Readers Write 9/3/08

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!

Lab Integration: Feds Mandate HITSP
By Product Management Guru

I probably won’t be the only one to point this out, but Interoperability Spec #1 from the federal HIT standards group is lab. This standard is ‘recognized’ by the government, meaning the Fed won’t purchase a product for lab EHR unless it complies. Of course, the standards are complex and most don’t mandate compliance. But, Fed now does.

The purpose of this Interoperability Specification is to describe the top-level specification for the HITSP EHR Use Case. This Use Case comprises two scenarios that describe the entities and interactions that would be needed to implement an electronic EHR or other clinical data system with a laboratory interface. The goals supported by this Interoperability Specification are stated in the EHR Use Case:

• Transmission of complete, preliminary, final and updated laboratory results to the EHR system (local or remote) of the ordering clinician
• Transmission of complete, preliminary, final and updated laboratory result (or notification of laboratory result) to the EHR system (local or remote) or other clinical data system of designated providers of care (with respect to a specific patient)

Many labs don’t care about the Fed and meeting the recognized standard. Or, the existing healthcare standards have plenty of gray areas to squeeze into. I think a lot of people do support the standards like HL7, ANSI, etc., but while the standards provide help for transport and app layers, they often leave mismatched coded values and other vagueness.

So, the two sides still need to spend a lot of time talking about what they place in the transactions. Plenty of people say that some vendor-specific format is less work then figuring out a standard. This seems to be the history of healthcare integration.

HITSP, specifically for the federal use cases identified by the Office of the National Coordinator, is trying to complete the picture by stating ‘use this spec’ as well as ‘use it like this.’ As a major purchaser, the Fed will influence vendor decisions. Early adopters are emerging already.

I noticed John Halamka coincidentally writes about lab values in his blog today (he is also chairman of HITSP). I’ve heard Dr. Halamka talk about how standards have knocked integration projects from $100K-200K to $10K-20K. HITSP is trying to knock them down to $1K-2K (paraphrasing – he may use different numbers). In the interest of disclosure, I have been volunteering time (or my company’s time) on some HITSP committees.

Lab Integration: Labs are Blocking the Plan
By Lab Dude

I think the labs agree this needs to happen, but just don’t want to invest in it. It is very painful to get a lab interface up and running. Each lab has multiple regions that act differently, have their own compendiums, etc. Because there is no standard test code, all the codes are proprietary. Testing is required for each and every one.

The EHRVA had a lab summit meeting in July and brought together the major players in lab (reference labs, EHR vendors, American College of Pathologists, HL-7, CCHIT, etc.) The goal was to create a three-year plan for faster adoption. We decided to create a use case to send to ONC, spent around six calls on it, then wrote it. All along, the labs were involved.

Recently a lobbyist for the labs sent a letter claiming the jointly developed use case goes too far and the labs can’t possibly do it. So, it looks like the labs are banding together to block the plan. It’s very frustrating. How are we going to get better?

Lab Integration: ELINCS Initiative
By e-Practice Management Chief

With respect to your request for comments about lab standards, there actually has been a great deal of work done in recent years in an attempt to establish a standard. While the HL-7 specifications are typically used for results communications, the individual lab providers themselves have different terminologies/codification of results within that specification. The ELINCS initiative attempts to set this straight by:

1. Establishing a more standard construct for the HL-7 specification so that there is less variance in where different pieces of data are placed (e.g. last and first names which are critical for matching). HL-7 adopted the standard in 2006.
2. Using LOINC codes as a standardized nomenclature for observations/results instead of "local" codes designed by different Lab Information System (LIS) providers, which result in variances between systems for the same concept.

One of the barriers right now is a normal one for our industry: the existence of entrenched systems which would be very costly to change. Since there are many regions with just one or two dominant lab players who control their local markets, there isn’t a great deal of momentum to make the changes happen very fast. However, the ELINCS standard definitely has traction with major players such as the Markle Foundation, CMS, HL-7, etc. and it is also the standard for results for CCHIT certification which is obviously a major force.

