A Report from the Cerner Health Conference

The Cerner Health Conference kicked off Sunday at the Kansas City Convention Center. Don Trigg, Cerner’s chief marketing officer, offered to connect me with some attendees for a report. (I should note that, despite my occasional criticisms of Cerner, Don has always been a straight shooter, has invited me to Cerner events, and offered to connect me with sources there, all in a casual, non-official way, which I appreciate).

My guests for this live update were Helen Thompson, CIO of Heartland Health of St. Joseph, MO; Reid Conant, MD, CMIO of Tri-City Emergency Medical Group of Oceanside, CA; and Stephanie Mills, MD, CMIO and CIO of Franciscan Missionaries of Our Lady Health System of Baton Rouge, LA. I’m sure they were ready to relax after a long day of conference education, so I appreciate their voluntarily taking time to speak with me.

What’s your impression of the conference so far?

Reid: It’s been very productive sessions so far. I gave two talks today and will be on a panel on Wednesday. I sat in on a few sessions and shared ideas with my colleagues. The setup of the CHC is kind of neat – it’s primarily client-driven educational sessions. The overwhelming majority of sessions are either entirely client-presented or have a panel with Cerner people and other clients. It’s sharing of ideas. It was in Orlando for a few years, now it’s back in Kansas City. It’s a very productive way of sharing ideas among clients. We’re using many of the same applications. You can always learn something from someone else who’s using what you are in a different way.

Helen: The networking that we get from this event, as well as the strategic look at what’s next on the agenda, makes this an extremely valuable conference.

Stephanie: It’s been very interesting to watch healthcare IT over the past several years. I’ve seen us as clinicians become more engaged, more involved, and more committed to developing solutions for quality and patient safety challenges. It’s a group of colleagues with the same experiences, tools and challenges. It’s important to get together in a safe environment and collaborate. It’s amazing what comes out. It breaks down a lot of the barriers.

How would you compare the value you get from attending Cerner’s conference to other conferences like HIMSS?

Helen: We’re just 45 minutes north of Kansas City, so the location factors in. We have an opportunity to do much more focused sharing and learning from one another. HIMSS has such a broad range that it makes it difficult to do this level of collaboration.

Stephanie: It’s practical, with stories from other organizations. Very practically oriented. HIMSS tends to be more theoretical, which is also good. You need both sides of the coin. In the trenches, to know what is or isn’t working.

Reid: Being in Kansas City, there’s been an even larger presence of Cerner associates. That’s done a few things. It’s gotten them more involved and given them a view of what clinical medicine is. I heard from a few of them that that is encouraging to them as they’re working on code. For us, it allows us to give them direct feedback. That’s very important and they seem to listen. I’ve been on an ED solution advisory group for years and they take direct feedback on specific issues. Today in one of my talks, I spoke about using scribes with PowerNote. Cerner has electronic, template-based charting. To augment productivity, we use undergraduate students to assist the physician in creating that document. That electronic record gives them the tool. After this talk, an engineer came up and said, “We liked what you did with that column. It fits with our code.” They want to put it in the product. These guys will listen and the next service pack will often have those kinds of suggestions in them. That reception of ideas is valuable.

Stephanie: Team members were here and some of the Cerner documentation team were dealing with some challenges that’s been difficult to diagnose, working over phone and conference calls and sending log files back and forth. We got in the room, got on the system, and had both teams together. To be able to share those experiences is really valuable, to have direct access to a vendor and share that knowledge and experience and frustration – it really gets folks bought in to finding the solution. We build relations with people, not just a voice over the phone.

Reid: It makes them accountable on a personal level.

Helen: It makes us accountable, too, because we share feedback with them. The success of our organization is tied to the success of this application. It’s very much a two-way learning street. They learn so much from us while we’re down here presenting and we learn from them as the dialog is opened.

Have there been any big announcements or revelations so far?

Reid: This morning, Neal Patterson said something that I felt was impressive. Cerner has taken a stand as an organization and said, “We are going to focus on the current code level.” In this day and age of rushing to get the next release out, they said they’ll focus on 2007 code and put all of the innovation into that code level. They’re going to, for the rest of this decade, ride that code level and make it the best they can, as solid as they can, before moving to a major change to the architecture of the code, incorporating Java and so forth. Thankfully, they recognized that ahead of time. I appreciate that.

