News 8/29/08

From Violet Baudelaire: "Re: RHIOs/PHRs. Are the goals so different between the RHIOs and PHR vendors that they will stay separate, or do you envision a time that they will merge? From a data collection perspective, are they not collecting mostly the same information from/to providers and payers, but only organizing and distributing it for different audiences and users?" The biggest differentiator of PHRs is that they give patients a place to record their own information, but certainly that function could be rolled up into RHIOs (and nobody in their right mind really expects patients to do that anyway). The biggest value of PHRs is potential direct-to-consumer advertising, so PHRs will desperately try to stay separate, hoping that RHIOs and system vendors don’t build the equivalent capabilities into their systems and squeeze them out of the revenue picture. That’s my guess, anyway.

From Tad Paoli: "Re: Howard Industries. Point-of-care cart manufacturer. 600 illegal aliens were arrested and the plant shut down." The newspaper stories rattled of a bunch of odd stuff made there, but I didn’t realize they did carts. The Mississippi plant is where fellow workers applauded as the illegals were hauled off by immigration, Legal workers claimed the illegal workers were getting preferential treatment and even the union was recruiting them. The company’s site indicates that the Howard Medical division sells computing and charting stations, COWs, scanners, and mobile devices.

From Blond Adonis: "Re: Epic. You buy the idea that Judy does not own a controlling interest in the company? And you are smoking what?" Pork shoulder, preferably over hickory, while watching college football (it’s back!) and drinking a Yuengling. 

From Paranoid Googler: "Re: HIStalk search. Did you change the search engine on the back end from Google? And on a different note – regarding the guy who is so busy he wants you to write less, I bet I am as busy as he is and I want you to write …more. Actually, the size of the blog as it is today is just perfect, and don’t let any annular muscle tell you otherwise." Ha … he said "annular muscle." Before today’s redesign, there was an old search box on the upper left (it had always been there) that didn’t do a Google search. The one in the right column was a Google site search. Now, the Google one is the only one left since I had the other one removed. Jeez, that was confusing.

From Lance Tenor: "Re: free cataract surgery in India. Even as 29 people were fighting to get back their vision at Joseph Eye Hospital in Tiruchirapalli after cataract surgery, 34 more people, who also underwent the operation at the same hospital, were admitted to Villupuram government hospital after they complained of blurred vision." Nine will lose their eyesight permanently, leading protestors to break into the hospital and trash it. The culprit is preliminarily identified as infected saline ophthalmic solution. It reminded me of an old story about traveling con men in India who would claim to cure cataracts. They would poke the eyes of patients with a briar or stick and drain out the fluid. Patients could miraculously see again, they paid the con men, the con men skipped town, and the patients went blind right after since draining the milky fluid is a temporary solution and the eye poking caused even worse damage.

Pardon our dust as the site changes, but hopefully you’re noticing some benefits even though we’re not quite finished. The smoking doc graphic is smaller, the top links are now horizontal to push articles further up on the page, the comments work better, and the page loads faster. Next step: resized ads.

The potential class action lawsuit against McKesson that alleged drug price-fixing (along with First DataBank) has been dismissed by a federal judge. That was a huge exposure that could have been disastrous.

I saw no announcement, but I noticed that LingoLogix, the natural language processing company we profiled in April, has been acquired by Cerner. Or at least I think it was: the August 1 announcement was on their site this morning, but is gone now (but the commented out HTML below from their main page proves it). The contact page also says Cerner. Hey, I’d be proud of it. Maybe Cerner found them through HIStalk.

I don’t get the ‘tude: the local paper in SD headlines the locals who were "stung" because Medicare accidentally overpaid them and now wants the money back. "Somebody who did this (made the error) should pay it back," said one recipient who already spent the money.

Jobs: Director, Clinical System Architecture (WA), EMR Implementation Associate (MA), Cerner CPOE Consultant (any location), SeeBeyond/Sun Health Systems Integration (any location). Sign up for weekly job blasts.

Cisco buys Linux-based Microsoft Exchange alternative PostPath for $215 million, saying it will add e-mail and calendaring services to WebEx, another Cisco acquisition from last year. PostPath was pretty aggressive about claiming its 100% compatibility with Exchange and was getting traction there, so surely Cisco will spank Microsoft a little by continuing to sell it for that purpose. I know several hospitals that are running it, finding it exactly the same as Exchange except for the price.

Nortel announces its "office on a stick" product (Nortel Secure Portable Office) that puts authentication, a VPN, and a virtual desktop on a USB key. When the key is removed, data and applications are removed with it.

I haven’t research it thoroughly, but this desktop remote control software can be downloaded free for personal use. A lifetime business license is $699. Pretty cool, maybe, for remote support or team projects.

A New Zealand health network bans iPhones, citing security risks and admitting that doctors aren’t happy about it.

Heartland Health, trying to clamp down on identify theft and insurance fraud, requires patients to show photo ID each time they appear for treatment. I think they’re in Missouri, but the goobers at the local paper are apparently so agog at the concept that someone from more than five miles away might be reading their site that they don’t put their location on it anywhere.

E-mail me.

HERtalk by Inga

From Former Road Warrior: “Re: Misys/Allscripts. I have friends working at both of these companies. Each camp seems to believe their products will survive the merger and the sunset products will come from the other company. Meanwhile, salespeople are being told to expect some territory changes as the two sales teams are merged. Glad I don’t work at either company right now.” I am with you there. I read the following comment in the Raleigh area business journal: “The company also has strongly hinted that local layoffs should be expected, with Misys CEO Mike Lawrie telling analysts the day the deal was announced that they could ‘let your imagination run wild’ about potential synergies in the Triangle.” I’d be running wild all the way to Kinko’s to clean up my resume.

From Scott Shreve: “Re: Perot and Medsphere. HIStalk just recorded its 1.5 millionth hit. Besides the snarky commentary, HISTalk (and the lovely new addition of HERTalk) has continued to gain readership with its deadpan commentary that is always dead-on. As the readership has grown, the quality of the tips and the accuracy of the insight has also increased. I believe nearly everyone with a need to know turns to HIStalk when they need to know.” We thank Scott for the shout-out, which he made recently on his Crossover Health blog. Scott also makes an interesting prediction that Perot will buy Medsphere.

From Vendor Exec: “Re: ICD10 effect. I think ICD10 will be very hard on the older vendors. I would hope that most of the newer vendors planned for it (we did, as we knew it would come eventually). I think it will cause a squeeze on vendors more than anything, as it will have a significant cost associated with it. I do not think it will really hurt EMR sales, though, as I think the vendors will just have to suck it up and do it. I do think that it might push some clients into asking their hospital to help via Stark. In that way, I think it might help drive EMR sales.” While I’m sure most vendors have been planning for this change, I stand by my original assertion that we’ll see a number of product sunsets by companies supporting multiple similar solutions. Say goodbye to some of those oldies but arguably goodies (at least in the day) such as vintage Medical Manager and Misys PM.

From Wompa1: "Re: Duffy and Inga. She has a real retro sound to her music. I haven’t heard anything (recent) that comes close to her style. I might have to start listening to more Inga Radio.” Wompa1 is such the Renaissance man. On top of his regular thoughtful HIT commentary, he appreciates great music and has whipped out a follow-up Inga love sonnet (ok, maybe it’s not a love sonnet, but it made me feel loved nonetheless): “Inga the incognito, illuminating, intrepid investigator of industry intelligence. Tirelessly trudging through online tomes…”

There have been a few posts of late regarding standards (CCHIT and others.) It reminded me of a recent conversation with a friend who is in the EMR implementation trenches. As a vendor, the complexities of lab connectivity are giving him fits. The way he explains it, all parties agree that sharing lab data creates a more complete patient record (and presumably leads to better care.) However, each lab has its own set of standards, meaning each lab requires a unique interface. And because of mergers and acquisitions over times, the national labs typically have multiple products and a variety of “standards” (in other words, just because you have a Lab ABC interface functioning in Dallas does not mean it will work in Seattle because Lab ABC products may differ). The underlying issue is who pays for whatever changes are necessary to develop a standard and the required interfaces. Currently, he claims, there are no mandated standards, thus no pretty fix. So, I am left wondering if anyone can shed some light on this. Are lab standards an issue one of the various work groups is addressing? Are the labs on board?

And speaking of standards, the SEC is considering requiring all publicly listed American companies to move from US accounting standards to international model instead. That GAAP stuff always gave me fits when I was in college, so I say good riddance.

Carilion Health System (VA) makes the front page of the Wall Street Journal. Critics claim Carilion’s monopoly in Roanoke has led to care that costs as much as four times more than other regional providers. And if they turn to the local paper for solace, the big story there is that Carilion’s CEO was paid $2.27 million last year.

I went with some girlfriends this week to see the movie Mama Mia. It’s a total chick flick that left my pals and me dancing and singing on the way home. If you are guy wanting to understand the stuff of female fantasies (e.g. rekindled lost love, hunky men on remote Greek islands, looking glamorous while singing at the top of your lungs), then buy a movie ticket, sit in the back, and observe middle aged women letting loose.

Sage Software Healthcare names former Cerner VP Lindy Benton as COO.

It appears as if Google Earth has more uses than simply checking out your home on the Web (or your boss’s home). Olympic cyclist Kristin Armstrong details how she used the application to help with a gold medal (I included a photo of Kristin because I bet Mr. H overlooked this one on TV. If you missed his Inside Healthcare Computing editorial yesterday, he only noticed the beach volleyball babes).

The CHIME folks tell me that CIO registration is up for their 2008 Fall CIO Forum in Henderson, NV in October, despite concerns over rising travel costs. And for budget conscious vendors, CHIME has a new entry level Foundation membership option. The Associate level member is $20,000 a year, far less than the $75K Premier level. I suppose you can’t knock an organization for having high fees that prevent vendor membership from outnumbering the CIOs (like at HIMSS, for example). I have actually been to a CHIME meeting in the past and am sorry my own rising travel cost concerns will keep me home this year. They are a fun, smart bunch.

E-mail Inga.

Readers Write 8/27/08

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

CCHIT, The 800-Pound Gorilla
By Jim Tate, EMR Advocate

Yes, it’s true. There is a monster in the jungle and he is devouring all that is creative and laying waste to the brilliant small companies trying to lead the way in HIT development. Only the giant dinosaurs will be left the divide up the swamp once the blood bath is over. We are doomed, the sky is falling, and the Mayan prophecies of the end of the world are coming true.

That seems to be the belief of those who rant and rave against the presence of the CCHIT.

I beg to differ. I remember all too well when there were NO STANDARDS. I remember physicians being completely at the mercy of salesmen with slick demos (now they are at least somewhat less subject to the snake oil speech). I remember the industry making minimal progress on interoperability until it became a standard. I remember when there was no forward pathway that gave any indication of where EHR development was headed.

Say what you will about the CCHIT. I have found it to be an extremely transparent organization that is helping level the playing field and make it safer for clinicians to take the plunge into electronic records. In my experience, the staff at CCHIT has been incredibly responsive and helpful providing answers and directing me to clarifying resources. They set the standard on credibility. Certainly more open, helpful, and responsive than any major EHR vendor I have every contacted for support.

So there it is. You can throw stones if you wish, but you ignore them at your own risk. The CCHIT is here and is becoming ingrained in the road that lies before us. As Dylan said, “You don’t need a weatherman to know which way the wind blows."

ICD-10 Risk Assessment
By Art Vandelay

Discussion around this topic will benefit us all.

With the changes to the ICD-10 coding scheme, I have classified our systems into four categories – highest risk, moderate risk, low risk and no-risk.

I determined the categories by considering a few areas of risk: (1) the perceived impact to their applications’ architectures; (2) perceived capability of the vendor to handle these types of changes based on past experience with HIPAA and Y2K; (3) the vendor’s ability to share a plan for ICD-10 (few have been thinking ahead); (4) the vendor’s use of ICD-9 in application and interface logic, such as order checking rules and code-to-procedure checking rules); and (5) the use of discrete ICD-9 or groups of ICD-9s to drive key reports.

After considering the areas of risk, our main ancillaries (pharmacy, surgery, pathology, radiology) and revenue cycle add-on products are in the highest-risk category. Also in the category is our EHR. This was only due to the decision rules around the EHR and the way the department-focused portions of the EHR are used. It could be much worse here if we were using more reporting or decision rules. The revenue cycle add-on products are the most troubling. These include claims scrubbing, coding rules, and charge edits.

In the moderate risk category are our revenue cycle, scheduling, medical records, and decision support products. The revenue cycle vendor has a decent plan in place.

The low-risk category includes many of the biomedical and patient education applications. These applications do not have much logic associated with a diagnosis. They also do not send interpreted data outside of the system. Some raw data without diagnoses is sent.

The no-risk category includes our enterprise resource planning (ERP) systems and document imaging system.

ICD-10 also enables the HIPAA-compliant claim attachments. We have not performed this risk analysis, but believe our EHR product will help. My fingers are crossed.

Because of this change, the independent physicians may start to approach the hospitals for some EHR-Practice Management system donations under the Stark and Anti-kickback law changes. This will place the hospitals in the unenviable position of thinking about themselves and their projects versus keeping the physicians happy. It could also impact the forms, order sets, and other data to be built in these applications because there are more possibilities to consider.

We have added ICD-10 contract language to our list of the usual items we negotiate with both our systems and medical devices. This mirrors our HIPAA and Y2K language.

Soarian Financials
By Clinton Judd

Last week, Otis Day clarified his positive comments regarding Soarian development to say he meant Soarian Clinicals, not Soarian Financials (SF). He went on to say, "I do agree that Siemens is looking to improve short-term and milk INVISION. And why should Siemens care, or the customer, for that matter? If the customer is happy (and paying their invoices), where’s the problem? Does Mr. Judd suggest this is a negative situation?"

Soarian Cynic answered this in Monday’s HIStalk by detailing how his hospital has waited six years for SF and they were recently told to wait at least two more (and asked to extend INVISION for at least five more, just in case). This is two years before SF is ready for them to start implementing. Hospitals have been hurt by the delay. They have been sold on the functionality to come in SF and, as a result, accepted that INVISION would stop being enhanced (not sunsetted, but few significant enhancements in years). 

If hospitals had known in 2005 that they wouldn’t have an integrated contracted management system or an integrated EMPI until 2012, they may well have solved their revenue cycle challenges with Eclipsys’ Sunrise Financials (formerly SDK) or they might have invested in bolt-ons to INVISION to get them the process improvements they sought. Waiting for Soarian Financials has frozen some hospitals with respect to patient access and revenue cycle improvements at a time when they desperately need to improve and be efficient. CIOs (particularly ex-CIOs) have been hurt by the Soarian delays, too.

Despite still collecting high-margin INVISION fees, Siemens has been hurt, too. For example, Monday’s HIStalk mentioned Oregon Health Sciences’ (OHSU) implementation of Epic to replace A2K and LCR (A2K is OHSU’s name for INVISION). Siemens lost a very big customer there to Epic. Soarian simply wasn’t ready to compete with Epic and a number of other very large accounts nationwide have or will make the same decision to stop waiting and go with Epic. Similarly, I have heard (second-hand) that MedSeries4 has lost a number of customers to Meditech in recent years. Perhaps Soarian would have helped there too.

The difficulty with Soarian Financials isn’t because there aren’t a whole lot of good people trying hard. Siemens has invested a ton in this effort (I think SMS started the effort in 1998). The challenge is that Siemens is replacing INVISION.

INVISION certainly has its weaknesses and shortcomings, but customers have done a lot with it. It is surprisingly flexible and open to integration, if you have the skilled resources. This flexibility will make (has made) it very hard to replace. It’s the hospital’s billing system, so any replacement has to do everything INVISION does plus more. SF not only has to be a super, everything-to-everyone solution, but it effectively has to be backward-compatible too. 

Oh, and it needs to keep up with the market too. Ten years ago, it didn’t need a patient portal for billing and self-scheduling, but it needs one now. Five years ago, it didn’t need registrar score cards; it needs them now. Three years ago, it didn’t need a patient payment estimator, but it needs one now. These are all bolt-ons Siemens’ customers keeping connecting to INVISION and now want in SF or require SF to integrate to. 

The goal line for Soarian Financials keeps moving back. I don’t envy SMS/Siemens for having to create a replacement to INVISION. 

Siemens has done much better with Soarian Clinicals, as Otis Day commented on. Soarian Scheduling is more like SF; at least one regional medical center de-installed Soarian Scheduling after just months of use for scheduling radiology.

When Soarian Financials is finally ready (however ‘ready’ is defined), the next challenge for Siemens and its customers will be the conversion process. Implementing SF is a massive, long project — a 24-month effort? It is supposed to replace the entire revenue cycle, soup to nuts. Everything. Siemens probably still has 400-500 hospitals using INVISION. How many can they convert/implement a year? If they can do 50 a year (one a week), they’ll need 8-10 years. That’s IF they could do 50 a year. If anyone has heard Siemens’ answer to this conversion/implementation effort, I’d be interested in what they think they can do.