The California HealthCare Foundation has managed this work, including pilots. Sujansky & Associates was contracted for technical consulting and other management. They have also provided an excellent and free testing tool (EDGE) which we use whenever we have to interface to a new LIS and do testing of those third party results files. Most of the time we seem to get cooperation, but there are some cases where a particular system and its technicians are not familiar with the standard and have problems with making changes.

This link provides good information about ELINCS.

With respect to the ordering process, there is enormous variation with very few true bi-directional interfaces available. Some clearinghouse operations are attempting to act as middlemen, but it is very challenging. Most of the demonstrations still show a manual entry process at the clinic side because they are not used to getting true orders which are typically expressed by doctors using billing terminologies (CPT).

We find that most labs are stuck on legacy systems and held hostage to the LIS vendor’s willingness to make changes. We don’t require that they meet the specs 100%, but we do refer them to ELINCS as optimal specs. Our interface developers think that maybe half of the vendors actually go to the ELINCS site to at least look at the specs. Because changes may have to be made anyway, labs have to invest some time and money changing their format, to some degree. This is also a reason why some entities like hospitals often contract to third parties like Iatric. They can keep their existing system and have the middleware keep up with other changes.

Lab Integration: Nobody Dislikes Standards
By Bob Nadler

You asked, "Are lab standards an issue one of the various work groups is addressing? Are the labs on board?"

When you say lab, what you’re really talking about is the large number of medical devices commonly found in both hospitals and private practice offices. As you note, the need for interfaces to these devices is so the data they generate can be associated with the proper patient record in the EMR. This not only allows a physician to have a more complete picture of the patients’ status, but the efficiency of the entire clinical staff is vastly improved when they don’t have to gather all of this information from multiple sources.

The answer to your second question is yes: many labs — medical device companies — are actively in involved in the development of interoperability standards. The EMR companies are also major participants. There are two fundamental problems with standards, though:

• A standard is always a compromise
• A standard is always evolving

By their very design, the use of a standard will require the implementer to jump though at least a few hoops (some of which may be on fire). Also, the device-to-EMR interface you complete today will probably not work for the same device and EMR in a year from now. One or both will be implementing the next-generation standard by then.

Nobody dislikes standards. Interoperability is usually good for business. There are two primary reasons why a company might not embrace communications standards:

1. The compromise may be too costly, either from a performance or resources point of view, so a company will just do it their own way.
2. You build a propriety system in order to explicitly lock out other players. This is a tactic used by large companies that provide end-to-end systems.

The standards problem is not just a healthcare interoperability issue. The IT within every industry struggles with this. The complexity of healthcare IT and its multi-faceted evolutionary path has just exacerbated the situation.

So, the answer is that everyone is working very hard to resolve these tough interoperability issues. Unfortunately, the nature of beast is such that it’s going to take a long time for the solutions to become satisfactory.

Lab Integration: The Thorny Problem of Semantic Interoperability
By Huckleberry

I work with hospitals sending data to physicians’ ambulatory EMRs. I had to say "thank goodness I’m not alone" when reading your comments.

I’ve been to many conferences (TEPR, HIMSS, World Health Congress, etc.), and nobody seems to be able to tackle the thorny problem of semantic interoperability. Everyone can speak HL7, but that’s only half the problem. There are so many different entities that need to agree on what each of those data elements MUST ACTUALLY MEAN that I’m not sure we’ll ever see a solution.

I heard one speaker say something like, "We can send a man to the moon, but we can’t exchange healthcare data." His point was that it might take that type of governmental effort (and mandate) to make this happen. I cringe thinking about it based on what’s happened so far on the governmental front with the NHIN, CCHIT, etc., but he may be right.