Stephanie: We’ve had keynote addresses, discussion about health policy, the future of healthcare, how technology can come to the table in a number of ways. Then, lots of sessions in different areas that focus on a combination of presentations from clients in the trenches and living this, and also some sessions from the Cerner team about what’s going on today in problem solving and development.

Helen: The conference is broken down into a series of tracks to select from. Some are application-specific, some are role-specific. There’s quite a broad range.

You mentioned code levels. Millennium’s Achilles heel for years seemed to be response time, with a rumor that the entire application would have to be scrapped and sent off to India for a rewrite. Was that mentioned and are you seeing performance issues?

Reid: When went live 3 1/2 years ago, we felt some of that. We’ve been remote-hosted since go-live. Some places that tried to do it on their own felt that impact. They had more delays then than now. ED is one of the fastest paced environments. Anything short of sub-second response time won’t cut it and I won’t hesitate to call them for a four-second delay. That’s just not an issue any more. We’re using CPOE with meds and every order I enter is through the system. I can enter 20 to 30 orders on a complex patient in 15 seconds, using order sets and other tools. There are lots of clicks. If response time is not immediate, I feel it and they hear about it. What Cerner highlighted today is the Lights On Network, a Web-based application that allows you to drill down to an institutional and user level on response times. They track some huge number of the most common and most important actions. They track each and every one, so you can literally drill down to Dr. Mitchell if he’s complaining and say, “We saw at 2:55 pm you had one delayed action, but other than that, it’s been sub-second.” You can also pull out by department, not just response times, but how they’re using it, like ignoring alerts.

Helen: We’re a client-hosted solution and Lights On Network user for over a year. We’re very pleased with system performance improvements that Cerner continues to develop from data they get from Lights On.

Stephanie: I agree. We’ve been quick to look for a quick fix for our healthcare woes and sometimes fall prey to technology seduction. We want the magic Band-Aid. At the same time, we’re quick to blame when the magic fix doesn’t solve the problem. You can’t do that in a vacuum. When you look at performance, we have a lot of challenges that can be pointed at a particular vendor or application. We’re maturing as an industry in applying best practices like ITIL. For leaders in healthcare IT, it’s important to have a comprehensive perspective and make sure our organization is optimized to provide quality of care and to apply technology. It’s about people and processes and workflow and not just automating a process.

Helen: We need to think back. When we had a paper record and a very ill patient and the chart got larger, it took longer to filter through that information. The more data we collect, it will be a more constant process to keep sub-second response.

Reid: One real strength of Millennium is integration, like accessing old records. If the patient rolls into the ED by ambulance, with a couple of identifiers I can pull up the record from visits three days or three years ago. The ED course is immediately accessible to the nurse in the ICU. For hospitalists, it’s worth it to get out of bed and get online. They can look at orders and tests.

Stephanie: It really does change the way we pratice completely.

Are you glad the conference moved to Kansas City?

Stephanie: It’s helpful for the reasons we mentioned, access to team members and architects and engineers and folks here behind the scenes that we don’t get to build a face-to-face relationship with. Orlando is a very big conference town and its nice to bring it to Kansas City.

Reid: It’s a busy week, too busy to bring the family to Disney World, so we get much more out of having it here.

Are you planning to check out any particular Cerner products?

Stephanie: We’re an integrated Cerner site using a lot of the solutions. We’re going through a reorganization of Information Services. The next step is to optimize what we have, dialing things back, looking at current state, looking at workflow. The next piece that we already own but haven’t implemented is Power Insight, which has clinical and operational dashboarding.

Helen: We’re optimizing the solutions, also looking at the Care Aware product, leveraging the application to move to a digital environment.

Reid: Care Aware is on the horizon. It was demonstrated this morning at the kickoff. In the ICU setting, where they’ve had antiquated paper flowsheets with graphs four by six feet double sided [laughs] someone goes in there with a pencil and traces the latest vitals on that graph. How antiquated is that? But it was one of the most useful tools. If I go to a code, that’s one the first things I look at. Care Aware is a centralized reporting tool and repository for acute care patients. Many of us were salivating at the demonstration. It uses a larger screen, maybe a 20-inch monitor, with an image of the latest chest X-ray, vitals, etc. It’s highly customizable at the user level. It asists you in decision-making, changes in plan. It appears that it will be an invaluable tool.