So, Soarian Cynic, if I were your hospital’s CFO, I’d either sign up for five more years of INVISION (maybe get a better price for seven years) and beef up your bolt-ons (there are great solutions available to enhance your access/revenue cycle processes).

News 8/27/08

From Truthtailor: "Re: Dairyland. At Dairyland’s User Group conference this week, they officially announced the acquisition of APS, making them the largest HIS provider to community hospitals. Also, they have re-branded — they are now Healthland." That news isn’t on the company’s site and the old name is still there. Too bad … they could have gotten some nice exposure in conjunction with the announcement. I see they have registered healthland.com, even though there’s no site there yet. Lots of companies use that name, so hopefully they’ve set some cash aside to fight off the inevitable ceasing-and-desisting.

From Bavarian Pretzel: "Re: German engineering. It seems the old ossified politics-of-obstruction SMS camp has taken over from the Germans. If we had some solid German leadership and engineering, perhaps Soarian would actually soar."

From Freddy Mae: "Re: Emageon. Anyone who wants the story can go to the investor’s page to access all SEC documents. Message boards feature interesting opinions, some very well reasoned, but they are only guessing. When — or if — Emageon gets new owners will be a decision of its board." Link. The company sounds like gangbusters on the Investor Presentation on that page.

From Peter Potamus: "Re: HIStalk. Write less, I’m a busy man." I bet you’re no busier than I am. All you have to do is read (try writing and see how long that takes). If you don’t have a few minutes three times a week to get fully up to speed on everything that’s happening (and likely to happen) in the industry, then you probably won’t be busy for long.

From The PACS Designer: "Re: teamwork. While the so-called fight over who owns PACS and other systems can get acrimonious, it really should be focusing on teamwork amongst the various players in IT and the departments. One way to break down silo walls is to have department members and IT personnel share some time each week in each others department to get educated on daily activities. Beth Israel Deaconess Medical Center has a program called SPIRIT which addresses department problems and gets various others evolved to solve a problem that can help other departments as well. Paul Levy, CEO of BIDMC, posted a piece on ‘Lean is not about dieting’ on his Running a Hospital blog that gives you an idea of what the program is all about." Link.

Listening:

Australia’s IBA Health, which bought iSoft and its big-everywhere-but-here Lorenzo hospital system, says the new version due out in November will be opened up to outside applications developers.

One of the folks at Pragmatic Marketing, a regular HIStalk reader, saw my mention of the book Tuned In (which I said I was going to buy once I hit $25 in Amazon stuff to earn free shipping) and sent copies to Inga and me. Its premise is that vendors have to connect with the general public (not customers or salespeople) to identify problems whose solution is likely to be profitable. Like most books of its type, it sometimes stretches its arguments a bit, but I  liked it because it’s refreshing. I enjoyed the Understand Buyer Personas chapter. The book also echoed something I’ve been saying for years: vendors spend too much time letting existing customers drive product development instead of soliciting fresh solution ideas from the non-customer public (example from the book: if you had interviewed Walkman users in the pre-iPod days, none of them would have said, "Invent an iPod." They would whine about the buttons or something trivial while Steve Jobs and Apple ate your lunch). I skimmed it closely, but it’s worth a more detailed read that I’ll be giving it shortly.

The TEPR people launch the Center for Cell Phone Applications in Healthcare, which they somehow turn into the obligatory acronym but make it C-PAHC. I don’t like acronyms, but especially those that are contrived to spell out something that they really don’t spell out at all (hint: pick a name short enough not to need an acronym and you won’t have to force-fit one). They’re already hawking membership and conferences, one of which is in India. MRI has one of those fake blogs that’s just a place for unnamed editors to post press releases.

Right as we talk here about the minimal influence that Revolution Health has had on healthcare (and its own profits), Modern Healthcare’s readers vote Steve Case as the most powerful person in healthcare. All kinds of regrettable quotes fawn on about Steve’s vision, how he’s going to reform the system, and how he has a huge impact on health IT throughout the entire world (he’s no Bill Gates, that’s for sure). Judy Faulkner is 50 spots below Steve (huh?) Steve Lieber is #92. Deb Peel is #72 (#4 last year). Careful readers will note that those named swing wildly from year to year: Case wasn’t even on the list last year (and hasn’t done much since). Brailer was #1 in 2004, then skipped town. It’s just another cheap magazine trick to sell ads with and lure readers with breezy reading and pretty pictures, right up there with People’s "Most Beautiful People" or any article that features a "By the Numbers" sidebar for morons.

My Inside Healthcare Computing guest editorial this week (coming out Wednesday): The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now. Here’s a sample of the highly analytical thought leadership I exhibit there in weekly prose: "In fact, I might be the only American who didn’t watch any of the Olympics, other than a little of the women’s nude … uhh, beach … volleyball (I think the US beat some other teams, but I’m not really sure since they kept running back and forth under the net while I was distracted)." The newsletter people will be happy to sign you up for a subscription or sell you The Best of Mr. HIStalk, Vol. 2, which, disappointingly, has resulted in no offers of a Hollywood script deal, a one-man Broadway show, or groupie liaisons. Well, it’s early.

PHNS names Dan Allison, formerly of EDS, as CEO. Chick Young steps down from that role, but sticks around as board chair.

The Allscripts-Misys merger or spinoff or acquisition or whatever it is (too complex for me, that’s for sure) will occur somewhere around September 26, this article predicts. I know you’ll be shocked, but Misys hints strongly that some of the locals will be Six Forked after the synergy shower starts spewing.

Wisconsin papers are enamored with Epics jobs, revenue, and culture, so here’s yet another installment. Factoids: 3,250 employees, $250 million payroll expense, $500 million revenue, a supposed Wall Street valuation of $1.2 billion (heck, even IDX was worth that to GE), and 98% of its 50,000 annual job applicants are turned away. Best factoid of all: Judy owns 43% of the shares, so even at that way-too-low valuation, that’s a cool $516 million (I’d always worry that the impatient spawn might slip something in the peanut butter).

Strange: if NASA ever sends astronauts to Mars (doubtful, given poor results so far and nearly limitless spending), communications will take too long to provide psychological counseling. Answer: software you can talk to, like an "interpersonal conflict widget." Sounds like that old Eliza software program.

A New Zealand woman dies after some sort of e-prescribing mixup in which she was given chemo meds with incorrect instructions. The software vendor punted, saying its product is like a typewriter and the doctor and pharmacist have to provide the judgment.

This is mildly interesting, though maybe marginally useful: a USP web page lets you type in a drug name, then lists reported errors confusing that drug with the others listed. I’m not sure why a group as authoritative as USP capitalizes generic names in its press release, though.

E-mail me.

HERtalk by Inga

Greenway Medical Technologies announces a 47% increase in sales in FY08.

IntelliDOT completes implementation of its wireless handheld BPOC products at Providence Healthcare Network (TX), integrating with Epic for the first time.

Samuel H. Adams is announced as new senior VP of sales for North America for Picis. Company co-founder Liz Popovich is now executive VP for international operations. Adams was president and CEO of St. Croix Systems and has had multiple roles at Lawson Software. Of course, I am curious about the beer and patriot connection. I wonder how many times a day Sam gets asked about that?

New to Inga Radio: Duffy (Welsh singer-songwriter, sort of Dusty Springfield-ish) and Sam Bush (bluegrass).

Nueterra Healthcare (KS) selects McKesson’s Paragon HIS and Horizon PACS systems for three new community hospitals.

More psychiatric hospital problems. After two Tampa General Hospital patients killed themselves, federal investigators find at least five patients sleeping in a psych unit hallway. The hospital isn’t talking, but a lawyer for the dead patients points to understaffing as a key problem.

Alabama state employees who don’t take care of their obesity or other health issues risk paying a $25 a month charge for health insurance.

The Washington Post has a piece on a growing trend for physicians to re-invent their practices to improve patient care. The article focuses on a couple of “micro-practices” that have used technology to improve wait times and patient care.

NextGen parent Quality Systems (QSI) announces that all three major proxy voting advisory services recommend that shareholders vote for all the QSI board nominees, saying that company performance suggests that change is unwarranted.

Streamline Health Solutions announces its Q2 numbers: revenue rose 51% and net losses fell from $1.1 million ($0.12/share) to $0.4 million ($0.05/share).

A former UW computer science professor is quoted as saying, “Epic Systems hires more people every month than all the biotech companies in Wisconsin combined." UW-Madison is trying to recruit more computer science grads to meet the area’s current and future needs.

USC Care Medical Group licenses several Lawson software packages. Here is an observation about the odd nature of press releases: Lawson just made this announcement though the deal was signed in May. Guess the PR department needed some good stuff to mention.

E-mail Inga.

Monday Morning Update 8/25/08

From Adam: "Re: Emageon. Not a rumor per se, but Emageon skipped the Q2 earnings press release and conference call. That usually means something is up. However, they also issued some scary language about the proxy fight and suitor search impacting sales. My question: deal or no deal?" I’ll defer to experts like Sonomaca (or any reader with info).

From Kaimuki: "Re: Revolution Health. On the blocks." Another potential dot-bomb 2.0 casualty, although this one has Steve Case’s AOL money and unfocused ambition behind it. He dumped AOL on Time Warner as they needlessly panicked over kids with web sites, so maybe he’ll unload this dog, too (actually the online part is OK, it’s the remainder that isn’t working). It might have been successful if he hadn’t been blathering on about resorts and all kinds of unrelated stuff, although outsiders trying to mount a healthcare revolution (no pun intended) usually fall on their faces in a pool of melted arrogance. Hopefully someone with knowledge and patience will buy the relevant parts and do something useful with them, although it’s the same old business model of running ads.

From byter: "Re: confirming Dairyland gobbling APS of Waco." Link. The deal was done August 1, the web page says.

From Roger Lapin: "Re: EMRs. What do you feel are the biggest hurdles in implementation and training for new systems in facilities today?" I’m mostly a hospital systems guy, so there I’d say lack of customer resource allocation, inadequate change management capabilities, product-user disconnect, and lack of resources to free users up to be trained effectively. Feel free to chime in.

From Dinah Shore: "Re: Cisco. They seem to be a big fan of PHRs, but I’m not sure I buy it. It almost sounds like they’re trying to justify the money spent. I have my health record on a memory stick … wow, I feel better already!" I would bet that the pilot group was voluntary, meaning self-selectors probably more acutely interested in managing their health. Unless the comparison was made individually to the pilot group pre- and post-project expenses, I would say the claimed ROI is irrelevant since the self-selectors probably already had lower average expenses. I’d need to see the data.

From byter: "Re: Sisters of Mercy Health System, St. Louis. They are requiring vendors to register at vendormate.com and pay an annual fee to do business with them." I hadn’t heard of Vendormate, which offers vendor credentialing and compliance solutions. It’s an ingenious business model run by mostly Georgia boys. Worth a look. 

From Soarian Cynic: "Re: Soarian. Our hospital contracted six years ago for Soarian financials. We are a large, metropolitan teaching hospital. We were recently told by our Siemens reps that the Soarian Financials will not be ready for hospitals like ours for another two years at least. They want us to sign up for five more years of Invision, just in case Soarian takes that long. No apologies, no regrets, no embarrassment. The reps did indicate that Siemens would still make money off us, Soarian or not. I’ve had this conversation with Siemens three times in the last five years. Every two years, Soarian is promised another two years out. So much for German engineering!"

Thanks to Ed Marx, CIO at Texas Health Resources, who gave HIStalk a mention in his blog as something he reads. I checked my e-mail archive and we’ve swapped notes going back to at least mid-2005. I’m always interested in increasing the number of CIO readers, so maybe Ed’s mention will bring them in (and I’m to other suggestions on how to do that).

The chairman and a third of the board members of University of Maryland Medical System resign as the organization struggles with governance between the medical school and the health system. This article says issues include doctor dissatisfaction with bottom-line emphasis and the governor’s appointing of board members without its input. It’s an interesting point: hospitals are one of few non-profits that operate under the business model, where they don’t pay taxes but have huge business-related income. Nearly all other non-profits are charities relying on outside support. When you think about a non-profit being a $2 billion dollar a year business like UMMS, that’s kind of weird, especially when hospitals that size sometimes pay CEOs $1 million or more a year in salary (according to tax records, the CIO job there pays $400K and UMMS, in fact, paid its CEO $2.6 million in the last tax year and some of the VPs are pulling down nearly a million). But, it supports building fancy buildings better than ringing a bell at Christmas.

Looks like the Allscripts-Misys flirtation is close to being consummated.

Jobs: Clinical Systems Analyst (IN), Director of Business Development (MA), PeopleSoft Technical and Security Admin (MA).

The federal appeals court may overturn state rulings in three New England states that allowed drug companies to continue to mine prescription records for marketing purposes (think IMS, Verispan, and McKesson). Interesting point: AMA makes tons of money from licensing its databases, which are used to match prescription data to individual doctors. In other words, profiting by selling the data of its members (we can identify with that in our industry, right?)

ED systems vendor Forerun gets $1.35 million in venture capital. The company was a BIDMC spinoff, I believe, using their homegrown ED Dashboard that was then commercialized.

Sign up to your right for HIStalk updates or the Brev+IT newsletter.

A New England technology journal profiles Premise Corp.

I didn’t scour the 2008 Inc 5000 list carefully, but I know Vitalize Consulting Solutions (353% growth) is on it. So is Hayes Management Consulting (79% growth). Congratulations. I like to think their sponsoring of HIStalk helped a little, but that’s just me.

At least two more incidents (from Google’s cache) of mobs charging hospitals in India. This time it was after patients died after being refused treatment, but usually it’s over claims of malpractice.

Medicare made its medical equipment fraud rate look good by instructing auditors to skip steps that could have detected it, such as matching invoices to doctors’ orders. In one example, a patient who had received one of those fun electric scooters hawked on TV to Medicare recipients said he hadn’t asked for it and wasn’t using it and the doctor listed as the prescriber didn’t know anything about it. Oddly enough, the patient’s wife got a scooter of her own, also unrequested. Rep. Pete Stark said, "This agency is incompetent."

I really dislike unions, so this struck me as typical. A UK hospital installs self-serve kiosks to speed up patient admissions. The union whines: "Unison will be looking at the trial very carefully to fully assess whether it is of real benefit to the patient experience or whether it is just cost-cutting. In today’s computer driven world, do we truly need a further erosion of the ‘personal touch’ that is so essential to the delivery of a positive health care experience?" I don’t know how much personal touch patients get from union members in the UK, but unionized hospitals I’ve been in have had openly defiant employees, bad housekeeping, and constant clashes with management trying to keep employee paychecks coming by making improvements.

Cedars-Sinai wants sidekick-turned-deadbeat Ed McMahon to prove his lawsuit allegations. He’s claiming he’s out of work because of an undiagnosed broken neck. Here’s hoping I’m not still trying to bag a bloopers show or walk-in bathtub commercial gig at 85.

E-mail me.

News 8/22/08

From Lloyd Bridges: "Re: ADT + EMR go-live. This is becoming far more standard as sites being converted are increasingly complex. OHSU replaced A2K and LCR big bang (all rev apps and majority of clinicals) with Epic. CPOE 6 weeks later. Slower implementations tend to get pushed by ever increasing  optimization cycles."

From Caroline Mulford: "Re: Dairyland. Rumor has it Dairyland is or has purchased APS out of Waco, TX?" I saw no announcements and nothing on Dairyland’s site, but APS’s is down.

From Otis Day: "Re: Siemens layoffs. I was speaking to Soarian Clinicals. However, I am hands-on familiar with both Financials and Clinicals. I happen to be quite close to someone who works in a multi-hospital site and they have had successful implementations (not to be confused with installation). This site also delayed implementation of some software deliveries, but not due to software availability. Mr. Judd doesn’t mention why Medicorp delayed their go-live. I do agree that Siemens is looking to improve short-term and milk INVISION. And why should Siemens care, or the customer, for that matter? If the customer is happy (and paying their invoices), where’s the problem? Does Mr. Judd suggest this is a negative situation?"

Listening: new Alice Cooper, still doing the mascara-and-codpiece shtick at 60. If you liked it then, you’ll like it now.

Microsoft pays Jerry Seinfeld $10 million to try to stop the bleeding, with Chris Rock and Will Farrell being considered to help him out. What a joke (and I’m not talking about Jerry’s material). Vista’s not selling, you can get most of Office 2007 for $99 with a "wink wink, I’m a student" discount, and the hottest Microsoft offering is an XP downgrade from Vista. Maybe Jerry will have some boffo lines about Amalga.