Something hilarious. Check the box at the top of the Wikipedia definition of semantic interoperabilty. Well, that’s it in a nutshell, isn’t it?!

Open Software Review -  Aurora by Adaptive Path
By The PACS Designer

Aurora is a concept video presenting one possible future user experience for the Web, created by Adaptive Path as part of the Mozilla Labs concept browser series. Aurora explores new ways people could interact with the Web in the future based on projected technological trends and real-world scenarios.

Through the development and release of Aurora, Adaptive Path, a research and development practice, will contribute its design expertise to support Mozilla’s efforts to inspire and engage a global community in an open design process to spur improvements.

The increasing ubiquity and importance of the web browser made it an excellent candidate for an R&D project. Mozilla Labs and its efforts to scale its open design process offered Adaptive Path an opportunity to contribute to the community and help Mozilla reach out to designers as well as developers. Adaptive Path’s emphasis on collaboration and openness was a good match for the culture and values of the Mozilla community.

The key components of Aurora are:

1. Natural interaction: Spatial, visual, and physical engagement with the Web
2. Continuity: Seamless, consistent Web and browser experience across devices
3. Multi-user applications: The Web as a space for collaboration, sharing, and remixing
4. Context awareness: Products that know where you are and what you’re doing, both physically and virtually

There’s a video of the Aurora solution.

While Aurora is possibly a Web 3.0 solution, it is a good example of what developers are focusing on to make the web experience more interactive and informative.

News 9/3/08

From Cherry Forever: "Re: RHIOs vs. PHRs. Another big difference is that RHIOS are controlled by the providers. They can add or remove data as they will. PHRs are controlled by patients – very different business model. The RHIOs sell themselves to providers as ‘safe places’ to share data. PHRs will have a harder time doing that. Also, RHIOs tend to be focused on data from a given region. PHRs are not, though that could be fixed by giving PHRs feed from the various RHIOs. Some RHIOs are set up as federated models (with a centralized index and a service API to call the provider data base when records are needed). I don’t see provider CIOs as lining up to allow random PHRs to call their data bases. It’s hard enough to get RHIO access, very hard.  They are also likely to want to limit the data that is fed to the PHR; it won’t be the same data set that is sent to the RHIO."

From Sarah P. Admirer: "Re: Sarah. Say what you will about Sarah P. Cheap shot to not editorialize on candidates equally, though." Actually the cheap shot was at former unsuccessful candidate Jeanne Patterson. Without the Cerner connection, I wouldn’t have had the slightest interest.

From The PACS Designer: "Re: OpenMRS Touchscreen. TPD posted a writeup recently about OpenMRS software that is used mainly outside of the U.S. and is gaining in popularity. Now, interns from Trinity College, Wesleyan University, Connecticut College, the University of Hartford, and the University of Connecticut have completed The Touchscreen Toolkit Project and four other software projects that can serve a variety of humanitarian applications, from Hartford to Africa to Sri Lanka. The Touchscreen Toolkit Project is a part of the Humanitarian Free Open Source Software (HFOSS) project. The toolkit is being implemented in the Open Medical Record System (OpenMRS) project as a module that will allow clinicians to use OpenMRS with a touchscreen." Link1, Link 2, Link 3.

Listening: to this gadget, which is streaming my old favorite Aural Moon progressive radio, one of the 13,000 streaming stations it runs. It’s just a USB drive with some jukebox software and predefined links to streaming radio stations, but it’s still cool (and the tiniest USB device I’ve seen, barely bigger than the plug itself). I got it from Buy.com for $24.99 and free shipping. Plug it in, up comes the jukebox with search by genre, name, or location. A couple of clicks and I’m looking at a list of 486 stations in China, followed by a supposedly alternative station that’s playing a bad, non-English duet of Rhinestone Cowboy.

An ED admission prediction tool is being used in Australia to forecast demand for staffing and OR time.

Tomorrow is Readers Write day, so if you’ve got something to say, send it my way (rhyming unintentional).