Stephanie: It will be great. It’s been fun to see this in development. In Louisiana, we have problems with access to care. We can leverage what we have outside of our walls to create a virtual critical care environment that’s more automated. We’ve been saying, “You have to be able to tell the story and have that snapshot in a comprehensive view.” Our Lady of the Lake has created our version using Cerner tools, but it’s pieces and parts and not quite as seamless. To be able to see that pulled together and configurable is certainly where the future is.

Reid: It takes something like the tracking board in the ED, the FirstNet application. The tracking board is highly customizable, data-rich, and drives processs improvement. It’s a very powerful tool. At a glance, you can see exactly what’s happening with each patient, what’s pending and what’s back. It’s a matter of getting as much data in an organized fashion right there in front of the provider.

What would you say has changed most dramatically about Cerner in the last couple of years?

Stephanie: I’ve seen consistent dedication to partnership, to collaboration from Neal Patterson down, a true interest in what’s going on and how Cerner can impact that. I think it’s authentic, it’s genuine. When the Cerner brass comes to visit your hospital, they’re out there and want to know what’s going on. They’re continuing to march the ball forward in that arena. We need all the help we can get in healthcare, to have companies that are truly committed. We’re all in this together. To feel that we’re able to collaborate with our colleagues and vendor partners in a meaningful fashion and with the patient as our primary responsibility – what more can you ask for? We’re continuing to see clinician involvement on the Cerner side. That’s promising. They’re taking a smart approach to technology, applying it where it makes sense, and not just trying to get the latest whiz-bang out.

Reid: An example of that is the organizational decision to take a step back and not advance to the next code immediately. That’s organizational maturity. There’s always the risk of misperception of what that means. I don’t think it’s a negative indicator. It just shows that, when they roll out the next code, that they want it to be a dramatic step up. Where we already are is phenomenal. Look at the curves on the Lights On Network and graph performance over the last year or two. You can see a very steady and fairly steep drop in response times, now to the point where it’s not an issue.

Monday Morning Update 10/8/07

From The PACS Designer: “Re: Oracle RAT. A new feature of Oracle 11g is Oracle Real Application Testing, or O-RAT. If you need to make frequent changes to your database applications, O-RAT makes it easier to identify and quickly fix any problems that may be occurring in the production system. One nice feature allows you to capture the production section that needs repair and bring back to the testing platform for analysis and testing of the changes you made to fix any problems. Also new in O-RAT is an SQL Analyzer to do more with fixing and improving performance of any SQL executions.” 

From Jake Ryan: “Re: HealthVault. Why anyone thinks our industry should connect patients to doctors before we connect doctors to their own data via other doctors and hospitals constantly blows my mind.” That’s where everyone thinks the money is – consumer advertising. Nobody pays doctors extra for demanding the full set of data that they know is available. Nobody pays insurance companies less if they don’t insist on it. Ads have a simpler revenue model – you make money for showing them or getting people to click on them. Whether that turns out to be beneficial to the clicker or clickee doesn’t matter. Until they stop clicking.

From Samantha Baker: “Re: HealthVault. I couldn’t agree more with your Healthvault comments. What strikes me is that technology companies often don’t understand that people have relationships with physicians, not Web sites.” PHRs are a pipe dream until (a) doctors can get paid for delivering care electronically; (b) access to patient-maintained information from the practice’s EMR is seamless; (c) information can be imported into the EMR to become part of the legal medical record; (d) patients and application vendors get serious about making data collection easy and error-proof; and (e) a firewall is created that keeps insurance companies and employers from digging around patient information to use it against them. I’m not even mentioning privacy concerns since those are obvious. The healthcare model is built around your driving to the doctor’s office, even when your needs could be addressed via electronic means. Parallel: there may be a few people who use TurboTax religously and constantly throughout the year and then make a CPA appointment to review their records at tax time, but not many. Plus, CPAs accept what you give them at face value, while doctors insist on observing it for themselves. Like much of the practice of medicine, you won’t change that unless you change medical education.

PHR counterpoint: the worst that can happen is that no one will use them. Surely they don’t cost much to build for a big company like Google or Microsoft. The search engine alone will more than pay the bills, most likely. These companies aren’t tied to healthcare anyway, so why not take a shot and walk away if it flops? Once the site is built, keeping it running even with few users is easy. Maybe enough of those little old ladies who love going to the doctor will keep PHRs with the same fanaticism as scrapbooking, clicking on enough ads to keep advertisers paying. That’s hardly a healthcare revolution, but then again, that’s not what motivates advertisers or Microsoft. And, the spur in medical device connectivity is a good thing.