National Review, which I read on occasion, is sticking to the "healthcare can be saved with competition" mantra. "According to HHS Secretary Michael Leavitt, Medicare rents an oxygen concentrator at the price quoted above [$7,000 over three years] — with Medicare patients shelling out a 20-percent co-payment for the rental ($1,418) — that it could buy outright for only $600. When Medicare was set to implement a competitive bidding program for DME last month, Congress killed it."

CoxHealth (MO) mentions its homegrown bed board system as part of its Innovator Award. Looks pretty cool. Bruce Robison is the CIO there.

At least one doc is unhappy that Nuance has blocked the use of Dragon Naturally Speaking with EMRs in Version 10. "We found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical." In other words, you have to buy the much more expensive Medical version for reasons that are financial rather than technical. 

Open source vendors Pentaho (business intelligence) and Open Medical Record System (EMR) will work together and integrate their products.

Xoova, a physician research site for consumers and poster child for those convinced that all it takes to change healthcare is a web site and a Foosball table, is apparently defunct. All that’s left is a blog whose last entry was in February, full of braggadocio and hipness right as the slow augering in was underway despite rosy press releases that mostly bragged on site hits. The company sniffed that it was "much more of a Health 2.0 site" than its competitors (which are still around, 1.0 apparently being more profitable). I can’t decide which is lamer, their name or the story behind it: "XO = hugs and kisses. OO = ‘you,’ as in, ‘this site is for you, you people out there seeking medical care and you doctors out there who wish to share your philosophy of care.’ Ova is both a Latin word for egg and a medical term for what happens to be the largest cell in the human body. And Va? Va means ‘go.’" If all that isn’t dot-bomb enough for you, they were even bragging on their Herman Miller chairs, the shark tank, and their proximity (in no way except physical) to Google. Most of these hip new companies are looking for buyers, not paying customers. In this economy, they’re likely to be riding those Herman Millers right into the toilet.

USA Today publishes hospital death rates online for MI, CHF, and pneumonia.

Your federal tax dollars at work: $300,000 for a Wisconsin pre-RHIO of some kind.

A reader pointed me to the court filing in which Epic apparently prevailed over patent leeches Acacia Research. My take: vendors, get yourselves a good lawyer and they will turn tail and run since there are plenty of other marks to shake down (like Siemens and GE) who will just pay up and write it off as a cost of doing business. The last thing Acacia wants to do is either have their patent (and gravy train) threatened. I hope Epic tore them a new one.

Intel is offering $100,000 for the best technology solution in global healthcare. Craig Barrett’s example: a PhD who created a cheap digital whiteboard from a Nintendo Wiimote (free download). You have until September 30 to register and January 31 to get your submission in. Pretty darned cool. "Barrett compared the world’ healthcare system to an ancient mainframe. ‘The hospital is the mainframe,’ he said. ‘If you get sick, you go to the hospital. What we need to do is bring the PC to the healthcare system.’"

Speaking of Craig Barrett, he rips the government on failing to encourage innovation and quality education (roger that) and also demos an unnamed PHR at the Intel Developers’ Forum.

Great news: 86% of people remember ads stuck on hospital walls or on wall-mounted monitors. That’s probably at least double the percentage that remember what doctors tell them.

GE Healthcare gets another FDA warning letter.

Remember this as you’re paying Oracle maintenance: Crazy Larry exercises a few options, netting him $544 million. Not to worry: at current prices, he’s still got $26 billion worth of shares.

E-mail me.

HERtalk by Inga

From dogofwar: “Re: Picis Survey. The announcement says that 87% believe a government-run EHR is the answer, but the slide shows the opposite.” Good observation. That 87% pro-government EHR number was buried in the press release and I thought it was surprising. I checked with the Picis folks and they confirmed that the write-up had an error. The text should say, “Close to 90 percent said government-run EHRs are NOT the answer, when questioned, but many expressed interest in joint funding from the private and public sectors.”

Sonitor is awarded a 2008 North American Frost & Sullivan award for Emerging Company of the Year based on its contributions to the RTLS industry and improved US market presence.

I had asked readers to comment on the impact of the ICD-10 transition and MGMA provided a response (OK, perhaps they weren’t responded to me, but the timing seems coincidental.) MGMA issues a statement that while they support the move, the proposed timeline is “not workable” due to the extensive changes required of health care facilities and insurance carriers. MGMA estimates that 95% of medical practices will have to purchase software upgrades or new software to accommodate the changes. Stay tuned.

HealthSouth is nw offering free wireless Internet access, courtesy of a new agreement with Wayport.

Good Samaritan Hospital is live on MEDSEEK’s eConnect clinical portal, enabling its 600 physicians anytime/anywhere access to disparate IS systems through one gateway.

Waukesha Memorial Hospital is installing RF monitoring systems in its pediatric and maternity wards to product infants and children from abduction (what a sad world we live in). RF Technologies is the vendor providing transmitters for patients’ wrists or ankles. The setup also includes receivers that track when a patient moves too close to a doorway, setting off an alarm and locking doors immediately.

Halifax Regional Medical Center (NC) integrates IntelliDOT BMA with their Meditech HIS. Caregivers will utilize a wireless handheld barcode point of care device.

MemorialCare Medical Centers (CA) contracts with Accenx to provide an interoperability platform for its physician outreach program.

Kryptiq (healthcare connectivity provider) acquires Secure Network Solutions (administrative workflows such as appointment reminders, waitlist management, and electronic billing statements.)

GE Healthcare recognizes six healthcare organizations for their innovative use of Centricity products.

Eclipsys announces Ali Zarzour as VP and GM of Middle East operations. He comes from Microsoft, where he served as a healthcare industry manager in the Middle East and Africa.

Five Sharp HealthCare hospitals are deploying Premier healthcare alliance’s SafetySurveillor infection control and pharmacy modules to track and prevent healthcare-associated infections and optimize antibiotic use. It sounds like cool technology that apparently 200 hospitals are using nationwide. Anyone have any comments on whether it works as advertised?

E-mail Inga.

Readers Write 8/20/08

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

Software as a Service
By John Holton, President and CEO, SCI Solutions

 

Software as a Service (SaaS) emerged with a new technology delivery (ASP) and a new business model (subscription) a little more than eight years ago. Since this time, SaaS has evolved from simple collaborative applications, such as e-mail aimed at small to medium businesses, to enterprise-wide systems (manufacturing, HR) utilized by Fortune 100 companies. A recent study by Goldman Sachs of more than 100 of large enterprises (including a number of prominent health systems) indicates that 55% of these companies currently utilize SaaS services for some of their IT needs.

One statistic highlights how far along the adoption curve SaaS has traveled: 10% of the companies currently have more than 25% of their applications being delivered via the SaaS model. A Saugatuck Technology survey reported that by 2012, "at least 40% of the mid to large companies will seriously evaluate SaaS-based ‘core’ financial systems of record.” In other words, they will rely on SaaS vendors for one of their most important IT applications.

Another area receiving increased attention is SaaS-supplied core IT infrastructure applications for a variety of system management services for desktop computers, servers, and mobile devices. SaaS is quickly moving from the confines of small business to being purveyors of mission-critical services to the enterprise.

Initially, large enterprises employing SaaS solutions were concerned with service levels, such as up-time reliability and software response time. Today, those concerns have been assuaged, with the SaaS vendors now focusing on interoperability with legacy on-premise software and compliance with the strict identity and access management requirements of large corporations (e.g. HIPAA). Enterprises moving forward with SaaS applications have benefited in a number of ways.

First, since SaaS vendors take responsibility for all aspects of software delivery, many IT departments have leveraged their internal resources by assigning increasingly more projects to SaaS vendors.

Second, because the SaaS vendors know their software intimately, installation and training is much faster with fewer problems than on-premise applications. Upgrades and services packs are installed almost immediately after general availability without being reliant on customer IT resources.

Third, since the business model is subscription-based without large upfront fees, capital can be utilized for other projects. The SaaS return on investment is almost immediate after go-live since the client receives benefits but has little capital invested.

Large corporations have had to adapt to SaaS realities that are different from their traditional on-premise experience. These adaptations include (a) limited control over the delivery of mission-critical applications; (b) less customization of software than they have had in the past;  (c) more vendor due diligence required before selection to insure compliance.

To continue their success, SaaS vendors will have to address enterprise expectations of customization, integration, and workflow. In addition to these challenges, unseating legacy vendor “stickiness” may prove difficult.

To date, successful SaaS companies began with the SaaS model and have not evolved from the traditional on-premise model. Traditional on-premise vendors have had difficulty with the SaaS model and its emphasis on rapid sales, installation, and training and software enhancement.

Saugatuck Technology predicts that by 2012, 50% of the SaaS companies will be pure plays and 50% will be today’s major players who started with traditional on-premise models (Microsoft, Oracle, SAP) that have re-positioned their businesses. This means major on-premise vendors will buy their way into the SaaS world. Expect significant consolidation within the current SaaS vendor community over the next several years.

Eight years after in inception, SaaS is a major component of successful IT management and a significant part of an enterprise’s cloud computing strategy (IT utilizing the Internet).

Siemens Layoffs
By Clinton Judd

Otis Day is wrong. The Soarian development layoffs are not because Soarian Financials is ready and stable. The truth is that Siemens is having trouble converting even single-hospital INVISION sites to Soarian, let alone multi-hospital or academic sites.

For example, Medicorp Health System has pushed their go-live back for at least the second time, for a total 11-month delay. The implementation will be about 27 months long if they hit their new go-live date.

My opinion, and this last comment is just an opinion, is that Siemens is looking to improve short-term results and continue to milk the INVISION product line, even if it means that Soarian development and adoption will slow. I don’t think Siemens really cares whether the sites use INVISION or Soarian — they basically get paid the same regardless (except for the one-time implementation and conversion fees).  If I were a Soarian customer, I’d be concerned.

The Problem with Meetings
By Richard Hell

Here is my thunk-the-head insight from attending hundreds of meetings.

The problem with meetings starts with the invitation list. You and everybody else looks to see who else will be there and how they rank among their fellow attendees. One of two strategies is chosen: either dominate the meeting because you’re the big dog or use the opportunity to impress everyone with the details they missed or the insight that only you could bring to the table. You were invited, so show you earned your chair. 

The only value managers can add is to question those who know their stuff, often without zero preparation. The engine that powers overheated gum-flapping is vast experience and intuition, not quiet diligence. It’s mental combat and it’s personal.

First meeting: horror of horrors, you’re not as uniquely brilliant as you thought. All the good ideas and smart conclusions have been taken by the other attendees. How dare they steal your brilliance? Now you have to challenge their thoughts as the quiet sage who has seen and done it all, or maybe make up a quick new tack right on the spot. Either way, you have to elbow into that limelight and show you deserve to be there. That means shooting down their ideas and furthering your own, all while self-importantly working the BlackBerry instead of paying attention to anyone else talking.

The big loser is the convener of the meeting. Instead of just validating the work already done, now there’s a rat’s nest of new concerns, options, and points of view. Everybody is engaged and empowered, although nobody wants to do any real work. Just looking smart in meetings is good enough. Losers do legwork.

So, the problem with meetings is meetings and the egos of those attending them. By definition, meetings ensure that broad viewpoints are represented. They also ensure that nobody gets anything done except ongoing posturing at the inevitable follow-up meetings. For managers who always pace the sidelines instead of influencing the game on the field, the conference room is its own battlefield.

News 8/20/08

From Radio Button: "Re: Betsy Hersher. Any word on her?" Last I read, she was going into CIO coaching, but she didn’t really say whether she would continue recruiting. She has six current searches on her site.

From Sharetheknowledge: "Re: AAN study. Does anyone know how much the RWJF gave to the American Academy of Nursing for their ‘Technology Drilldown Study?’ It annoys me when someone gets a grant for knowledge exploration and then doesn’t share findings with the industry. The AAN supposedly analyzed hundreds of clinical workflows and explored the technology implications. Why not share with hospitals and not just their members? If the reply is, ‘You have to go through the process yourself,’ I disagree. Can you imagine if everyone posting to HIStalk just said, ‘I just finished endeavor XYZ, but can’t share any lessons learned because your hospital is different, so it wouldn’t apply to you?’"

From Otis Day: "Re: Siemens layoffs. Yes, Soarian WAS singled out. Lost (as I have heard): 150 Soarian programmers in Bangalore. Also, consider this: when Siemens took over SMS, there was a huge push to get Soarian (formerly known internally as TNT) to be a viable, installable (not just marketable) product – so Siemens threw a bunch a people at it to get the base system working. Its stability has greatly improved in the last year. Therefore, why keep the overhead? Just a thought." The surge worked! Interesting thought. Unless they’re selling enough of it to need enhancements, I suppose it’s tempting to cut back (nice reward for getting the job done). TNT? Too easy.

From Melvin Cooley: "Re: Siemens layoffs. Revenue per employee is too low. More people will leave. All employees age 60+ with 15+ years of service have been offered early retirement. That’s another 100 people. Stopping offshore development in India is another 200." Unconfirmed so far.

From The PACS Designer: "Re: virtualization and PACS. TPD has read Doctor Dalai’s latest post on virtualization and thought it would be good reading for HIStalkers since the VEE (a TPD acronym) is gaining momentum in our move to a more digital world through the proliferation of PACS and other digital systems around the world. In case you didn’t know, TPD’s VEE stands for Virtual Electronic Enterprise!" Link.

New poll to your right, this time about to the Brev+IT e-mail newsletter. It’s a conundrum: it takes a fair amount of time that I don’t always have, but Inga likes it. I’m happy that so many copies go out and that it’s sponsored, but the spam filters are a challenge. Worth doing or not?

Speaking of Brev+IT, here‘s the latest edition. I’ve evolved into this format: a smart-alecky headline, straightforward facts, a short opinion, then some "musings" that are really whatever I’m thinking about the story (it covers the top three stories each week). This week’s headlines: German Re-Engineering: Siemens Corporate Layoffs Whack Hundreds in PA; MyWay or the Highway? iMedica Gives Misys the Answer: B; and Perot Makes Giant Acquisition Sucking Sound. I had one a few weeks back pertaining to that mythical contestant quote from The Newlywed Game featured in Confessions of a Dangerous Mind that I toiled a long time to work out, but I’m not sure anyone got it.

Anesthesia systems vendor DocuSys closes on its acquisition of Prompte, which sells presurgical care management systems. I would have included a link to Prompte, but its page is already forwarded over to that of its new owner.

SIS launches a customer portal that includes a knowledge base, support ticketing, education, and discussion.

Listening: Sam Phillips, the uniquely voiced and moody female singer-songwriter who did most of the excellent music from the Gilmore Girls.

Wednesday is Readers Write day here at HIStalk, at least if said readers do, indeed, write. Bang out 500 words about something industry-related that’s interesting or funny and send it my way.

Vendors beware: Acacia Research, which buys or files broad and likely unenforceable patents and uses them to shake down technology companies into paying licensing fees instead of the cost of a lawsuit defense, plans to expand in healthcare. Several vendors already pay them to go away, with only Epic standing up for themselves (I haven’t heard how that turned out). The company, which has raked in $150 million so far in its lifetime, has five new medical ones coming: progressive image downloading in PACS; automatic paging of abnormal lab results; medical image stabilization; heated surgical instrument blades; and surgical catheters. Siemens is already paying tribute for the PACS patent.

A Nigerian teaching hospital is the first there to start a department of medical informatics.

HP software will analyze code and represent it graphically to find inefficiency and spaghetti coding. An interesting comment from California’s controller, who talked the governor out of temporary programmer pay cuts for fear of losing the few COBOL programmers available to maintain the state’s payroll system: “It’s not that you couldn’t find people smart enough to do it. You can’t find people who would want to.”

BearingPoint, the folks that brought you the Bay Pines CoreFLS debacle that cost a few hundred million dollars and couldn’t even pass the VA’s beta testing, spent $500K in Q2 federal lobbying, some of it with the VA. Several politicians wanted them banned permanently from government work back then, but that apparently didn’t happen, probably because banning consultants with mega-failure government projects wouldn’t leave many and there’s always the risk that the consultants would expose bureaucrats as the problem.

UMDNJ is still laying off.

Another security camera-taped patient death occurs in a mental hospital while staff pay no attention. Nurses at a North Carolina mental hospital left a man sitting in a day room chair without food or assistance while nearby staff watched TV all night, played cards, and talked on their cell phones. As in the case of Kings County Hospital Center (NY), falsification of the patient’s record is suspected.

Premier offers data breach insurance.

Annals of Internal Medicine hates medical nomograms, instead recommending software development.

An iPod-sized device called the Zuri sends medication reminders to patients and reports compliance back to their doctor.

It’s not just a California thing: the Des Moines paper uses unemployment claims to create a fairly long list of Iowans who have been fired for privacy breaches and accompanies it with a good article. In one strange case, a woman operated on for heavy menstrual flow found her full name and medical problem in an article in the local paper, which she claims was planted there by a surgical training company and its PR flack.