A Computerworld article says that hospitals aren’t using supply chain automation like they should, calling healthcare "dinosaurian." Reasons: low budgets, acceptance of labor-intensive processes, lack of a big player like Wal-Mart, and lack of standards. One multi-hospital client spent eight times what it could have if all of its buyers purchased together at the most favorable price. Good article.

Peter Bodtke, vice president of non-profit WorldVista, will ride his motorcycle 11,000 miles throughout eight Central American countries to promote awareness of VistA. He’s doing all of South America next year. He’s looking for donations and sponsors to help pay for the trip.

Google rolled out the beta (isn’t everything Google in permanent beta?) of its new IE-killer browser, Chrome. I’m running it and it’s a bit sparse and slightly buggy, but I’m sure that won’t last. Like the new IE, it has Porn Mode (i.e., "incognito"). They were supposedly anxious to get Chrome out because IE’s Porn Mode won’t let Google collect stats and user habits for advertising targeting. It’s not ready to be a permanent replacement for Firefox (it seems to be slower except on Javascript-heavy sites) but it’s worth playing around with.

A hotly debated issue: is the fist bump an acceptable form of business greeting?

Federal investigators hit the road for Indiana, making unannounced hospital visits to audit billing for the back surgery called kyphoplasty after whistleblowers brought billing issues to Uncle’s attention.

Send me your news, rumors, and ideas. I read every e-mail.

E-mail me.

HERtalk by Inga

e-MDs founder Dr. David Winn is stepping down from his CEO role and will assume the role of Chairman of the Board. Dr. Michael Stearns, who has been serving as President will now add CEO to his title. Winn says he will expand his medical missionary work in foreign countries and other philanthropic endeavors. e-MDs also just hired Maria Rudolph as VP of Business Development. Rudolph previously worked at Cerner, Quadramed, and a couple of medical associations.

King’s Daughters Medical Center (KY) claims its ED wait times have been cut from an average of 220 minutes to 118. The hospital attributes most of the increased efficiency to the implementation of its T-System EMR.

Medicity is spinning off a new venture named Allviant which will develop a product called CarePass. The new group will be based in Scottsdale. It will focus on designing tools to help consumers interact with providers and ultimately reducing the time patients spend waiting, calling, and filling out forms.

NQF endorses nine national voluntary consensus standards for HIT. The areas included are eRx, EHR, interoperability, care management, quality registries, and the medical home. Will the endorsements have any effect?

Last week I asked some questions about labs, lab standards, etc. Thanks for all the great words of wisdom on obviously a hot topic. I am compiling a few of the responses into one piece for our Readers Write posting on Wednesday. Here are a couple thoughts to consider until then. “I think that labs agree we all need to work together to bring faster adoption. Following a recent EHRVA lab summit with participants from multiple affected parties, everyone agreed we needed to develop a use case to send to ONC. Now it appears the labs are banding together to block their support because they don’t want to invest in it.” Another: “There actually has been a great deal of work done in recent years in an attempt to establish a standard. While the HL-7 specifications are typically used for results communications, the individual lab providers themselves have different terminologies/codification of results within that specification. The ELINCS initiative attempts to set this straight.”

I had to visit my local Apple store today (note that one can only drop an iPhone so many times before it starts to have problems). In case you decided to wait until the stores were less frenzied over 3G sales, you best keep waiting. It was packed at 11:00 a.m. with lots of happy shoppers.

Gustav thankfully was not Katrina, but still has created some chaos. Twelve Louisiana hospitals are considering moving 800 patients because they don’t have air conditioning. Meanwhile, at least three Iowa hospitals have asked for over $4 million from the Rebuild Iowa Advisory Commission to restore facilities flooded earlier this summer.

I plan to watch some convention coverage tonight. For those interested in mixing fashion in with your political viewing, Cindy McCain is all about haute couture. I just wish we could see more of her shoes.

