken Follett. No healthcare IT references at all, though it is Oprah-approved.

I was pretty amused by the number of posts related to Meditech and their technology. To be fair, I should note that I am the one who introduced the MUMPS technology issue when asking if Meditech had difficulty finding employees with expertise in MUMPS (to which he pointed out that the current technology was not MUMPS.) I was a bit surprised by the passion my Meditech friend still had for his company. Whether or not you agree with his opinions on Meditech and its technology, my impression was he honestly believed in the company and their products. On one hand that is commendable, and certainly understandable. How could you stand by your company and its products and people for so long if you didn’t believe in them? On the other hand, it’s easy to get blinders on after a period of time. I know little about Meditech’s management but I hope they take time listening to the market (and not just their clients) since it appears the world views things differently than the Meditech folks.