From Farmer Ted: “Re: ‘I’ll Have What He’s Having’. With such a major investment and one that has the potential to be significantly disruptive and impact patient safety, can you blame people for the approaches that have been taken in purchasing systems?” Not really, especially since the minefields are many. However, hospitals like to think that continually seeking more information will lead to a better decision. There’s only a dozen or fewer clinical systems vendors out there, so it’s not an infinite universe of possibilities (although the one option they often should choose, i.e. not buying anything, is often given the shortest shrift). If a vendor can produce even one hospital that is achieving great clinical or financial results while using its software, then (a) it’s good enough; or (b) software isn’t a critical factor in that outcome anyway. In fact, I’ll postulate that the search process is of far more value in giving a hospital information about itself than about potential vendors. However, that discovery may lead hospitals to believe that identifying the problem, plus simultaneously looking at systems that claim to solve it, means that the problem is nearly solved. Unfortunately, ain’t so, usually for organizational reasons, not technical ones.

Speaking of HealthVault, Bill Gates has an editorial in the Wall Street Journal. It’s grand and eloquent in scope in its observation of human endeavor and frailty, skillfully masking the message that Microsoft is getting sand kicked in its face by Google and everybody else and needs a new advertising platform. It has the obligatory IOM quotes, healthcare crisis boilerplate, fragmented information examples, etc. Bill claims that HealthVault “will undoubtedly improve the quality of medical care and lower cost.” I’m doubting, so prove me wrong in a research study. Or, why not go at risk for a percentage of the savings instead of charging for ad space?

Last on HealthVault: lots of people hate Microsoft. Blue screen of death. Microsoft Bob. Forced upgrades. Browser security holes. Antitrust issues. Internet tollgate. Assume people buy into PHRs on a big scale. Of all the companies offering PHRs, which one would they trust least with their most personal information? Some Ukrainain hater will have it hacked by this time next week, I suspect.

A couple of readers e-mailed me with the names of a few customers of Unibased Systems Architecture. To clarify: I wasn’t doubting that they have customers, but I am saying that I don’t know who those customers are, have never heard USA mentioned in a CIO’s presentation, and haven’t gotten any e-mails requesting or offering information about them. Their site lists three new customers the past year. I talked to them once years again, but we bought from a competitor.

Speaking of USA, they get a mention in the St. Louis newspaper, which unfortunately managed to misspell the company’s name in its headline. It is a weird and unwieldy name, I’ll admit.

Some NHS trusts want to break ranks from Cerner Millennium for mental health applications.

McKesson announces Horizon Homecare Wound Advisor. Says its integrated. Could be since it’s home care, but when you see Horizon, always ask: Were all modules developed internally by the same company? Are the development offices in different cities? Is more than one database required? Can the integrated suite run without an interface engine or HL7 processor? Can the entire app be upgraded in one step and by one team? How many ADT feeds are required? Does every client run all the pieces, and if not, how are they disconnected from the mix? Are multiple copies of any table stored? Does any system in the package have different data rules, i.e. dumbing down configuration data so the most backward system in the chain can understand it? Are user tables maintained in just place? Well, I could go on, but you get the picture.

Eclipsys is having its user group meeting starting Sunday (October 7) in Orlando.

Listening: The Clash, London Calling.

Interesting comment from J.D. Kleinke of Omnimedix, the company that was originally developing the Dossia PHR application for big employers, among them Wal-Mart and Intel. “We don’t believe a system that is developed and operated by employers will be trusted by employees.” Based on that, I’d bet that privacy issues were somehow involved in the parting of ways and eventual lawsuits between Dossia and Omnimedix. Maybe the employer-led Dossia wanted keys to the PHR’s back door?

Tennessee vendor Aionex gets some angel investor money. The company is 12 years old, the product seven, and it’s still trying to get going. Advice: lay off the techie buzzwords unless you think programmers are making purchasing decisions. Example from the first paragraph of the home page: “The APRP core is a relational database and data repository for monitoring and modeling process results.” OK, I give up: what are you selling and why should I care?

You know who Philips should buy? Varian Medical Systems. Just a thought.