E-mail Inga.

CIO Unplugged – 9/1/08

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

Green Standard Time
By Ed Marx

In the last few years, the Green movement http://en.wikipedia.org/wiki/Green_politics has picked up momentum as the world comes to grips with the reality that we belong to a single ecosystem and must be prudent caretakers of our shared Earth. Sidestepping political foray associated with the movement, one principle I agree with is conserving our precious resources. The most precious non-renewable resource of all is our time.

I advocate “Green Time.”

My audiences and Blog subscribers often ask how I manage to accommodate all my passions—and do them well. After a recent talk on mentoring, a woman said to me, “I have read your blogs and seen your YouTube Ironman videos where you share the amount of hours invested in training. If you were to take a 20 week period and subtract the time for training, sleeping and working, how do you have time for anything else?” She stated the exact hours associated with each.

Part of the answer boils down to personality where my wife will attest to my unconventional modus operandi. Aside from that, however, I do not subscribe to the work-life balance philosophies popular over the past decades. Technology has created the capacity for more fluidity and integration in the post-modern lifestyle, freeing us from the bounds of compartmentalization. If I am inspired at 3am to work on something, or on a Saturday, so be it. If I want to be home for an important mid-day occasion, I do it. I measure my productivity in outcomes, not hours.

There are numerous books on time management that will do a far better job than I in providing tools and tips, but here are a few that work for me.

· Team Work Makes the Dream Work (http://en.wikipedia.org/wiki/John_C._Maxwell)

You are only as successful as the people around you (see post “Talent Rules!)

You must have a great assistant like I do

Delegate authority and responsibility to the lowest levels possible

Provide vision and remove barriers, then get out of the way and allow your team to make it happen

· Multi-Task

I carry out the majority of my conference calls while in the car (Safety tip: integrate a complete bluetooth environment in your car to do this)

My laptop with “aircard” shadows me everywhere enabling me to catch-up on miscellaneous tasks during any unexpected downtime

I keep up intake while biking and running indoors (see post “Chief Intake Officer”)

All division leadership meetings include 29 minutes for professional development

Outdoor runs, rides, and swimming incorporate prayer and reflective thinking; Blackberries are great for spontaneous note taking

· Meetings

I attend fewer meetings by allowing others to represent me

Too often, I have looked around a meeting room at the people involved and wonder at the duplication of effort and wasted resources

I ask myself, “Is my attendance really necessary?”

I adopted principles from “Death by Meeting” and improved outcomes http://www.tablegroup.com/books/dbm/

I create regularly scheduled “block times” where I do not attend meetings

Practice those things you probably know but don’t do: Agenda, Meeting Purpose, Facilitator, Timekeeper, Action Items, etc.

· Stop Watching TV

The average person watches somewhere around 20 hours per week. Set yourself free, and buy back 20 hours!

I married my college sweetheart between our junior and senior years. Possessing little cash, we lived without a TV and never became addicted. Today, we watch a couple of movies per month and enjoy an exceptional TV moment such as the Olympics. Even then, one of us will climb on the elliptical or stationary bike instead of acting the couch potato (see multi-task)

· Vendors

I only spend time with strategic partners; my team handles tactical and emerging partners

I rarely do lunch or dinner meetings or other boondoggles. Instead, I do occasional breakfast meetings, which are quick and part of my existing work routine (see multi-task)

I’ve started doing workout meetings. We meet at the gym and talk while working out (see multi-task)

· Work from Home

I save up many routine and/or intensive tasks for my home workday, Fridays. My productivity easily increases by 50% or higher. My assistant does this as well. My entire division is encouraged and free to work at home as much as possible

If the above is impractical, carve out a minimum weekly 4 hour block of time and visit your neighborhood Starbucks, Barnes & Noble, Panera, Library, etc. Free yourself from distraction, and concentrate on work for an extended period of time