A big real estate developer, an Indian hospital, and Johns Hopkins are building a "health city" in India. It’s interesting that, as bad as US healthcare is claimed to be, everybody seems to want to train doctors the way we do. Maybe that means doctors aren’t the problem here.

E-mail me.

HERtalk by Inga

The top concern for hospitals over the next 12 months is physician and nurse recruiting, according to a Picis-conducted poll of 300+ physicians, nurses, and hospital administrators. EHR rollouts is the next biggest issue. Eighty-seven percent believe that government-run EHRs would advance EHR adoption.

Question: How will the transition to ICD-10 diagnosis and procedure codes (deadline October 1, 2011) impact HIT vendors and the provider systems? The easy answer is that it will cost everyone some money, but I wonder if some vendors will be unable to accommodate the change? Will any vendors look at the mandate as an opportunity to sunset legacy products? How much training will staff need to learn the new system?

An Investor’s Business Daily profile on NextGen and new parent company CEO Steven Plochocki suggests the possibility of proxy fight with a "dissident board member" who claims the board chair has too much control. Plochocki mentions he has historically worked with small- to mid-market companies and taken them through growth and consolidation, suggesting that NextGen will expand offerings and consider fill-in acquisitions. The company reported great numbers on August 7.

Valley Baptist Health System (TX) contracts (warning: PDF) with The Breakaway Group to provide implementation services for four simultaneous HIT initiatives. Valley Baptist is in the process of adopting GE Centricity Enterprise EHR, Streamline Health document imaging and workflow software, Picis perioperative system, and ImageCast RIS.

UPMC appoints GE alum Katie Taylor as VP for business development in the International and Commercial Services Division. Taylor will lead efforts to market UPMC’s IT products and services internationally and expand its cancer centers. She served in various management roles in her 20 years with GE and is fluent in four languages (which impresses me).

Blogger and author Maggie Mahar writes a thought-provoking and probably controversial post asking "Should More Hospital CEOs Be Physicians?" She has plenty of criticism for non-physician CEOs who have engaged in fraud for personal gain. While she does not think CEOs must be physicians (or nurses), she does promote special health care executive licensure and believes all CEOs should be required to work closely with a panel of the hospital’s physicians. Of course, if the primary concern is reducing fraud, I don’t see how holding a special license or medical degree can be the answer. MBAs aren’t the only greedy people in this world.

The 45 providers at Presbyterian Anesthesia Associates (NC) are now live with athenahealth’s PM/billing platform.

Yesterday I hung out with a relative having outpatient surgery and did a little technology spying. Actually, it was more along the lines of observing the lack of technology. Though the facility (which is affiliated with one of the country’s largest chains) required online pre-registration, everything related to the nurse documentation involved lots of paper. Apparently all the history (which in this case included previous surgeries) was nicely compiled into a single paper chart. The nurse made manual notes directly on the paper records to update medications, weight, etc. I suppose I shouldn’t have been surprised by the lack of automation; however, I admit had higher expectations for this for-profit (and profitable) outfit.

Managed IT service provider Prematics names David H. Kates VP of product management. Kates has worked in health care technology over 20 years, most recently as COO of Hx Technologies. He also spent some time with WebMD, Sage, and Cerner.

Cleveland Clinic’s Sydell and Arnold Miller Family Pavilion and Glickman Tower will open next month and, by all accounts, it looks pretty slick. The buildings add 1.3 million square feet to the main campus, cost about $634 million to construct, and include a rooftop plaza, several retail stores, food options, more than 1,000 works of art, and a tree-lined boulevard with six reflecting pools. And the views aren’t bad, either.

Noteworthy Medical Systems announced earlier this month that it had closed on its MARS Medical System acquisition. Today’s news is Noteworthy’s acquisition of ChartConnect, a provider of web-based software for connecting healthcare communities.

Sunquest hires David M. Post as VP of strategic programs. He’s spent time at Cigna, Kintana Software, Accenture, and Keane.

E-mail Inga.

Monday Morning Update 8/18/08

From topexecit: “Re: HealthPort. HealthPort has acquired ChartOne (its biggest competitor) for an undisclosed amount of cash.” I saw no news, but I ran across this financing teaser that’s way over my head, but seems to say that EMR vendor HealthPort had financial backing of up to $150 million to acquire ChartOne, which does HIM technology stuff like release of information and workflow.

From MSCFan: “Re: ClearHealth. The application’s look and feel and terminology is a clear carbon copy of Medsphere’s Clinical Information System (CIS). The purpose of releasing Medsphere CIS under Affero General Public License (AGPL) was to generate an open source ecosystem and for the community to have the freedom to enhance and expand the functionality.  However, the terms of the public license should be honored.” I’m not much of an expert in those areas, so I’ll leave the analysis to those who are.

From Otis Day: “Re: Siemens layoffs. I heard those laid off got two weeks’ pay for every year worked, up to 26 weeks. Although Soarian got hit heavy, other foundation departments lost people as well.” Otis, my man! That’s a fairly generous severance. The layoffs, even though they represent nearly 10% of the Malvern headcount, aren’t surprising. What would be interesting is whether Soarian was singled out, which might signal Germany’s loss of patience with the project. It’s gone on forever, it seems, and while people who know say it’s impressive, I don’t hear of much adoption. Both Siemens and GE claimed to be writing state-of-the-art systems, but their lackluster results won’t encourage others to try.

From Marketing Girl: “Re: scoring press releases and bad writing in general. Here are a few sites that I like: www.pressreleasegrader.com.  I put in this PR and it was given a 21 / 100 (wow, is that low!) www.fightthebull.com – this is a hilarious site created by Deloitte consultants who decided to fight back against gobbledygook consulting speak (also known as $5 words). I got both these suggestions from a few Pragmatic Marketing courses – which are highly recommended for folks in B2B technology marketing. (thanks to my unnamed company for sending me).” I’ve used Bullfighter here to critique press releases, so that one’s fun. I’ll have to try the grader. I put a Pragmatic Marketing book in my Amazon cart, but wasted too much time at work trying to find something else to get me over the $25 free shipping hurdle, but I’ll be back.

From Murse: “Re: CHW. The Sacramento region of CHW (five hospitals) is scheduled to go live with Cerner and MS4 on the very same day, December 2nd. They have pushed back their CPOE for 1-2 years and will have clerk and nurse order entry. Curious, does anyone think its a good idea to go live with ADT and your hospital EMR on the same day?”

From Mr. Boogie: “Re: hackers hit Wuesthoff Health System.” Link. Hackers got into the Florida hospital’s pre-registration web page and grabbed information on 500 patients. The widely used Google Analytics web visitor tracking is suspected as the back door, which seems unlikely to me.

Speaking of hackers, I’ve finally rid my PC of nasty trojan that takes over your wireless router and starts sending information off to some hacker-friendly country (the clue: I entered CNN.com in the browser and up came my router login). It came from a web page, apparently. My advice, from experience, is to use the free Spybot: Search and Destroy malware detector and the also-free Online Armor personal firewall (the WinXP one is crap). I was running good antivirus (BitDefender) but it doesn’t find this one and neither does AVG. It’s surprising since I installed Online Armor how many times it has kept me from hitting an infected web page that came up as a Google link. Run Spybot right now and I bet you find some nasty stuff.

Housekeeping: sign up to your right for HIStalk e-mail update and the Brev+IT weekly newsletter. Use the ugly Rumor Report box I amateurishly drew if you want to send me secure information, including attachments. Send telepathic air-kisses to HIStalk Queen Inga for being entertaining and keeping me sane. She’s got 126 LinkedIn connections and yearns for more if you’re so inclined. We’re both just blown away, of course, that Dann’s HIStalk Fan Club there has 216 members, each of them outstanding in their own way (I heard that line again in an Animal House 30-year anniversary special the other night, so I vowed to use it at first opportunity, along with "Otis, my man!") The picture is unrelated to HIT, but it gives you a visual break and we don’t ALWAYS have to talk about work, do we?

Jobs: McKesson Software Instructor, Clinical Systems Analyst, Director of Business Development, EMR Software Staff Development. Here’s a recruiter’s quote: “We decided to post on HealthcareITJobs.com because of the very targeted audience. It’s such a delight to receive qualified applications from a job posting for a change! And Gwen does such a nice job providing personalized service." Sign up for job blasts here.

Former Sonitor sales VP Don Zeppenfeld joins ED software vendor LOGICARE in the same role. It’s pretty cool that the company uses employee photos on the web site instead of the usual snooze-inducing stock photos.

Alok Gupta, former Siemens VP of computer-aided diagnosis and knowledge solutions, joins CareFirst BCBS as VP/CIO.

Listening: The Duke Spirit, London-based and female-led big 60s kind of sound, kind of like Nico or Grace Slick. 

Here’s another regrettable press release a reader found. Unibased Systems Architecture finds it nationally newsworthy (warning: PDF) that its campus was to go smoke-free by the end of 2007. The company background section was one line longer than the “news.” I’ll alert the media … oh, wait, they already did that. Companies must put the PR people on quota to crank out press releases, even when nothing’s happening.

University Hospitals (OH) names Mary Alice Annecharico SVP/CIO. She’s a nurse and former CIO of Penn’s medical school and replaces Ed Marx, who left for Texas Health Resources nearly a year ago. University is spending $90 million on Soarian Eclipsys (my mistake – Soarian is revenue cycle only at UH).

This may be a sign that it’s a tough market: even stalwart Meditech is turning in lackluster numbers due to small revenue growth and higher expenses, with a 30% drop in net income for Q2 compared to last year. Product revenue was down, too. Patient Care Technologies hasn’t done all that well since the company was acquired by Meditech last year either, with net income down 19.5%.

Odd hospital lawsuit: a terminated employee at Somerset Hospital (PA) says a sexually harassing male manager sent female employees genital-shaped pastries. I have about 500 fun riffs on that, but I’ll leave you to your own devices.

Of the 100 highest paid state employees in New York, 88 work at SUNY, most of them physicians who work at the system’s hospitals. A surgeon was paid $1.2 million.

Wanted: Chief Athenista. athenahealth co-founder Todd Park announces his retirement on August 31, which follows his removal from management on January 1 of this year. He’s got 900,000 shares (around $30 million worth) and seems intent on getting rid of them on his way out the door.

Perot Systems, faced with slowing healthcare revenue growth, says it will make an acquisition. Any guesses who?

Biomedical informatics ProSanos, located in the not-exactly-Silicon-Valley Harrisburg, PA, releases (with drug company GlaxoSmithKline) SAEfetyWorks, pharmacovigilance software that analyzes EHR and claims data to look for correlations between drugs, conditions, cohorts, and effects. Jonathan Morris, the company’s chairman, president, and CEO, came from SAIC and Oceania.

E-mail me.

CIO Unplugged – 8/15/08

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

CIO reDefined: Chief Intake Officer
By Ed Marx

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker “CIO” itself is not limited to “Chief Information Officer.” No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post continues a series on how the “CIO 2.0” will push the boundaries of conventional thinking surrounding the role. We continue with the “Chief Intake Officer.”

Regarding my training schedule, many have asked, “How do you keep from going crazy while biking and running for endless hours?”

Sound boring? Leading up to the Ironman race, I biked indoors every weekday for hours at a time. Often that was followed by a long run on the treadmill with a cool down on the elliptical. As one who dislikes wasting time, I spent many of those hours reading magazines, books, and newspapers. I drank. I ate. I read. All essential intakes. This pattern did not work well in the pool…

One factor that adds complexity to the practice of medicine is the amount of new information a clinician must absorb to stay current. Studies suggest it would take a clinician an average of 351 hours of study monthly to stay abreast of the latest in medicine. That is a tall order for any profession, especially when you combine it with the age-old equation of balancing work and life.

I have not encountered any equivalent studies, but I speculate that the effort required for CIOs to remain current is equally as challenging. This post does not convey how to make the time but rather gives a feel for my personal amount of “intake.” The sources below detail the individual reoccurring resources but exclude the interactive ones (conferences, professional organizations, staff, education, etc.)

· Newspapers (online when practical)

Local paper

Local business journals

Wall Street Journal

· Magazines (online when practical)

Healthcare

Read ~5 healthcare IT magazines (Advance, etc)

Read ~1 clinical journals

Read ~3 healthcare business/leadership magazines

IT

Read 3 general IT magazines

Read 2 IT leadership magazines

Business/World

Business Week

Harvard Business Review

Time

Other/Fitness/Spiritual

Outdoors

Running/Biking

Triathlete

Miscellaneous spiritual growth

· Books

Top 10 Books for CIOs (updated annually)

Books based on our division IT book review clubs

Bible (attempted at beginning of each day)

Miscellaneous spiritual growth

· CDs

Monthly subscription for business books

Monthly mentoring series

Miscellaneous cross genre

· Blogs

HISTalk

Miscellaneous (IT, healthcare, fitness, spiritual)

· Online

Healthcare

Reference sources (Gartner, KLAS, etc)

Miscellaneous research

Professional organizations (CHIME, HIMSS, AHA)

Other

CNN addiction

General business

General fitness (nutrition, Ironman, Argentine Tango)

Sports

Social Networking

LinkedIn

Facebook

My main points:

· Drive home the vast amount of intake required for the CIO 2.0.

· Intake does not solely focus on IT and healthcare. You must see the bigger picture, beyond healthcare and IT and from a broader context.

· A key to personal health is pursuing interests and passions outside of healthcare and IT. This also aids in innovation (see “glorious mashup” post.).

· Continuously invest in yourself.

· Be a good steward of your time. (More on this in a future post.)

Too many leaders lack adequate intake. Would you go to a physician who was behind in CEU’s, the latest in technology, or research? Are you recycling old ideas or stifling your learning environment. What are the last three books you read? How much time is allotted in your schedule for professional and personal development and renewal? As with cycling, you can stop pedaling and coast based on previous intake, but eventually you will lose momentum, then balance, and then you will fall. Meanwhile, others will pass you by. So get on your leadership bike and ride!

In a subsequent CIO 2.0 post, I will discuss the art of integrating and distilling all this information for key stakeholders such as staff, clinicians, and non-IT leadership.

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

News 8/15/08

From Carmine DePasto: “Re: EMR. The picture with the Cerner rollout in Abu Dhabi looks like NextGen’s EMR. Did you have an oops?” No, that was a sinister subliminal message to buy stuff from HIStalk sponsor NextGen. That’s my story and I’m sticking to it. Actually, I snipped the picture from the article I linked to, a testament to both that site’s inaccuracy and my inattentiveness.

From Charm Leachman: “Re: struggling vendor you mentioned. I believe one of our competitors took that post, attached our name to it, and forwarded it to a hospital in an effort to win back the business that they lost.” Yessir, that’s a real scumbag competitor there. It wasn’t Charm’s company. It wasn’t even a well known company, in fact. It must be getting mighty ugly out there in the sales trenches.

From The PACS Designer: "Re: thick client vs. PDA. The Personal Digital Assistant is starting to resemble a thick client workstation. A company TPD is all too familiar with from past work relationships has ported their image viewing expertise to the PDA, specifically the iPhone, using software called Osirix. The YouTube video will give you a view of a workstation-like session." Link.

From Marketing Girl: "Re: bad press release. This was a horrible press release which shouldn’t have seen the light of day. I’m holding out hope that maybe, just maybe, the writer is brilliantly trying to use this press release to feed the search engine spiders. Press releases are a great (free) way to use oft-searched content to increase your site’s search engine ranking. I say this as I note the liberal use of competitor names, healthcare trends, and general hooey. This site http://linuxmednews.com/ already has a link to this PR, proving someone actually read it. But, as I still can’t find their website in the first two pages of Google using their own keywords (to see for yourself, go to IE and View/Source), I assume the spiders are still hungry. Or at least they aren’t feasting on this press release." I’m thinking about grading press releases. Someone should call out the duds.

From augurPharmacist: "Re: barcoding. Actually, as much as I agree wholeheartedly with Mort R. Pescle regarding intra-pharmacy bar code validation steps, it is not accurate to write ‘No technology can detect having the wrong dose drawn up of the right drug.’ In fact, chromatography, spectroscopy, and other technologies CAN be used to confirm the concentrations of particular drug solutes in solution. Take a look at what Valimed provides to the market, for instance. Remember also that the determination of concentrations of drugs is solution is very familiar in the hospital environment in another area, the clinical lab. Pharmacy could be doing many more solution concentration assays in our hospital pharmacies to provide QA for IV products, especially for IVs that are made in batches." I found Valimed and it was interesting, although not too practical if you have to pull a sample from every bag to check it. Maybe IV bag manufacturers should provide a standard "read port" that the assay machines could read from without needing a sample. While they’re at it, it would be nice to provide a penetrated port indicator since I bet many incidents either involve no drug added at all or the same drug added twice.