I forgot to gloat about the Healthvision acquisition scoop: a reader tipped me off long before the official announcement, meaning you read it here on September 14 instead of October 3.
VA had some VistA disruptions in August, ranging from 15 minutes to nine hours. Interesting, but hardly headline-worthy. I’ve never worked in a hospital that didn’t occasionally have outages like that. There are so many points of failure, especially in a regional deployment, and so little money for redundancy that I’d be surprised at five-nines application availability anywhere other than in the data center. Notice I didn’t pile on Kaiser during their HealthConnect downtime problems last year, which I found unremarkable for an IT environment of their size and scope.

Perot Systems loses its Triad Hospitals IT contracts following that hospital group’s acquisition by Community Health Systems.

Shares in athenahealth keep going up: $39.39 at Friday’s close, up $3.09. Tim Draper, inventor of viral marketing by e-mail, has $156 million worth. That’s not how he made his bundle, though: he was an investor in Hotmail and a bunch of other tech companies, also including Skype, for which eBay paid way too much.

E-mail me.

Inga’s Update

Thank you, XLT is Groovy, for enlightening me on Epic’s document manager status. “Epic doesn’t have a DM solution that works at large customer sites. Almost all of their customers go with one of the big DM vendors & interface the pointers to the documents into the system. It works well. Epic does have “EpicScan,” which can be used for low-volume scanning needs.  But most customers don’t use it – it moves too slowly to meet their needs.” So it does bring up more questions in my mind (would customers prefer a fully integrated offering?) but I won’t go there.

The endless iSOFT saga appears to be ending. Shareholders approve the $411 million takeover bid from IBA Health. The final merger is scheduled for completion October 30th.

I have enjoyed reading all the news and commentary about HealthVault. Obviously quite a few people are like Mr. H and see it as just a bunch of hoopla. But I am a bit of a Pollyanna and I like a few aspects. For example:

• Until Thursday of this week, I bet millions of folks never gave any thought to maintaining their own personal health record electronically. If nothing else, Microsoft was stirred the PHR pot a bit and raised awareness – for good or bad. (That being said, my 70’s+ parents have not called to tell me they are ready to use a PHR, though a friend with a special needs child was pretty excited about the concept.)
• I love the device integration aspect. Makes me want to go out and buy a heart monitor just to see how it all works. (And I am sure Bill Gates and friends were betting there were a lot of folks like me.) I could see using HealthVault for this feature alone.
• It’s free. Well, at least to consumers. And likely to healthcare providers. I think EMR companies would have a hard time charging for a HealthVault “interface.” Instead they may be driven to make products “HealthVault-ready.” Personally I like that aspect, too.

Ok, so I see it may all be a pipe dream and never catch on and there are still a lot of missing links. And I have no idea if HealthVault is the best product (will Google’s be better?) or if one day all consumers will want to want to keep their own PHR (perhaps in the next generation). But, I must thank Microsoft for the announcement because now I have a HIT topic I can discuss with strange men in bars over cocktails.

HHS awards $22.5 million in contracts to nine HIEs participating in trial implementations of the Nationwide Health Information Network. I look forward to reading more about how my tax dollars are being allocated when Mike Leavitt posts commentary on his blog.

Inga Chats with Ed Marx About Soarian

Over the past few months, some less than favorable commentary has been posted about the Siemens Soarian application. A couple of “in the know” Soarian users suggested we talk with CIO Edward Marx of the University Hospital Systems in Cleveland, since UH system runs the Soarian revenue cycle products. Ed was happy to share his thoughts with HIStalk, in part because he “wanted to set the record straight” about what was going on at his facility. Ed has headed off to Texas Health Resources in the DFW area to take over as CIO. We thank Ed for making time between packing to discuss the Soarian project at his outgoing 2,000 bed, seven hospital system (and wish him luck!)

Inga: Can you provide with some background on your relationship with Siemens?

Ed: We have been a partner of Siemens for 20+ years and running classic applications like Invision. We decided that we were ready to install a new revenue cycle application for everyone, hospitals and physicians. We selected Soarian after our selection process in 2002 and we have been in the process of implementing over the last two years. We have two out of seven sites up, and will add five more over the next year and a half. We had purchased hospitals with legacy systems, so we ended up replacing QuadraMed, Invision, and a homegrown system, all for Soarian.

During the selection process, who else did you look at?

We were using IDX on the physicians’ side, so we looked at IDX at the time. I wasn’t actually involved at the time, but Soarian and IDX were the finalists.