· Be mission and vision driven, and take control of your destiny (see Post “Taking Control of Your Destiny”)

· Focus

Where ever I am and whatever I do, I am in the moment

I begin each workday by seeking God and preparing for the day’s and week’s tasks and objectives

I give everything I have to the task at hand

· Outsource

I hire others to do tasks that sap my energy and time, such as lawn care and household/car repairs. Some say they can’t afford this. I argue you can’t afford not to if you want to have energy to focus on what will help you realize your vision

“Outsource” other home tasks. Teach your children certain tasks. (Our son received his A+ certification training at age 12; for 6 years, he became the household go-to person for all things technical.) The neighbors hired him on several occasion for computer needs. Do your neighbor kids have skills you can employ?

· Exercise

Studies have shown that exercise not only improves the odds of a longer more healthful life, but sharpens the mind

I do the majority of my workouts while others are sleeping. My workout facility opens at 5am and is 5 minutes from my office. Time and location are significant conveniences

Golf! I’ve never stepped foot on a course, but many CIO’s do. Are you using those 3-4 hours wisely? Can you golf with family or with vendors?

· Family time

Evening walks. Weekend bike rides

Got teenagers? We connect with ours by playing Rock Band. (Although I am the lead vocal, my kids warn me not to quit my day job)

My kids let me practice my speeches on them and use them as sounding boards. They get a taste of what I do, which keeps us connected and broadens their perspectives

Part of my weekly dates with my wife include a joint workout and prayer, things we both believe in

Regular dates with the kids is crucial

Family first + work second = everybody happy

· Rest and the Sabbath

I get to bed around 9pm each evening for an average of 7 hours sleep per weeknight, more on the weekends

I attempt to reserve Sundays for pure rest, no work of any kind. Counterintuitive, this principle applied leads to more time abundance

· Mood affects everything

Gratefulness allows me to enjoy the time I do have

Always give thanks. I was a janitor and I was thankful. I was a pizza delivery driver and I was thankful. I was an Army Private and was thankful. I am a CIO and am thankful. In all things, give thanks. It’s a choice.

I don’t believe our environment is completely controlled by the actions of the population, but I do know I’m responsible for how I manage my personal time. Hence, my choices govern my impact on those around me. In this sense, I’m a dogged proponent of “Green Time.”

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

Monday Morning Update 9/1/08

From The PACS Designer: "Re: stackable switches. When constructing a network, developers use Ethernet routers and switches to create the user networks of PCs. Now, there is a new 3com switch being advertised that provides better redundancy. When connected to each other through a stack, they provide hot swappable units to insure networks remain up during component failures." Link.

From The Skeptic: "Re: Siemens. To Leyden, you are absolutely right – Siemens’ HIS days are numbered. Their experiment with Clinical PowerPoint didn’t conclude with a good outcome. But knowing Cerner as well as I do, I would not laugh all the way to Leeds or to any other location on this planet. Modules that are supposed to be ‘seamlessly’ integrated are NOT. Interfaces are inconsistent, like they originated from different vendors. Users need to document the same info again and again. If I had the resources and courage, I would short their stock."

From Attendy: "Re: Epic’s UGM. Mr. HIStalk, are you attending?" No, I’m not an Epic user.

From Dave: "Re: Eclipsys. Eclipsys laid off its entire Alliance team today (Thursday) that focused on its best clients." Unverified.

From Epic Calculator: "Re: Epic revenue. Revenue per Employee at Epic is a bit over 153k (using the data published on HIStalk). It is OK, but not stellar or in anyway spectacular. Software companies go from 150K for the SMALL ones to 220k and up for the LARGE ones. Just some food for thought for the potential investor out there." Thanks, I meant to run the calc myself. I’m a little surprised that they don’t excel there. Meditech’s at $131,000 by my calculation, low in the range.

Yes, I’m laboring on Labor Day. Apropos, yes?