From Johnny Journalist: "Re: Siemens layoffs. The company won’t divulge specifics, but it sounds like a bloodbath." Think Virginia Hospital Center is happy about that news since they just announced a $14 million Soarian purchase? I hope they locked in resources. The Siemens spokesperson never bothered to reply to my inquiry, so if you were affected or have details, let me know so I’ll have at least one viewpoint to present. I did find a tiny mention in local paper – 350 Malvern heads rolled as part of the overall 16,000 company jobs the company eliminated, so that’s close to what the rumor reporters told me (not including the offshore resources). Too bad employees had to suffer for all those bribes the company admitted its execs were slipping under the table worldwide.

From King Buzzo: "Re: MD to CIO. CHOP just promoted Bryan Wolf, MD, PhD, to SVP/ CIO from pathologist-in-chief. Has this been successful in other healthcare organizations?" Physicians, yes (Halamka and Nigrin come to mind from a short list) but I wouldn’t expect pathologists, who in my experience rarely have the skills or patience for the glad-handing and tolerance of the glacial progress that’s involved. Lab people are, of all healthcare professions, the most collectively comfortable with technology, but CIO isn’t a technology job. In fact, if you love technology and care deeply for patients, it will probably drive you nuts to see how hard it is to make serious improvements through technology with all the politics that are put in the way. Wide-eyed newbs with big ideas usually end up in a fetal position or consulting.

Listening: The Melvins, anti-establishment but massively influential proto-grunge. And HIStalk radio, of course.

Inga noticed that HIStalk just had its 1.5 millionth visitor. It doesn’t seem very long ago that we hit the magic million mark.

MedAssets reports Q2 numbers: revenue up 42%, EPS -$0.03 vs. -$0.21, both affected by its Accuro acquisition.

Michael Malone, former president and COO of RemedyMD, is named CEO of real estate search vendor PropertyMaps.

The St. Louis paper says healthcare IT jobs are hot, at least if you don’t work for one of the many vendors that are eliminating them (from the survey to your right, 1/3 of HIStalk readers work for a company that’s laid people off in the last two months.)

New text ad to your right, which will be of interest if you’re involved with outpatient rehab in any capacity (except as a patient, anyway).

TV business reporter Alexis Glick does some fawning over Jonathan Bush. I don’t watch much TV, but I caught Morning Joe the other day while getting my oil changed and not only liked it, found co-host Mika Brzezinski sassy and cute, which is pretty shocking if you remember her dad Zbigniew from the Carter years. I also have no interest in the Olympics (synchronized diving is sport??) , although in celebrating human accomplishment and worldwide good will, I carefully watched the women’s beach volleyball matches last night (and made jockular comments to Mrs. HIStalk so my interest wouldn’t seem prurient).

Someone tells me that Misys isn’t supposed to sell any MyWay deals until their spat with its own iMedica is involved, so that had to make a tough sales job even less fun.

No snide comments: patients in England are being dumped by dentists. Privatization is the problem (or solution, depending on which side of the table you’re on).

McKesson is named in a wrongful death lawsuit against Avandia for some reason (because its trucks dropped it off at the hospital’s loading dock?)

FiatLux, the medical imaging company founded by some Microserfs a year ago, has its first product hit the market this week. They worked in video games, so images are sent to remote devices that display them with DirectX at $2,800 per license (but I found a $1,000 discount here).

The CEO of imaging vendor Merge Healthcare, part of new management team mostly placed there from its new investor, says the company’s bad days (over $450 million in losses in two years) are behind it. The stock price is up (although still 66% off the 52-week high) and market cap is up to a modest $54 million. Q2 results: revenue down a little, EPS -$0.45 vs. -$0.32, with high-fives premature.

InterSystems wants to block Microsoft from building a research center in its building in Cambridge, MA. They’re suing MSFT and the building’s owner, complaining that the landlord took Microsoft’s offer of nearly double what InterSystems pays per square foot (shocker). That argument doesn’t make much sense and neither does the second one: that InterSystems doesn’t want its employees fraternizing with the competition and they don’t want to work under a Microsoft sign on the roof.

E-mail me.

HERtalk by Inga

From Dr. Otto Octavius: “Re: device connectivity. A big push over the past few years has been to capture the information to populate flow sheets in the EMR, with most vendors using Capsule. The limitation is that. once in the EMR, the information is dated. Telemedicine, JCAHO, and IHI want systems that immediately respond to changes in a patient’s condition, with central surveillance of devices as a front-end technology. However, many hospitals have, through the IT department, committed their only device output the EMR, leaving to competition for data access. Real-time is critical for monitoring adverse outcomes, so it will be interesting to see how device manufacturers respond. I agree that the agnostic middleware vendors will have significant market opportunities.”

From Paul Brient: “Re: PatientKeeper funding. Thanks for the mention! This is a very exciting time for PatientKeeper. In the past year we have signed a record number of new customers, including HCA and Catholic Health Initiatives – two of the largest health systems in the country. This funding will help us continue to innovate as we expand our operations and infrastructure to accommodate new customers, build additional new products, and support continued growth moving forward.” Paul is PatientKeeper’s CEO and is referring to the recent announcement that his company secured $7.5 million in VC funding to accommodate additional product development and company growth.

Michael Leavitt’s solution for fixing the health care sector is to create a new acronym (since we don’t have enough). Leavitt proposes the formation of Chartered Value Exchanges (CVEs), which are community-based collaborations among providers, employers, health plans, and consumers. The CVEs will provide local control for health IT standards and quality controls. Leavitt discussed the topic at a recent Town Hall meeting in NC. Leaders of the NC Healthcare Information and Communications Alliance liked the idea so much they passed a resolution to create their own version. No word yet on the correct pronunciation for CVE.

Marengo Memorial Hospital (IA) selects McKesson’s Paragon community HIS as well as McKesson’s Practice Partner EHR/PM for its outpatient clinic.

Sentillion issues 152,400 new user licenses for its identity and access management in Q2.

Second Life founder Philip Rosedale admits that majority of people who try out the product don’t stay. Instead, they are like Mr. H, who try it for a short time, are unable to get it started or work in a useful way, and don’t come back. Rosedale doesn’t sound too worried and indicates the market and product are still evolving.

Tammi DeVore, senior healthcare marketing manager for (HIStalk sponsor) AT&T, tells me that (not surprisingly) iPhones have been “crazy popular” with docs, who are downloading ePocrates in huge numbers.

Integrated communications solution provider TeleHealth Services acquires Pathware, providers of an interactive on-demand video system for patient bedside use.

Greenway Medical Technologies and revenue cycle management firm ZirMed announce a partnership to integrate their products.

Ten physician groups share $16.7 million in incentive payments for providing improved quality of care during the second year of CMS’s Physician Group Practice Demonstration. The program rewards providers for improved outcomes delivered to Medicare patients with congestive heart failure, coronary artery disease, and diabetes. The CMS press release does not indicate the number of physicians involved or an average payment per doctor, which I think would be an interesting statistic.

Tennessee RHIO CareSpark announces it is now online and operational. The infrastructure is now in place to permit secure medical record sharing among physicians, hospitals, and other healthcare facilities. A patient portal will follow. Will anyone use it?

ICA is now a recommended supplier for healthcare group purchase organization Amerinet.

I’m thinking this is pretty cheesy, but what do I know? CollaborateMD issues a press release announcing a discounted upgrade program for existing Medisoft, Lytec, Altapoint, Medical Manager, and Misys users. My favorite part is the clause stating the program is valid only through “4pm EST August 29, 2008.” Kind of reminds me of those TV commercials where you get an extra liter of cleaning supplies if you call in the next two hours (!)

E-mail Inga.

Readers Write 8/13/08

Siemens Medical Solutions Layoff Rumors

From The Walrus: “After years of making ugly PowerPoint presentations, ignoring to the customer voice, and mainly keeping themselves busy with internal fights and not much more, Siemens Medical Solutions, Malvern PA has started the dreaded massive layoffs. 480 people have lost their jobs this week out of a team of 1100 So-Aryan developers. And this is just the beginning … What happened to all those ‘world class leaders?”

From Azkaban: “It’s no rumor. Siemens Med laid off around 350 in Malvern, and about 250 in Bangalore who were working on Soarian Clinicals. Lots of senior people let go in Malvern. Feel free to speculate on what this means for the future.”

From Bestürzt: “About 400 people were laid-off today at Siemens in Malvern, PA.”

Note: I e-mailed a Siemens spokesperson to confirm or deny and received no response, so this should be taken as nothing more than a (widely reported) unconfirmed rumor. Still, the parent company announced barely a month ago that it would be axing 17,000 workers.

Planning to Fill the “Career Is Over (CIO)” Position
By Art Vandelay

At least once I month, an article, blog post, vendor or consultant makes reference to CIO meaning "Career Is Over." This is happening at the same time that many organizations are realizing their leadership positions are graying. Some are not only graying in the leadership ranks, but also in their key technical positions. One organization realized that over 2/3 of their leadership and 3/4 of their technical positions supporting their major application were within five to 10 years of retirement.

The only way to ensure a flow of qualified candidates exists for the CIO position is to prepare the staff and to fill the pipeline. This post is about preparing the staff. A future post will be about filling the pipeline. Staff need to be prepared for what the job is now and what the job and our departments should be.

From my view of the world, some organizations have begun to reexamine their career ladders and formally defined succession plans. Fewer have provided leadership training or formally defined mentors with time carved out for key leaders to mentor staff. The fewest have defined cross-department leadership rotation programs. These are all traditional human resources and organization development techniques.

To ensure the best prepared candidates, I’d recommend each of the techniques contain the following. Career ladders need to encourage the ability to work horizontally across rungs to gain knowledge of other disciplines within your department and in the organization. Succession plans need to groom the staff for the position rather than just aging them in their departmental barrels without guidance. Mentor programs need to be supported by executives who want to participate and these executives need the time to participate. The mentors should include IS and non-IS executives to provide alignment with the business. Also realize that not everyone is good mentor and protégé material. Cross-department rotations need to include real opportunities to run projects and operations.

All of this needs to be done while taking into account individual learning styles. Some people learn by observation, some by doing, and some by discussion and reflection. One size doesn’t fit all. It also needs to take into account how the workforce is changing. Expectations of and tolerance for telecommuting, communication styles and techniques, diversity in race, ethnicity and age, along with work-life balance expectations, are elements of the changing workforce.

If someone creates, implements, and continues to operate such a program, let me know. That is a place I want to work. This type of a program would deliver aligned and well-rounded leaders. It would also foster mutual respect between IS and the business. I am planting the seeds of this in my own organization. I hope they grow.

Pharmacy Barcoding
By Mort R. Pescle

You said it right. The technology most vendors are peddling would not have helped those 17 Texas babies who were overdosed with heparin when pharmacy staff put the wrong drug dose in their IVs.

Most errors that harm patients are caused by IVs. Most of those that don’t get caught are due to mistakes in mixing, not mistakes in ordering or hanging. The huge investments in CPOE and bedside barcoding systems haven’t addressed the majority of potential patient harm even in the unusual situations where those systems are actually used as planned without workarounds or deficiencies. Minimally trained pharmacy technicians put clear drug solutions in clear IV solutions, so the only check is to compare the containers they said they used with what the label says.

The fix involves barcoding inside the pharmacy walls. Barcode what is received from vendors to make sure nothing was shipped incorrectly. Barcode again when packages are broken down to stock shelves in the IV room to make sure drugs are put in the right place (which they aren’t in many cases, surprisingly). Barcode again when mixing the IV to compare what was ordered against what was chosen to mix.

Unlike bedside barcoding, this is really not very hard. The pharmacy system “knows” what items were intended. Each of those can have a list of acceptable NDC numbers defined. Scan the label against the product and it either matches or it doesn’t (with some exceptions due to imprecise ordering when employees aren’t necessarily aware of the exact packages that will be used to prepare the IV).

No technology can detect having the wrong dose drawn up of the right drug, but catching wrong drug IV mistakes should be a piece of cake, at least if there’s any money left that wasn’t squandered on unused CPOE systems.

Open Software Review -  WebVista
By The PACS Designer

With all the talk about the VistA EMR System and how it is languishing in the healthcare space, TPD thought it would be good to review an open source solution from ClearHealth called WebVista.

ClearHealth has taken the powerful VistA EMR system which powers the Veterans Administration health network and modernized it. With added, seamless, scheduling and billing WebVista offers the only fully comprehensive VistA based system in a cost-effective, Web 2.0 package. Utilize all of the capabilities from a standard web browser.

ClearHealth’s WebVista system has many examples of forms and dashboards on their website which can be accessed at:

http://www.clear-health.com/content/view/41/51/

After clicking on an example, you can zoom the document by clicking once on it for easy reading.  Since there are quite a few to view, it is recommended that you proceed through each one to get a better perspective of its usefulness to you.

ClearHealth is still looking for more Beta testers, so if you want to help, feel free to contact them to further the VistA movement.

You  can contact ClearHealth at info@clear-health.com or call 877-571-7679.  Also, you can go to the Open Enterprise Platform for more on ClearHealth at:

http://www.op-en.org/

While there is a reluctance to use the VistA EMR system by the DoD and other government agencies, it is worthwhile to use the open source path to perhaps make VistA more usable by other healthcare organizations around the world through enhancements to WebVista.

News 8/13/08

From Benny Hannah: "Re: bad press releases. I nominate this one. No news except that the company’s moving for whatever reason, but it dumps in all the positive events from months before. It even pointlessly name-drops Sharp HealthCare." Link. It’s all over the place, that’s for sure.

From Company Man: "Re: Soarian. Does anyone know of any locally hosted Siemens Soarian Financial (revenue cycle) implementations, or are they still using the Invision Billing Engine and American Healthware Eagle for claims scrubbing back in Malvern? This is apparently why Sloan Kettering and Hackensack cancelled their agreements – – no locally-hosted implementations."

Virginia Hospital Center goes with Soarian for a big implementation, a nice win for Siemens (which needed one).

The CEO of 58-bed Major Hospital (IN) resigns suddenly and CIO Jack Horner is named interim.

iMedica apparently files notice with Misys that it considers their agreement (by which iMedica’s product is relabeled and sold by Misys as MyWay) to be terminated. No reason was announced, although I’ve heard whispers that confidentiality was involved (maybe connected to the Misys-Allscripts merger?) I e-mailed iMedica’s Michael Nissenbaum and he says he might be able to provide more information in a couple of days. It’s awkward in any case since Misys owns a little chunk of iMedica. And, they don’t seem to be selling much of their own product.

Scott McFarland, former CEO of Awarix before its recent McKesson acquisition, is named president of online communications vendor Mobular Technologies.

Newt Gingrich pops up at Silver Cross Hospital (IL) to brag on Misys technology, of all things. Well, mostly about himself and his business, Center for Health Transformation, which the newspaper calls a "collaboration of public and private sector leaders." He’s our Jesse Jackson, sticking his head anywhere there’s a camera, somehow becoming wealthy without ever having had a real job, and working the system for personal benefit. I still kind of like him, but it’s trending down.

Wednesday is Reader’s Write day, but only if more folks send me something. The cupboard is bare. Seems like everyone is enjoying the last days of summer since not much is happening.

Here’s a story on the Cerner rollout in Abu Dhabi.

One of the Top 10 things a medical resident learns: "The electronic medical record more than likely does nothing but slow you down." Don’t tell all the attendings or they’ll stop using it (satire alert).

Pakistan has a paperless hospital.

HIS vendor HMS agrees to pay $3 million to settle an incident from 25 years ago, in which a programmer claimed his hospital demo software was copied by HMS and sold to customers.

Battlefield systems in Iraq are sending digital pathology images stateside for interpretation. The former military health system CMIO now works for Harris, one of the big contractors looking to cash in on the technology.

I keep running across news stories from India about upset family members who get a mob together to trash a hospital after a relative dies there, suspecting medical error. Seems to be routine practice.

Nebraska’s Medicare computer system sends $2.8 million to 7,400 recipients who weren’t supposed to get it, many of whom say they’ve already spent it and can’t afford to repay it. That doesn’t seem like much of an excuse.

Croc shoes are banned in Austrian hospitals for fear that static electricity buildup could damage computers and other electronic equipment. They’ve been flagged in some hospitals for infection control reasons, I recall.

Hospitals and health centers in Massachusetts will have to use interoperable EMRs to be licensed after 2015.

E-mail me.

HERtalk  by Inga

From Obiwan Kinobe: “Re: vacation summary. Hi Inga. Back from a great cruise vacation in Europe, visited many places – Italy, Greece, Croatia, Turkey. The dollar-to-Euro exchange hurt, but it was well worth the expense. My favorite place was the Amalfi Coast of Italy (Ravello, Positano, Amalfi) , where the scenery and the ride is breathtaking. Highly recommend that you go there.”