Why was Soarian selected?

The fact that it offered a single database, a single application could handle both the physician and acute components, rather than require a lot of interfaces. We wanted a single MPI and single database. No one else could, and maybe still cannot today, make the same claim. One of the key drivers was the architecture. At the time they were the only vendor building a system from the ground up rather than re-packaging older systems.

Has it lived up to expectations?

We have had a long-term relationship with Siemens. We knew that going into a new product wouldn’t be smooth and we went with eyes wide open, and we knew that going in that it would take more time. We knew if we had purchased a more mature product it might take less time. There is no doubt about it has taken longer, but we are getting the product we wanted. Being able to work directly with the vendor in a partnership in the design is worth some of the pain.

Overall, what is the satisfaction level of the users in your organization?

Overall we haven’t done a survey of them, but they are pleased. In some cases, it is replacing paper records – hand-written appointments – and in some replacing mainframes. As with any radical change in applications, there are change management issues. People are use to doing things a certain way and change causes anxiety. They are a couple of people in the organization that are adamantly against changes and they are the ones that are probably posting to HIStalk. What happened when we implemented Oracle eBusiness Suite was similar – we also had big change management issues. It took six months to a year – maybe two years – to understand the value of it. Now people don’t know how they ever did what they did before Oracle. I think it will be the same thing with Soarian and with EHR, when we get there.

Which modules would you say are fully developed versus those that still need work?

You probably need to talk with Liz Novak, the VP directly leading this and has more direct knowledge. But, the scheduling module had some logic issues that have since been corrected. Issues that were causing slow-downs. As we find them through testing or during go-live, they are very responsive to make the corrections.

I assume you communicate with other Soarian users. Are there other happy users?

We have extensive communication with other sites. Most of them wish that implementation went faster. The pipeline that is coming down with Siemens is huge. And that is not just marketing rhetoric – I’ve seen plenty of things to suggest it is accurate. There are other users similar to us that are working through implementations and going live. Everyone wishes it could be three years faster, but that is the nature of products of new products.

What are some of the most exciting recent product announcements?

The thing that brings us the most comfort is that there are more institutions going live and their pipeline is quite large. The more customers using the product, the better the product becomes. It seems the product is finally rolling. There is a certain build up before you get the inertia of an initiative. They have now hit the tipping point, so the future looks very bright. We have been live on two sites for a year and are very pleased with the progress.

What have you heard is on the development agenda?

I struggle to give you specifics, but they do have regular releases that we have helped develop and test. New releases are coming every six months, but I can’t articulate well what they are. They have a published schedule and they are starting to hit their dates. With each release, there are that much more feature/functions.

Everyone agrees that the workflow engine is unsurpassed in healthcare, but that doesn’t seem to result in sales. Do you think users undervalue that aspect of the software or are users not really committed to redesigning processes to be workflow-driven?

I think they have made more sales than people think. I have been privy to this list. My concern was that have they tested enough in terms of volume. We are fairly large, so we pressed them pretty hard to be sure they could handle our volume. I have seen up close and personal their testing processes and was privy to a lot of detail in terms of volume and it is impressive. I think they have hit their tipping point and you will see them more and more of them as they hit the implementations.

What Soarian direction is provided from the Malvern office vs. the Siemens AG executives in Germany? How strategic is Soarian in a big company like Siemens?

Good question. I may not be the best one to answer the question, but from what I can tell, there were a lot of best practices and processes brought over from Europe in terms of design and development and discipline. I think it has now kind of shifted back to Malvern in terms of specific directions.

You said you are implementing Eclipsys for clinical. Why not Soarian?

We looked at Siemens. We looked through a robust process at a number of vendors. We tried to determine, “Is there an integrated solution out there today that is rich enough to displace our Soarian as revenue cycle and rich enough to replace Eclipsys?” I am really into integrated solutions as are some other executives. We looked at Epic and IDX, and after a thorough analysis with heavy reliance on our customer base, we didn’t think Siemens was strong enough on clinicals to replace Eclipsys and Eclipsys wasn’t strong enough on the revenue cycle, so we went with the best-of-breed approach. Vendors are getting closer to it, but a year and half ago, we didn’t think anyone could do it real well.

With Eclipsys, our first live will be on the ED Tracking module in December. Our hospitals go up with orders in late 2008. It is going very well, but the project is young. It is a four-year process and we are still in year one.