Listening: The Makers, angry garage-glam, Stones meet Stooges. And one of my favorites, long defunct Moxy Fruvous: witty, harmonizing Canadians (they play it serious on the greate Thornhill, although some old-time fans couldn’t handle the change).

A trustee of Regional Medical Center (SC) questions the hospital’s choice of Cerner over Meditech, complaining that at $12 million vs. $4.5 million, "I don’t think we got the low bid, folks." The CIO claims that Cerner underbid Meditech overall, $11.9 million vs. $12.1 million (that’s hard to believe). Some trustees complained that they didn’t get to go to Kansas City to see Millennium first hand, which would seem to indicate some misunderstanding of the role of a trustee. 

Not surprising except to those who think healthcare is free if you don’t feel like paying: clinics are dropping patients who aren’t paying their bills, many of them with self-chosen high deductible plans who knew the risk of paying out of pocket going in. I believe it’s safe to say that, very soon, it will be the rule rather than the exception to make patients pay for care upfront since so many refuse to pay afterward.

A liberal group’s blog draws a savage but amusing parallel between McCain VP pick Sarah Palin and failed congressional candidate Jeanne (Mrs. Neal) Patterson: "She came off looking like a Tupperware lady who had read too much Ayn Rand."

Bayfront Health System (FL) is looking for a RN-Clinical Informatics/Transformation Leader. Since nobody ever seems to finish transforming, it’s probably a good gig.

Another example of Microsoft’s desperation and/or willingness to litigate rather than innovate: they apply for and receive a patent for "Page Up/Page Down." Maybe they’ll send out a little trademark symbol for your keyboard keys.

Asian doctors are turning cell phones into a mini Wii Fit. COPDers walk to software-driven music that optimizes their lung capacity, with reports going back to doctors. One-year hospital admissions were 22 of 24 in the control group, but only 2 of 22 in the control group.

There’s a new text ad to your right from the folks at Sun, which now owns the database that powers the Internet, MySQL. The ad mentions FairWarning, an interesting sounding EHR surveillance tool for privacy issues. I hereby contribute my more memorable product name, Snoop Doppler, or for the appliance version, the Britney Box.

Gustav is headed toward the Gulf Coast at this writing, just what New Orleans doesn’t need. The former Charity Hospital, now University Hospital, still has its electrical systems in the basement and it’s sitting in a natural depression. Labor Day hurricanes are always nasty, it seems. Here’s a positive thought to those in its path, especially those hospitals that, as always, are the beacon of safety and healing for those affected. While everybody else hunkers down with their families, hospital workers leave theirs to help strangers. The final 85 unclaimed Katrina bodies were symbolically buried Friday just ahead of the Gustav evacuation.

BIDMC will share its patient portal data with Microsoft’s HealthVault.

Mt. Sinai (NY) will redesign its smartcards to follow CCR standards, hoping other hospitals will do the same to allow exchange data (is that a RHIO in your pocket, or are you just glad to see me?)

Meditech-owned Prowse Farm, a historic site in Canton, MA, is throwing a fundraising doo-wop outdoor concert on on Saturday, September 13. Funds will be used for development of its museum and education center. I’m a big doo-wop fan and seeing Gene Pitt and the Jive Five alone should be worth it. See the live video of "My True Story" here although "These Golden Rings" and "Do You Hear Wedding Bells?" are better; they changed to soul music later, charting with "What Time is It?". I don’t know of any doo-wop group whose entire lineup contributed like the Jive Five’s. Epic’s campus gets a lot of attention, but this view of Meditech’s from Prowse Farms (by ophis) is more interesting if you like history and non-flat ground.

Hawaii Medical Center files bankruptcy after Siemens Finance declines to extend its $5.5 million loan.

London trust hospitals are apparently gearing up to seek damages from BT and/or Cerner over system problems.

I hope you have (or had) a nice holiday. Thanks for reading.

E-mail me.

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.

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