From Device Dude: “Re: Response to Indy Man. Not sure where to start to answer Indy Man’s question, but typically hospitals and vendors alike are using middleware that provides vendor-agnostic connectivity from bedside monitors, vents, and pumps into the hospital EMR. The EMR manages most of what clinicians will see once the data is sent across. Middleware includes data management tools, but clinicians generally want to maintain the workflow in the EMR so each brand of EMR will offer different bells and whistles. There are a number of device manufacturer offerings for connectivity (like GE, Philips, etc.), but as you can imagine they prefer you to use their solutions so will push the hospital to standardize. Many hospitals will find it better to choose vendor agnostic middleware when using a variety of devices and device manufacturers. A leader in device connectivity is Capsule Technologies. My company partnered with Capsule to be able to provide the connectivity solution to MEDITECH customers and in our due diligence could not find any other product that could integrate over 350 different device types and provide the level of features that they do.”

NextGen’s parent company Quality Systems names Steven T. Plockocki president and CEO, replacing Louis Silverman, who announced his resignation in June. Plockocki has been on the board for the last four years and most recently was chair/CEO of Omniflight Helicopters. Other past companies include Centratex (healthcare billing company,) Apria Healthcare (home health,) and Insight Health Services (diagnostic imaging services.)

PRSouceCode announces the winners of its "Top Tech Communicators,” honoring the best IT PR as ranked by IT journalists. In addition to PR companies, the study recognized top corporate IT departments, including the following in HIT: Allscripts, Cisco, Covisint, eClinicalWorks, Eclipsys, and Hyland Software.

Speaking of Eclipsys, Yale-New Haven activates Sunrise Clinical Manager, claiming 100% CPOE.

PatientKeeper has raised $7.5 million in Series F funding, according to a regulatory filing. The company has now raised more than $75 million in total VC funding since 1999.

QuadraMed posts a 10.5% increase in y/y revenues for Q2 despite a decline in net income. The company says most of the revenue gain was driven by the QCPR integration. Once again it sounds like the CPR acquisition was a pretty good move. Somewhat buried in their press release was a statement announcing the resignation of CFO David L. Piazza, who is leaving for a COO position at another company.

Picis announces that six major US and Canadian health systems are replacing existing OR and AIS systems with their perioperative suite.

Nuance announces Q3 earnings, which were one cent higher than expectations. Despite a 46% rise in revenues, Nuance saw a net loss of $9.9 million or $.05/share. The company attributes the loss to acquisition-related amortization and restructuring charges. Revenue for Dragon fell 23% y/y though hosted software revenue grew 42%.

Merge Healthcare releases Q2 results and there isn’t much to cheer about. About the only thing up is their loss: $18.3 million for Q2 versus $10.7 last year and $8.4 million in Q1.

E-mail Inga.

Monday Morning Update 8/11/08

From The PACS Designer: "Re: RIA post followup. Since TPD’s last post on Rich Internet Applications (RIA), an article has come out in InformationWeek magazine giving an excellent description of what RIA is all about." Link.

From DrM: "Re: Epic. Does anyone know the formula Epic uses to determine the minimum staffing levels at an organization that wants to implement Epic? I need to reality check some people and this would be useful information."

From Lukas: "With regard to the Kaiser deal to provide medical records on USB drives, there is a small problem: organization of the medical record. No provider can take the time to dig through a medical record that contains a lot of pages from a lot of specialists. Organization may not be a problem at Kaiser, but could slow things down with other practices. The rule of thumb for profitability is a family practice doc needs to see one patient every 15 minutes. Derm, one every 10 minutes. Which is why in derm we say: if it’s dry, wet it. If it’s wet, dry it. If it sticks out, cut it off. That helps out a lot with the turn around time for derm." I’ve been saying that too. Doctors don’t want to go prowling around a hodgepodge of mostly irrelevant information (whether electronic or not) when they know patients will tell them anything important anyway. There’s not much point in keeping a PHR if doctors won’t look at it, but doctors already get more information than they have time to process (that’s why they interrupt you within seconds in many cases). And you’ve got me worried with that "if it sticks out, cut it off" philosophy (I assume there are anatomic exceptions).

From Mike: "Re: earthquake. UCLA did fine. I was in another building nearby, but my friends who were inside the hospital said it felt like they were on a boat, swaying side to side a bit. Mildly disorienting because you felt like you had lost your balance, but nothing serious. It was a bit rougher where I was. Most people I know still thought it was the strongest they had felt. It was so much weaker than we’re supposed to be able to take, though, that it barely counts (mag 5.4 35 miles away, and we can take a mag 8.5). Our old ‘non-seismically-safe’ hospital did fine too."

From Bailout: "Re: [vendor name omitted]. People are leaving in droves. In the last six weeks, President, CFO, VP Sales, all of support staff, both Sales Engineers, half of sales, IT support staff, etc., etc.. Looking for angel investor. Inside source said if they don’t get funding, doors will close. Rumor is they owe everybody money." I’m trying to verify and I’ll add the name if I do.

Symantec announces a virtualized desktop product that will let a user run their applications and data from anywhere.

Dann tells me that the HIStalk Fan Club he started on LinkedIn is up to 202 members. "Wow" is about all I can say about that (except "thanks"). Inga and I will promiscuously approve all intro requests if you’re trying to build up your connections.

Hospitals are using Nintendo Wii games to tune the hand-eye coordination of surgeons. I bet doctors everywhere are thinking "tax deduction" for those Christmastime purchases of hand-eye coordination simulators.

Reorg time at Promedica, with an expanded role for CIO David Selman.

E-mail me.

News 8/8/08

From Ringo: "Re: NHS. With all the problems NHS is having with contractors and ongoing problems with the software, I am surprised they aren’t trying to switch to Kaiser’s vendor. Did Epic turn down the NHS?" I haven’t heard, but I’d bet so.

From Inside Outsider: "Re: AAPS article. Must have been the title ‘The Free Liberal’ that fooled you. AAPS is no liberal organization. In fact, they are think that Rush Limbaugh is too liberal. Dr. Jane Orient is about as right wing as they come. She fronts about three or four conservative PACs that really do nothing more than push her agenda to keep government out of medicine. Her organization is run out of a one-room doctor’s office in Tucson that has not been updated since the 50s. The office consists of her, her mother, and her nephew. They sit all day and listen to Rush and other talk radio and mail out letters to doctors warning them of liberals. During the Clinton administration (remember the good ol’ days?), their sole purpose was to sue Hillary Clinton for every single thing she ever did." I can’t verify one way or another, but here’s an interesting analysis of AAPS that you may or may not believe.
 
From Brad Delp: "Re: AAPS article. Holt’s distaste for the free market notwithstanding, I think Jane Orient’s article raised some points we rarely consider any longer. Medicine did, in fact, exist in this country prior to massive government intervention. She does seem a bit scared of technology (I try to discourage the use of words ending in ‘phobic’). Those interested in another physician’s point of view on government and healthcare would enjoy Dr. Ron Paul’s ‘The Revolution: A Manifesto.’ For those unfamiliar with Congressman Ron Paul, he is a libertarian-leaning Republican presidential candidate. He is also a physician." I agree. RP is the only candidate to whom I’ve donated money, so I was sorry to see him drop out (this was after I took an online politics quiz and stumbled downstairs to announce, "Honey, I think we’re libertarians.") I liked the AAPS article too, if for no other reason than it nudges people to distinguish between "insurance" and "healthcare."

From PFS Guy: "Re: layoffs. I can confirm the ‘rumor’ of Picis layoffs. I received an e-mail today from a Picis employee who confirmed that he, and others, were laid off today." Condolences to those affected by layoffs anywhere. The poll on your right shows that 25% of the employers of HIStalk readers have laid people off within the past two months. It’s not scientific, but I don’t doubt it a bit.

From Steve Thunder: "Re: HRBs. Bill Yasnoff leaves a few important details out of his post on HRBs. First, he neglects to point out that he’s applied for a patent on the idea of health record banks. Second, while Bill says that several states are working towards this model, he also neglects to point out that he’s involved in all of these initiatives and that the states did so on the advice of his consulting firm. The reality is the HRB model has a lot of problems — there are huge bootstrap issues — providers won’t invest in the interfaces needed with HRBs until there are lots of patients who have them and patients won’t pay to play until providers are set up to provide info. Indeed, it appears that Bill has backed off his initial HRB plan: that patients would play a monthly fee and providers would be paid for each ‘deposit’ to the HRB. To present, Bill has relied on grant funding — it’s quite unclear that the model is sustainable (particularly with the new dependence on advertising, reminders and researchers paying for data)."

From Bumpy Jonas: "Re. HRBs. Non-profits don’t have to hire a for-profit company to run it. There is no reason the non-profit can’t do it themselves or hire a non-for-profit to operate it. Alternative models to advertising could also be other sources, such as employer funded or state grants. An alternative to paying the docs for data could be pushing the emerging trend of malpractice insurers providing discounts to docs that use an EMR to reduce their risk profile – that same logic is even more relevant for care history provided by a HRB to address the our chronic ‘discontinuity’ of care across setting and info silos. We can’t get it right within an info silo, so across silos is a huge opportunity to address high risk, ball-dropping areas."

From oneHITwonder: "Re: PHR. ‘Kaiser Permanente Oakland Medical Center is offering adult patients a free copy of their medical record on a small USB flash drive that can tap into their health history on any computer. A pilot program started July 15 and about 25 people a day are requesting the 1-gigabyte USBs, says Thomas Barbar, MD, an orthopedic surgeon who came up with the idea.’ Interesting approach to a PHR. (published in today’s California Healthfax)  Question #1: Will a provider be willing to access a flash drive that may have a virus (you just never know)? Question #2: If there is a full medical record on the flash drive, and the patient is only being seen for say an ingrown toenail, if the provider looks at the record to see medications, is he liable for reviewing the entire record?"

From Steve Aylward, General Manager, Microsoft Health & Life Sciences: "Re: HSG. Please allow me to clarify the previous comments attributed to others from Microsoft regarding support for the Microsoft Health Solutions Group (HSG) products. Support for our Health Solutions Group products is provided by dedicated support teams within the existing Microsoft support services organization. These employees have expert knowledge of the healthcare domain as well as extensive knowledge of the Microsoft technology platform and the Amalga products. The emerging Health Solutions Group products (i.e., Amalga) as well as those from the Health & Life Science Industry team will continue to utilize and leverage the infrastructure of our existing worldwide support organization."

From Shaker Man: "Re: UCLA. Does anybody know how the new earthquake-safe hospital did recently compared to the other hospitals in the LA area after the recent quake? The new hospital was designed to withstand a much larger quake, so what was the outcome?" Good question that I’ll throw out to you Left Coasters. For what it cost, you’d hope you could do a circumcision during the Richter-ing, which I vaguely remember from some movie or SNL fake car commercial.

From At the Office in August While Others Frolic: "Re: press releases. How ’bout a HIStalk contest to write the worst healthcare IT press release? One could model such a contest on the Bad Hemingway contest, requiring for example that press releases mention HISTalk and Inga in some way, and that the press releases be hilarious. You could also select some real releases as examples to get the HIS ‘hood started." I like it! How many rules could you break? I may crank one up myself if I get time.

QuadraMed gets a $15.8 million QCPR deal expansion with Daughters of Charity that includes care grid, orders, access management, decision support, nurse doc, chart management, scheduling, document management, CPOE, and other apps. CEO Keith Hagen uses the occasion to observe that QuadraMed has already sold more QCPR business than they paid Misys for the entire product ($33 million) last year. The Misys response: "Doh!!!"

In the UK, NHS finally replaces Richard Granger with the two big-bucks positions previously announced. Former Cadbury Schweppes CIO Christine Connolly is named CIO and former pension service CIO Martin Bellamy is now head of Connecting for Health. I like Christine because her former employer makes Stride chewing gum, which sponsored that superficially goofy but surprisingly moving video that Inga found featuring Dancing Matt traveling the world.

Fred Trotter is raving about ClearHealth’s GUI version of VistA, soon to be in Beta (screen shot above). They’ve just posted an online demo. "If you had asked me yesterday I would have said that it might be a good idea for Medsphere to buy ClearHealth. If you ask me today, I would say that it might be a good idea for ClearHealth to buy Medsphere."

Johns Hopkins develops a software prototype for remotely diagnosing traumatic brain injuries on the battlefield.

Medicity’s latest customer newsletter confirms the earlier HIStalk rumor: one of its five new customers is Dubai Healthcare City, where the company will install an EHR system and a patient referral application. I didn’t realize that Harvard Medical School will open a branch on the Dubai campus in 2011. The company also announced an 18-hospital results distribution contract with Adventist Health. Here’s Medicity’s new recruitment magazine (warning: PDF) that talks up the benefits of working there (the golf simulator and pool table isn’t exactly the kind of perks we hospital types enjoy, being more accustomed to a 20% discount on 50% overpriced portion-controlled mystery meat and the occasional chance to peruse celebrity medical records … kidding). Whoever did that magazine is a genius since I was ready to pack up and move to Salt Lake myself and I’m usually indifferent to anything that involves change or effort.

Correction: Eric Rosow’s Team Freeman raised over $50,000 for The Jimmy Fund in last weekend’s bike challenge, not the $5,000 I wrote earlier.

The Advisor Board Company’s Q1 numbers: revenue up 12%, EPS $0.36 vs. $0.38.

A computer magazine mentioned this freeware replacement for Windows Explorer, which is a zillion times better (multiple open windows, for example). It’s just a single 387K executable. Isn’t the idea of a no-DLL application both quaint and appealing, kind of like if Microsoft would finally admit that the Windows registry was a horrible idea? Hard drives are huge and cheap, so those old ideas are trouble-causing leftovers from the dark days of DoubleSpace.

Mike Gleason’s HIStalk article on EMR adoption was such a hit that it was summarized on EHR Decisions, CCHIT’s blog (I didn’t realize they had one until I saw the incoming link.)

Marty Jensen is peeved that Medicare got CMS permission to break its own rules on NPI. "Let’s put that into English for the benefit of the nontechnical reader — say a provider who is dizzied by the inability to get Medicare to pay any claims for the last three months: The same numbers that Medicare said you can’t use anymore as of May 23 — the ones that caused your 837 claims to bounce if they appeared anywhere in the claim — those are the same numbers that Medicare says are okay for it to send in its own 837s to its secondary payers."

The FBI raids three LA hospitals to investigate alleged Medicare fraud, in which hospitals allegedly paid shady recruiters to cruise skid row looking for insured homeless people to bill. The MD CEO of City of Angels Medical Center was indicted last week for fraud. Named in a new suit are several hospital CEOs, CFOs, and physicians. That might be a rallying call to pay caregivers for promoting health instead of cranking out the billable procedures. (photo above: San Francisco Sentinel).

Listening: Tift Merritt, probably more Inga’s taste than mine since Tift’s more mainstream than my usual fare, but I was in the mood.

Here’s the official word from RelayHealth on its just-announced agreement with Microsoft. "The initial RelayHealth-HealthVault integrated platform will bring to the market a new solution which makes RelayHealth an essential part of the HealthVault solution by positioning it as the physician-patient connectivity service. Microsoft HealthVault recognized RelayHealth’s proven ability to provide the means for hospitals, physicians and other affiliated providers to connect with patients and insurers, and collaborate with each other, in a safe and secure mode. The RelayHealth service makes it easy for physicians to electronically prescribe, review clinical data and share appropriate information with their patients or other clinicians efficiently. Hospitals and physician providers using RelayHealth, will be able to market HealthVault ‘enablement’, meaning their patients’ HealthVault PHR can automatically be populated if they so choose." Sounds to me like Microsoft is endorsing RelayHealth as its partner for getting hospitals and health plans to sign patients up for HealthVault, rather than the usual "our EMR now works with HealthVault" announcement from vendors.

Be one of the cool kids: sign up for HIStalk updates in that Subscribe to Updates thingie at the top right. You can sign up for the Brev+IT newsletter there too, although I’m beginning to wonder if it’s worth my effort to write since a lot fewer people signed up for it that get the HIStalk e-mail blast (about 1,200 vs. nearly 3,000, but stats show many of those aren’t opened). I’m open to suggestions on that, although I do like the smarmy and snarky personality I channel when I write it.

Cardinal Health, struggling a bit of late, is considering selling off its medical equipment business, which is a lot more profitable than what would be left (ho-hum drug distribution).

Harris County Hospital District announces that an employee lost a flash drive containing PHI on 1,200 patients, reportedly those with HIV. The county judge, who admits that punishment would deter future voluntary reporting (which is how this loss became known – the guy who lost it said so), still says he should be fired. As always, optimism was expressed that the thief is stupid and the drive was probably destroyed (thieves don’t usually do data-grade destruction, but you never know). Hey, how about a $10 reward for the drive’s return?