Anything additional you want to add?

Well, you are getting this from me. A lot of people have written in that Soarian is not ready, there is no one live. That is myth that needed to be dispelled. The other thing is, they do have a very active pipeline and we share development notes. The volume is pretty impressive from new customers. It is true that not everyone is satisfied, but no one ever is carte blanche. There are always change management issues, but at the end of the day, you have to work with your customers and ensure you are doing the right thing and the majority will come to find the benefits of the new applications. But, you won’t ever satisfy everyone.

E-mail Inga.

News 10/5/07

From Joe Bob Priddy: “Re: Battery Ventures/Quovadx acquiring Healthvision. So far, they have purchased two questionable assets under the theory that if you tie two boat anchors together, maybe they’ll float. Maybe three or four anchors is the key.” I love succinct cynicism about the company’s acquisition plans. I was offered an interview with Quovadx’s CEO, so I’ll stay neutral like a journalist until I hear first-hand.

From Gunga Din: “Re: the former El Camino CEO. He was fired from Legacy Health System after a tenure of 18 months.”

From O.W. Shaddock: “Re: physicians on planes. I got the dreaded tap on the shoulder on a recent long flight, where I stabilized a patient who was later met by an ambulance on the tarmac. The airline’s response was tremendous: food and gift packets for my family, moved us to business class, gave us a $250 certificate for the in-flight catalog, let us off the plane first, and sent three bottles of wine with a thank you note. I don’t sent a bill to the state when I’m first on the scene of an accident, but this sense of entitlement has become more prevalent in the physician community at a time when overall volunteerism and social responsiblity is on the rise. On the other hand, treatment was delayed 40 minutes waiting for the airline’s on-call physician to give permission to open a surprisingly skimpy drug box, I was unable to speak to him directly because passengers aren’t allowed in the cockpit, and many cars today come equipped with a better first aid kit than a plane holding 500+ passengers – no otoscope or ophthalmoscope.” I’m doing everything I can… and stop calling me Shirley. A little doctor-plane humor for you.

From Duude: “Re: your editorial, ‘I’ll Have What He’s Having’. I discussed this with my aunt, who used to be in the industry. She asked how the industry was going, whether hospitals are doing a better job in system selection, etc. I had the misfortune of telling her that health systems still follow the pack, still rely on vendor products more through past associations rather than a comprehensive and unbiased system selection process, C-level backroom deals, pissy-pant ‘not feeling current vendor love’ feelings, etc. It was interesting to see her reaction when she realized nothing has changed. We all know that C-level people from the more controversial system selections read HIStalk. I dare them (Kaiser, Stanford, etc.) to refute me. Explain your system selection criteria and let us believe that it really didn’t have to do with ‘I know Neal’ or ‘the system next door is using Vendor Y, so we need to also.’”

I heard from Lynn Vogel, CIO of MD Anderson, when I mentioned their EMR development work. He tells me that the redesign of their ClinicStation EMR suite is going great. It’s now off VB6 and fully SOA and .NET driven, with up to 4,000 service calls a second (!). Interestingly, MDA is following a vendor-like quarterly release schedule, with a faculty committee overseeing the agenda. Lynn also says that SOA is letting them link the EMR to their research software, even though much of that is open source. He also mentions that the CIOs of four big hospital development shops will speak at AMIA in Chicago: Lynn, John Glaser of Partners, Bill Stead of Vanderbilt, and Justin Starren from Marshfield Clinic. I’ve argued previously that hospitals are too reluctant to do their own development (or contract it out), so that’s an interesting topic (how can you excel competitively when you’re using the same off-the-rack systems as everyone else, at least if you really believe that IT is strategic?)