Microsoft ships SQL Server 2008. Free Express version here.

E-mail me.

HERtalk by Inga

From Dancing Queen: "Re: Shoes and dancing. While your blog content is informative as usual, I have to step back for a moment to comment on two things. 1) Love the Dancing with Matt link. It was fun and did make me feel good. Loved the music. 2) ‘Where In the Hell is Matt’- Should be replaced with ‘Where in the Hell did you get $100 shoes for $23?’ Maybe you could have a ‘Dancing with Inga and Mr. HIStalk’ at HIMSS next year in Chicago?” Hmmm, not a bad idea. Mr. H was mulling over an Inga kissing booth, but twirling around the McCormick Center could be fun, too.

From Sesame Street: “Re: athenahealth’s offshoring. Companies like Dell have slowed down their offshoring to India and started ‘nearshoring’ to Canada. Why? Because they knew how dissatisfied their customers were with their sub-par tech support. But there is a major difference between someone telling you how to run anti-virus scans in safe-mode and someone in India looking at your diagnoses and procedures. athenahealth and other offshoring billing companies are paying Indians $4/hour now, but as the Indian economy grows, their wages go up, so they go to the next developing nation."

From Indy Man: “Inga, what’s the latest in the device connectivity market? (Company) continues to feed off of their EMR provider partners but they do not appear to have the best overall product. (Another company) has device connectivity, vitals integration, HCIT monitoring, COW/WOW. monitoring and location, the ability to integrate disparate systems, as well as remote monitoring and troubleshooting.” I am unaware of this space, but flattered that a reader thinks I might be so well versed, even if I didn’t include the company names just in case there was a hidden agenda. If you are an authority on this subject, then perhaps you could advise Indy Man.

The board of Virtual Radiologic authorizes the repurchase of up to $8 million of the company’s outstanding common stock after last week’s earnings announcement (22% y/y increase in revenue) and share price drop.

ASP-based Clinix Medical Services acquires MedicWare EMR. Clinix provides PM services and provides billing services.

EMR software provider Noteworthy Medical Systems announces it has completed the acquisition of PM software vendor MARS Medical Systems, originally announced right before HIMSS.

Philips completes the previously announced sale of its 69.5% MedQuist stake to CBaySystems Holdings. Philips received $287 million for the transaction. Not so good for a billion-dollar purchase made just three years ago.

St. Vincent Health System (PA) is upgrading signs on for McKesson’s Horizon Clinicals Care Team release.

A survey finds that 80% of Americans believe the health system needs either fundamental change or complete rebuilding. There is also strong support (86%) for doctors’ use of computerized medical records. Most of the 1004 participants also support electronic access to test results (89%), electronic information exchange between doctors (89%), and electronic prescribing for improving patient care (71%).

The University of Puerto Rico hospital selects Healthcare Management Systems.

The ickiest news of the day comes from the BBC, which reports that numerous NHS Trusts have suffered invasions of rats, fleas, bedbugs, flies, and cockroaches. The story makes mention of maggots in a patient’s slippers, fleas in a neonatal unit, rats in the maternity ward, mouse droppings in a clinic, and wasps in operating rooms.

E-mail Inga.

Readers Write 8/6/08

The following are recently received writings from readers of HIStalk. Your submissions are welcome, subject to editing and with a suggested length of 500 words or less. E-mail me.

Campaign 2008
By Donald Trigg, Managing Director, Cerner UK

Don lived in Washington, D.C. for ten years where he worked in a number of senior public policy roles prior to coming to Cerner in 2002.

Barack Obama swung through London recently for the final stop on a global tour designed to buttress his foreign policy credentials in advance of the Denver convention later this month. Even the oblivious found it hard to miss, as Obama met separately with Prime Minister Gordon Brown and Tory opposition leader David Cameron.

But the US election will not be decided by foreign policy photo-ops. The economy is set to dominate the next 100 days. And the question that Mr. H posed for my guest column was: what are the implications for healthcare if the economy defines the fall campaign?

An understanding of the US healthcare debate begins with what Theda Skopol described as “the rise and resounding demise of the Clinton plan.” From a grand start that embraced Health Security amid an economic downturn, it ended in stunning defeat.

The assumed political lessons for the two parties have held for the better part of fifteen years. The Democrats, wounded by Arlen Specter’s organizational chart and Dick Armey’s glossary of terms, embraced “smaller, faster” policy pursuits. The Republicans, with the exception of the Medicare Modernization Act (MMA), decried calls for more government-funded coverage such as their depiction of SCHIP reauthorization last fall as “welfare for the middle class.”

The trend lines of the core policy issues, meanwhile, have been almost as stubborn as the political framing. On cost, spending as a percent of GDP has risen from 13 percent in 1993 to 16 percent today. On access, the number of Americans without health insurance exceeds 47 million. On quality, OECD data shows the US with the third-highest rate of medical error among the 26 countries submitting data.

Of course, the intractability of these health issues is a claim that might have been advanced in 2004. The shift in 2008 is a relative decline in Iraqi violence (allowing electoral mindshare for other issues) coupled with a teetering economy that offers a powerful contextual framework for a debate on healthcare.

In June, more than 60,000 non-farm payroll jobs were lost. Existing home sales dropped for the sixth straight month. Inflation increased to its highest level in seventeen years. These uncertainties have stoked middle class anxieties and healthcare costs are part of that increasing duress.

Substantively, Obama and McCain play to type on healthcare.

Obama’s starting point is coverage for the uninsured –guaranteed eligibility and a new National Health Insurance Exchange to ensure individuals can purchase private plans. He advocates greater transparency. He champions disease management. He backs strategies to elevate care coordination, including $10 billion per year for five years to drive “broad adoption of standards-based electronic health information systems” (not quite as catchy as “Yes, We Can!” and unlikely to make it to yard signs in Ohio).

Like Obama, McCain supports elevated transparency. He promotes “21st Century information technology” (absent much detail). He also calls (notably) for a single patient bill for high-quality disease care over the lifetime of treatment. McCain’s animating principle is cost containment, with choice and competition as core strategies.

As we watch the two candidates in the months ahead, we shouldn’t anticipate exchanges on whether Obama knows what CCHIT is (he doesn’t) or whether McCain had the same problems with EHR becoming HER as he was drafting his plan (he didn’t). Neither Obama nor McCain have the deep healthcare policy acumen of a, say, Hillary Clinton. It is not their comfortable terrain.

We will see broad brush strokes. Obama will challenge McCain for failing to offer a true plan to cover everyone. McCain will question Obama on cost. They will make competing claims about who will be better at standing up to special interests and working across party lines. The exchanges will definitional and foundational.

And so, if the global tour that ended here in London begins to answer the threshold national security question for Obama, the past will be prologue. A recessionary economy will make fiscal matters the paramount campaign topic, delivering a mandate –including healthcare—to a new President for the first time since 1992.

Transformation of the IT Department
By Art Vandelay

There have been a number of articles about CIOs taking-on responsibilities beyond simply the Information Systems (IS) Department. Here are two of them (1, 2).

For once, this change is happening at nearly the same pace in health care as it is in non-health care organizations. The CIOs of Alegent, Trinity Health System, and UPMC own significant functions outside of IS. These functions are more than clinical engineering.

Alegent’s CIO owns the project management for construction, retail business, and the budget process. This has come after some glowing successes in managing the build-out of a new facility with new technologies. UPMC’s CIO has struck some innovative partnerships and created new products. This has lead to revenue as well as some notoriety. Paul Browne, from Trinity, operates the organization’s program management office and functions as a COO. This evolution has occurred while they developed and deployed their Project Genesis.

Why has this happened? There was true alignment. This was spurred by their dynamic CIOs and leadership teams. These IS departments have successfully delivered major enterprise-wide projects.

We (IS) often lament about being in the back room. From the case studies and first hand accounts I have heard, IS didn’t tell them what wasn’t possible. They showed what was possible and drove the transformation. These leaders were able to garner business support in the forms of trust and human and financial resources.

In these organizations, IT matters. Structurally, the organizations have strong project management (PM) functions and business analysis (BA) capabilities. In many of our organizations, PM capabilities haven’t developed or matured. This has occurred while our BA capabilities have eroded.

As applications have become more easily configured, more users are comfortable owning their own destiny. Our organizations have a major decision to make. Will they support our transformation to deliver these capabilities, or will they develop them elsewhere in the organization? Think Allina. There is definitely a balance to strike between IS central control and departmental ownership in health care. At the same time, PM and BA resources are scarce and need to be centrally managed for the good of the organization.

What I Did on My Summer Vacation
By Matt Grob

We were in Mexico and stopped in at a couple of pharmacies looking for an topical anti-histamine gel that we like which is used for treating bug bites, but is not yet available in the US. I had always heard about the availability of prescription drugs available in Mexico OTC, but was truly amazed that virtually everything was available.

Aside from getting a kick out of watching the men (and some women) lining up to buy their Viagra, Levitra, and Cialis, what truly caused concern was the lack of knowledge on the part of the customers regarding potential interactions, side effects, and dosage limits. On top of that, many active ingredients for even common OTC drugs were in Spanish and therefore not easy to decipher. Sure, many customers asked the people behind the counter questions regarding the drugs, but these are – for the most part – simply retail clerks with no pharmacy training at all. I finally found one guy in a shop who, while not a pharmacist, did have some training and knew enough to answer my question by pulling out their version of the PDR to look up the active ingredient.

Were the drugs cheaper? For the most part, yes. Were they easy to obtain? Certainly. This is why so many people – especially in the current economy – are seeking their meds from beyond our borders. I wonder, however, what happens when they then re-enter our healthcare system with ailments or illnesses caused by improperly self-medicating.

The Future of RHIOs
By William A. Yasnoff, MD, PhD

Bill is founder and managing partner of NHII Advisors, a consulting firm, and was previously HHS Senior Advisor, National Health Information Infrastructure.

In answer to your question about the future of RHIOs, I’d direct your attention to the health record bank (HRB) model, a central community repository of complete health records controlled by patients (including both medical records and patient-entered information — all clearly marked as to source).  

Whenever a patient receives care, the new information generated is deposited in her health record bank account (note that HIPAA requires that all records be released on patient request, thereby ensuring that such deposits will occur when patients ask for them). A non-profit community organization provides governance and hires a for-profit to develop and operate the HRB (the for-profit would raise the capital, and pay ongoing fees to the non-profit to defray its operating expenses).  

The HRB accounts are free to everyone, with the costs defrayed by a combination of advertising (to patients), fees to researchers for searches (to protect privacy, patient permission would be required and only anonymized tables of summary results would be released), and fees for reminders (paid by patients and/or third parties). In addition, the HRB would incentivize physician use of EMRs by either paying physicians a small fee (e.g. $3 each) for deposits of standard encounter reports from their EMR (for those who have them already) or subsidizing ASP-model EMRs for those who do not.  

Thus, the HRB model solves the key problems of making all the information electronic (by subsidizing physician EMRs), ensuring stakeholder cooperation (via HIPAA), earning and maintaining public trust (through patient control and community governance), and establishing financial sustainability (with a realistic business model that does not depend on charges to health care entities or capturing health care savings).  

The central repository is much simpler and cheaper to operate than the financially and technically infeasible "fetch and show" model that has been widely promoted (but is not operational on a large scale anywhere). In addition, HRBs do not need to connect to each other since the complete records for each patient are in a single HRB — this eliminates an entire class of interoperability. An HRB using this approach can be started for a modest one-time investment in a community non-profit (less than $1 million), since the cost of building the infrastructure would be paid by the capital raised by the for-profit HRB provider and ongoing operational expenses are covered by the business model.  

Washington State, Oregon, Louisville (KY), and Kansas City (MO) are all working towards this model. Note that while Microsoft, Google, and Dossia have all embraced the central repository approach, they are not complete HRBs because they lack community governance and mechanisms for incentivizing physician EMRs. The Health Record Banking Alliance (http://www.healthbanking.org ) is a national non-profit that is promoting this approach and has developed a set of principles for HRBs. I’d be happy to share more details with anyone who may be interested.

My blog has detailed articles about the concept, including Why Your Complete Lifetime Health Record Needs to be Stored in One Place, Health Record Banking: A Practical Approach to the National Health Information Infrastructure, and Health Record Banks Facilitate Consumer Control and Promote Privacy.

LinuxWorld Presentation Response
By Randy Spratt

Randy is the CIO of McKesson.

You apparently read Information Week regarding my recent address at LinuxWorld and were unfortunately not able to attend and listen in person. I’m afraid that Information Week got it a bit wrong: I said nothing about insurance companies footing the bill, and I do not regard that as a viable option.   

Rather, my point was that healthcare providers are increasingly insistent on technology that provides a real and demonstrable benefit – either a strong ROI or strong guardrails regarding patient safety or both – and that vendors who layer on costs without providing those benefits are unlikely to succeed. I noted that hospitals and physicians are heavily regulated, under enormous financial pressure, and struggle to be able to afford the technologies that have proven benefits. 

The case studies I advanced showed how systems that have a reduced third-party embedded cost (the basic value proposition of open source architectures) allow hospitals to absorb more needed technology without expanding their budget, or to divert money to other areas while attaining critical levels of reliability and performance. 

Finally, my discussion about MUMPS was not about the adequacy or quality of the platform – after all, our own STAR platform is MUMPS-based – but rather to show that IT investments in healthcare tend to have long lives, as hospitals cannot afford to make a mistake and require many many years to gradually and continuously improve their IT portfolio. The solution to funding, I opined, is to drive to the standards and the technologies that will allow reliable and facile interchange of healthcare information electronically amongst all of the stakeholders in the healthcare system. Until we achieve that, the high administrative costs we see today will continue to permeate the reimbursement system.

In every other information-based industry, where market forces are alive and well, LINUX and other open-source strategies have delivered exceptional levels of performance at much lower cost when compared to the alternatives. We are showing that the same value proposition can be delivered to the healthcare sector.

MedicalPlexus
By Brijesh P. Mehta, MD

Brijesh is a co-founder of MedicalPlexus and a medical resident at Mass General and Brigham & Women’s. He asked for a little PR for his new company MedicalPlexus, so since he’s a medical resident, I agreed. Here’s an abbreviated version of the e-mail interview.

What’s your background?

I have done clinical neuroimaging and translational laboratory research in neuroscience with publications in high impact peer-reviewed journals. I Completed medical school at the University of North Carolina and am currently a resident physician in the department of neurology at the Massachusetts General and Brigham & Women’s Hospitals. I plans to become a vascular and interventional neurologist.

What led you to start MedicalPlexus?

Advances in medical technology, the electronic transformation of medical education, and widespread use of digital tools in medical practice has led to a proliferation of digital multimedia content with valuable educational merit. However, the content is scattered on individual physicians’ computers, department intranets, and behind firewalls, making content management and sharing among physicians extremely ineffective. Concerns about patient privacy and intellectual property issues have also restricted content sharing.

Because the medical community is predicated on continuous learning, many physicians and researchers have begun to share digital medical multimedia on existing social networking communities such as iTunes, YouTube, Flickr, Slideshare, and even Facebook. Given the uncontrolled nature of these broad communities, physicians simply are not able to efficiently find relevant content, trust the content, or candidly discuss the content.

Based on their frustrations finding, accessing, and sharing digital medical multimedia content as a medical student and a resident physician, respectively, Mr. Nallasamy and Dr. Mehta created the MedicalPlexus concept for the purpose of improving patient care by more effectively disseminating medical knowledge.

Who is your intended audience?

Two tiers. Individual users: physicians (academic and community), residents/fellows, medical students. Groups: medical societies, clinical departments, residency training programs, medical schools, research laboratories.

Who are your competitors?

Online physician communities are still in an early stage with low barriers to entry, moderate competition, and uncertain revenue models. Although a few companies have grown their membership base, there is yet no market dominance.

Current sites range in their focus from enabling physician interactions to social networking to information sharing. The majority of these sites provide a service to physicians with the packaging of traditional social networking sites. Most do not address important patient privacy guidelines, content ownership guidelines, or ensure the exclusivity of these communities to physicians. This combined with the lack of appropriate content oversight is a barrier to providing an online educational platform to physicians that is  trustworthy.

For other sites, trust and privacy concerns stem from their revenue model, which is dependent on providing third parties, such as pharmaceutical companies, fee-based access to physician postings and interactions on their sites.

How would MedicalPlexus be used?

View content with a built-in media streaming module.
Upload, manage, share, rate, discuss content.
Aggregate content from online medical sites.
Subscribe to physician profiles and medical groups.
Add meta tags to community content.
Search PubMed, link e-publications to content.
Receive newsletters and email alerts of activity on MedicalPlexus.
Full access to unlimited multimedia content.
Personal, scalable storage space for archiving content.
Browse and bookmark content by specialties, groups, ratings, times.
Search with tags, labels, groups, diseases, imaging modalities.
Create personal user profiles to display own content, showcase work.
Assign sharing level for each piece of content: private, specific users, groups.
View, share media on mobile devices.
Private messaging between physicians.

Is the site live?

Currently we have presented the platform to select Harvard medical school departments for beta testing and their feedback has been very positive. As such, at this time, we have a couple hundred users which reflects the departments we have presented to. We have not done any publicity so far. It has been primarily word of mouth and through our presentations. At this time, any medical student, physician, or resident around the country who is affiliated with an academic medical center may create an account and begin using MedicalPlexus.

How will you get the word out?

Viral marketing, company blog to provide updates and highlights of  platform features, recent launch of a revenue sharing model, and reaching out to influential blogs such as yours to profile the site. Once we obtain funding, we will launch a national ad campaign in print/online media such as scientific/medical journals and presentation booths at annual medical society conferences.

What are the next steps? 

Traction at key Harvard medical school departments and tracking usage with our analytic tools. Adding more interactive features to the platform based on feedback from our users. Collaboration with Cisco Systems’ global life sciences group to add live video conferencing, chat. Partnerships with medical societies to develop clinical registry database.

What do you hope to get from HIStalk’s readers?

We’re looking to spread awareness of the platform to ramp up usage and make improvements. As such, we would be very interested if your readers, who may have great deal of experience in health IT, take a look at MedicalPlexus, sign up for an account, and ideally give us some feedback on their initial impressions, dream features they would want, parts of the interface they may or may not like, etc.

We have some great ideas in the pipeline about future directions for the site, but we’re very interested in making sure that we continue to develop a product that will be useful to doctors and researchers in their daily workflow.

If your readers really like what they see, it would be great to have them pass it along to physicians in their respective hospitals. The more use we have, the more content there will be on the site with potential to translate into a valuable resource.

News 8/6/08

From Outside Looking In: "Re: Picis. I read your column with regularity and I also see that Picis is a Platinum sponsor. After their acquisition of Lynx, you would think they have one of the best ED products on the market, so why then do I hear that layoffs are imminent at this company? My source tells me they have had a mandatory non-client related travel ban for over a year as well as a hiring freeze. He says that while all of these bans are in place, they continue to hire senior VP of this and senior VP of that. Sounds like a case of too many chiefs and not enough Indians. Your thoughts?" We asked the company and received this response from Mike Mitsock, chief marketing officer: "We believe Picis does have the best EDIS on the market, in particular the most complete integration between clinical and financial functionality for the ED. According to Millennium Research (December, 2007 report), we hold #1 market share, which we view as validation of our vision and ability to deliver. As for the other comments, we do not discuss internal financial policies, but will always manage the business as efficiently and effectively as possible. We have hired 100 employees this year, at all levels, and we continue our hiring in areas of focused investment."

From The PACS Designer: "Re: mashups become RIAs. TPD has posted about mashups in the past and now those mashups are getting more robust by becoming Rich Internet Applications (RIAs). Even Bill Gates has been commenting on how they will evolve in the WEB Operating System (WebOS) to enhance the information presented. With the diverse number of silos in healthcare, the RIA experience would be a good way to unlock those isolated stores of patient data in radiology, cardiology, pathology, and other applications. The eXtensible Markup Language (XML) will play a key part in migrating these data stores to the WebOS." Link.

From Johnny Smooth: "Re: UHG. Was at the Healthcare Quality Conference yesterday in Boston. Got to talking to a United Health exec who informed me that they have signed an agreement with Google Health and have a pending agreement with HealthVault. This backs up UHG’s previous statement that member records would be made portable. Individual made mention that the Google Health relationship extends beyond just claims records transfer and includes a technology partnership regarding UHG’s OMX." 

From Lazlo Toth: "Re: TPD’s comments on Kensho. Actually the OVF standard didn’t come out of Kensho, it’s a formal standard adopted by the Distributed Management Taskforce and was developed by  Dell, HP, IBM, Microsoft, VMware, and XenSource (now Citrix). The standard is still a work in progress. The OVF standard only addresses the packaging of a virtual machine image and doesn’t address management of virtual environments. There are two important standards that address management of virtualization : libvirt and CIM. Historically virtualization vendors have been reluctant to adopt open management standards that break the bond between the hypervisor and management platform since it removes the vendor lock in. In many cases vendors such as Citrix and VMware have created their own APIs (XENAPI and VMWare API) rather than adopt standards that would allow cross hypervisor management. Libvirt and CIM (DMTF’s System Virtualization, Partitioning and Clustering schema) are two open standards that hold the promise of allowing hypervisor agnostic management. Today, IBM, HP, Red Hat, Sun, Novell, Futjitsu, Hitachi and many other ISVs and OEMs are contributing to the project. While Kensho has been announced the only details available are in the form of press releases and blogs from Citrix. We’re looking forward to seeing the project or product in September." I didn’t understand any of that except the list of vendors, but I’m humble enough to admit that fact and leave in all the juicy details for those who are better informed. I figured hypervisor was another name for Luke Skywalker’s googles.

From WirelessGuru: "Re: Sonitor. On July 15th, Sonitor Technologies laid off 40% of its worldwide staff, including four people in the US Largo Headquarters. The US staff is now down to three people. It makes you wonder how they will support their newly announced contract with 3M. Is a deal with 3M bigger than we think?" We tried to contact the company and didn’t hear back, but another source confirmed. I like the company (disclosure: they sponsor, but I’m talking about seeing their RTLS product at HIMSS, which was one of the coolest things there).

From Neal’s Pizza Guy: "Re: no pizza for you, Cerner! Any readers know if the head honcho at iSoft likes pizza?" Link. NHS may give iSoft some business via CSC now that Fujitsu has slunk off.

From Nep O. Tysm: "Re: recruitment. Here is how some HIT companies do recruitment. From a contingent recruiter to a potential candidate: ‘Eclipsys let me know yesterday that there is going to be a 2 week delay in moving forward on this VP position. A member of the Eclipsys’ Board of Directors referred a candidate who is being strongly considered for the VP of Ambulatory and eHealth Solutions position. I will keep you posted on the outcome of this interview process. Again, I am sorry for the delay, and thank you for your patience.’ I guess it helps to have friends in high places."

From EMR_Dude: "Re: CCHIT. You’ve had a number of interesting items about CCHIT EMRs lately. Here is another. I had a long discussion with the head of engineering for a major CCHIT vendor. His feeling is that CCHIT is holding back some innovation in the industry. He said that well over 50% of his resources go into CCHIT ever year and some projects get pushed to the bottom of the list due to lack of those resources. What you wind up with is a bunch of ‘me too’ vendors that all have pretty much the same features with little differentiation between them." I not so sure that wasn’t the goal. Commoditized functionality = commodity pricing = increased adoption. Theoretically, anyway, since EMR adoption hasn’t improved much.

Inga dropped this gem my way in an early morning e-mail salvo today: "Do you really think I’m neurotic?" To which I replied, "No, but I bet everybody thinks I’m paranoid."

Dewey Howell MD, PhD, CEO of Design Clinicals (disclosure: they’re an HIStalk sponsor, but this has nothing to do with that fact) has an excellent editorial in EHM. Snips: "How can you expect to impact patient care and safety if you don’t engage the entire team of providers using a comprehensive, multidisciplinary approach? Current CPOE systems don’t accomplish this. They are designed for docs. Period … I, for one, am weary of hearing that doctors’ lack of acceptance of computerized systems is the problem. It is often said that doctors ‘aren’t ready’ for systems or that it takes a cultural shift to get doctors to practice differently. If online banking or shopping took me twice as long as running down to the local branch or grocer, and at the end of the transaction I wasn’t sure if it really went through correctly, I would never become an adopter." 

Welcome to new HIStalk Platinum Sponsor TeraMedica of Milwaukee, WI. The company offers the Evercore Clinical Enterprise Suite, which manages and integrates clinical objects like images into the electronic health record (imaging experts like TPD can probably help me out with a better description). Their client list isn’t too shabby: Mayo, Marshfield, MD Anderson, Meriter, and UC Davis, to name a few (and check out their medical advisory board). Thanks to TeraMedica for supporting HIStalk and the folks who read it.

You’ll soon notice some minor changes in HIStalk’s appearance, so don’t be alarmed (smaller logo, tighter layout, smaller ads, etc.) Readers and sponsors alike have been asking for some tweaking to improve readability and page loading times, so we’re nearly there.

Jobs: Account Executive, HIS Consulting; EMR Software Staff Development, Principal Account Systems Engineer – Healthcare, Epic Ambulatory Trainers. Sign up for job blasts.

McKesson CIO Randy Spratt ticks me off with his keynote at LinuxWorld (do they really need for-profit vendor speakers who only offer Linux options on cheap servers?) US healthcare is a national tragedy, Randy opines without obvious original thought, but his novel solution is that the government should increase reimbursement (i.e., stick taxpayers) so that hospitals can buy software from vendors like the one that sends him a large paycheck (that being more important than hiring clinicians or providing charity care, apparently). He disparaged 30-year-old applications "written in MUMPS," omitting the fact that those products routinely kick the bejesus out of multi-heritage (aka, spit and baling wire integration) amalgamations of equally old and disparate applications ("integrated" and "developed" being unfamiliar concepts to certain vendors). Glass houses.

I’m feeling a slight pull to attend a conference, perhaps facing a twixt-HIMSS need for the PowerPoint-lit ballrooms and pointless glad-handing. Could be WHIT or CCS. Anybody going?

The outsourced IT shop at Children’s Pittsburgh is the first to achieve eSCM Level 2 certification. I don’t know anything about it, but I figure if cross-towner Carnegie Mellon is involved (they created the capability maturity model, I think) then it must be pretty good.

Premise CEO Eric Rosow and Team Freeman raised over $5,000 for The Jimmy Fund (Dana-Farber) in the Pan Mass Challenge this past weekend.

I don’t frequent many liberal sites even though I’m becoming a disillusioned right winger, but this editorial is pretty good (written by the president of AAPS, which I’ve barely heard of). "What all this medicine is breaking is the bank. Neither party is willing to admit that the federal government has made promises that cannot possibly be kept, and incurred debts that cannot possibly be paid. That’s not the fault of either party, both of which promised to just pay the bills and not interfere. It must therefore be the fault of those sending the bills. Accordingly, it is they who must be ‘fixed.’"

An interesting quote from the Eclipsys earnings call: "Q2, 2008 operating cash flows were negative $300,000, down $6.1 million over the same quarter of last year. We had negative free cash flows in the quarter of $10.7 million. Day sales outstanding were 80 days, up six days sequentially and seven days year-over-year. We believe this temporary increase is partly due to the transitioning of our billing function to India."

AMICAS Q2: revenue up 9%, EPS $0.00 vs. -$0.01.

Hartford Healthcare, parent of Hartford Hospital, chooses Allscripts for EDIS and EHR.

Big layoffs at Cape Cod Healthcare. Speaking of which, new poll to your right: is your employer laying off? The poll service now allows comments, if you’re so motivated.

Thanks to readers who read, commenters who comment, and sponsors who sponse. My pre-HIStalk life was pretty dull five-plus years ago (it’s no rave party now, but at least I can tell Mrs. HIStalk I’m working when I’m derelict in my duties to her as I bound off to my sanctum sanctorum to tickle the Logitech ivories).

E-mail me.

HERtalk by Inga

Last week Mr. H mentioned a couple of tiny ethical dilemmas we were facing. Here’s my two cents. Regarding the company that wants us to post a CEO commentary but supposedly has an anti-blog policy, I am going to give them a bit of slack. Perhaps it is the case of the right hand not knowing what the left hand is doing (is there an HR policy that marketing doesn’t know about?) Perhaps management does not believe all blogs are equal and HIStalk is considered an elite, more professional publication (my favorite theory). Perhaps they just made a judgment error. In any case, I would love to hear an official (even anonymous) response from this company.

Regarding the other company who offered up a CEO but could only deliver a marketing VP or GM, I think it was simply a case of a PR person unintentionally overpromising (surely you sales types know how that can happen). What I did find not nice was the company’s position that a mere blog wasn’t worth the CEO’s time. I wonder if anyone even asked the CEO’s opinion on the interview. My guess is that this CEO is so far removed from the day to day PR activities that said CEO is oblivious to the controversy. I’m blaming the handlers.

Wonderbread had mentioned that most docs didn’t seem concerned about sending claims off-shore for processing a la athenahealth. Wonderbread would rather keep things stateside if possible. I think finding an HIT company not sending some sort of work offshore is becoming increasingly difficult, though some companies are more open about the policy than others. Selecting a vendor based on whether or not some processes are outsourced internationally may not be practical any more. Which reminds me: I had to get help on my Dell a couple of weeks ago and simply judging from the very helpful gentleman’s name and accent, I’m pretty sure he wasn’t from Texas. Dell doesn’t advertise that its support comes from outside the country and I doubt knowing in advance would have kept me from buying my Dell. My open mindedness about the whole offshore thing might change if Mr. H tried to outsource me, I suppose.

Evangelical Community Hospital (PA) will provide Allscripts EHR for its 40 employed physicians and 60 affiliated doctors. Also, Hartford Healthcare (CT) has selected Allscripts EDIS for two hospitals and EHR for its 200 physicians in affiliated medical groups.

Those UCLA Medical Center employees are snoopier than we thought. The CA Department of Public Health announces that 59 more employees improperly peeked at patient medical records, bringing the total implicated to 127.

Here is a universal truth about shoe shopping: if you find a fabulous pair of $100 shoes for $23, you HAVE to tell as many people as possible. Like I just did. (The same formula works for $400 shoes, though my HIStalk gig does not afford such luxury … but I’m not complaining).

Going green is big at HP, where new technology has yielded energy savings about the same as removing 1.1 million cars from the road for one year.

The street seemed to like athenahealth’s earning report. Shares were up 21% Tuesday.

I’m guessing the street will also like the earnings report of Allscripts, which beat expectations by $0.02/share. Excluding non-recurring items, earnings were $.13/share; revenues rose 16.4% year on year, also above estimates.

Kaiser announces a 68% decline in overall income in Q2 compared to the same period last year. Operating income fell 43%, though operating revenue rose 7%. With capital spending and membership remaining flat, Kaiser is blaming the declines on market turbulence.

The HITransition folks have a new low-cost data service for providers, billers, and clearinghouses that need to add Provider Taxonomy codes to their billing databases. Provider Taxonomy is a standard code set that specifies a healthcare provider’s specialty or care setting in electronic health insurance claims and has been adopted by health plans as a way to resolve NPI ambiguities.

Microsoft researchers studied billions of electronic messages between 180 people and concluded that on average any two strangers are linked by 6.6 degrees of separation. (I guess if you are Microsoft you can afford seemingly frivolous studies.) Meanwhile, I am tingling just thinking how close I am to knowing George Clooney.

In one of those press releases that doesn’t say a whole lot, Nuance announces that almost 300 healthcare organizations in the greater NY metropolitan area use a Nuance solution. What I found most interesting is that one in 14 Americans live in the New York region. When you take into account the six degrees of separation thing, it made me realize that next time I go to NYC I probably can find a few hundred New Yorkers that I almost know to let me bunk in for a few days.

QuadraMed announces its Smart Identity Exchange (Smart I/X) solution is now generally available. Smart I/X is designed to help hospitals and HIEs identify, reconcile, and manage patient records across multiple data sources.

In the town made famous by Merle Haggard, DocuSys teams up with CPSI to provide Muskogee Community Hospital with DocuSys’ anesthesia information system. The physician-owned, 45-bed hospital is scheduled to open in early 2009.

D2 Sales lands a nice sale to UPMC, which will use the My Patient Passport Express kiosk for its patient check-in program.

A.D.A.M. names Dr. Alan Greene to the newly created post of Chief of Future Health, responsible for helping drive strategy for consumer-focused health initiatives. Am I the only one who thinks the title is a bit goofy?

Still haven’t heard too much about anyone’s summer vacation, although a reader did forward me this link about a traveling fellow named Matt. If you like the idea of seeing (or dancing around) the world or just want to smile, check it out.

E-mail Inga.

athenahealth To Acquire MedicalMessaging.net

Physician services vendor athenahealth will acquire the assets of patient messaging service vendor Crest Line Technologies, doing business as MedicalMessaging.net of Rome, Georgia for $7.7 million in cash, the company announced after the market close today.

MedicalMessaging.net, a partner of athenahealth since last fall, provides hosted telephone and e-mail communication between practices and patients, managing appointment reminders, prescription transactions, and test results for customers in 13 states.

athenahealth also reported Q2 results after the market close today. Revenue was up 35% and earnings of $0.11 per share beat consensus estimates of $0.09.