Microsoft is the star of the day for introducing its HealthVault PHR and health search engine tweaks. The HealthVault Search is OK and has a scrapbook feature to save stuff you find, although the results are already peppered with ads (if you have medical issues with a certain male body part, the ‘sponsored sites’ can help you with just one claimed outcome). I still think PHRs are a waste of time since patients won’t keep them and doctors won’t really use them (is it illogical to keep a Web-based record that you can talk to your doctor about only by making a weeks-ahead appointment and sitting in front of him or her?) The Connection Center is a good idea, assuming it works (plug and play medical devices, anyone?) The need to have Windows Live ID, however, will kill what little interest there is. I used to curse emotionally and loudly about Passport and Wallet, previous (and also bad) attempts to lock users into some sort of mindless and proprietary Microsoft loyalty. My reaction to all the HealthVault hoopla: it’s like watching a once-vibrant and edgy man turn gradually into a doddering senior citizen that the whippersnappers make fun of without his catching on. I’m just not finding Microsoft to be all that relevant to what I want to do any more, either on my PC or on the Web. HealthVault won’t change my mind. Hotshot companies always want to profit from healthcare without getting into the ugly trenches of care delivery, contracting, procurement, and labor management, cherry-picking the fun consumer stuff and building a business model on advertising.

Speaking of HealthVault, you may have noticed that its PHR isn’t really that at all, it’s just a document repository. A later announcement today may have explained that: CapMed will create an “In Case of Emergency” (ICE) PHR for HealthVault. icePHR will provide users with a custom URL that emergency providers can securely access. A demo is on the site. It seems to hold basic contact, condition, and allergy info. They sell it for $9.95 a year. It’s maybe enough to help a paramedic, that is, if they have an Internet-connected laptop to use while you’re convulsing on the floor, if you’re coherent enough to tell them about it, and if you’ve kept it up to date (like a piece of paper strapped into a MedicAlert tube, in other words). Maybe I’m just being curmudgeonly, but this looks like a solution in search of a problem. I can’t imagine either patients or doctors taking PHRs seriously enough to trust for making treatment decisions.

Listening to now: The Apparitions. Recommended by a reader. Sounds good, kind of Frank Black meets The Magic Numbers. Also, the best album in history: Bowie’s Ziggy Stardust. I’m desk-drumming.

A milestone for eScription: the company’s product now handles over a billion lines of transcription a year. They’re at AHIMA in Philadelphia next week, booth 225 if you’re inclined to drop by and say hello. If you meet Paul Egerman and don’t leave happy, I’ll reimburse you for your footstep mileage.

Speaking of AHIMA, it gets a $10 million CMS contract to evaluate the possible changeover from ICD-9 to ICD-10.

Wow, am I ever humbled by Scott Shreeve’s writeup in honor of HIStalk’s soon-to-be millionth visitor. My version of blogging is lonely and free of feedback (other than e-mail), so it’s sure nice to hear it mentioned as though it’s something real, not just the empty screen in an empty room that I see from this end. I’m not emotional, but it choked me up a little after I got over being embarrassed by the attention. Right back at you, Scott.

Cerner has their big Health Conference cranking up this weekend, with 400 education sessions led by Cerner customers. What’s cool: chief marketing officer Don Trigg is hooking me up with some attendees on a live call Monday evening for a report. I’ve never attended, but colleagues who’ve attended in previous years speak highly of it. I’ll have to think of insightful questions to pose to them.

Lightning round housekeeping stuff that I always forget: use Search to your right to zip through four years’ of HIStalk, sign up also to your right for instant E-mail updates (at the top) or the Brev+IT newsletter (below that). E-mail me for a sponsor packet. Feel free to e-mail me otherwise, although I confess I’m absolutely buried in jobs (day and other) and can’t always reply. And no, I won’t send you a picture of Inga (ask her yourself).

Unibased Systems Architecture brags on its KLAS surgery system scores. I honestly don’t know a single hospital that uses it, even though it’s perpetually up there. I’m taking away points for using the word “space” four times in a short press release. I can’t help but think of sleazy, dot-com salespeople when someone lobs out a “space” instead of “market”, as in “I’m in the dogfood space” or “I specialize in the porn space”.

Carilion uses software from Scalent Systems to roll out Citrix boxes for its Epic implementation. “They’re allowing you to re-provision a virtual server very quickly — within five minutes.”

Who knew Glen Tullman’s big brother is a CEO, too? Both are on the agenda of a Chicago business event. Hope Howard doesn’t embarrass Glen on stage by holding him down and giving him noogies.

Mediware adds to its stack of Nasdaq notifications, but says this one doesn’t threaten delisting.

E-mail me.

Inga’s Update

Nuance Communications, Inc. acquires Commissure. Nuance provides speech and imaging solutions (they are the ones that bought Dictaphone awhile back). Commissure provides speech-enabled radiology workflow optimization and data analysis solutions. Also this week, Nuance announced a new president of their Enterprise Division, Wes Hayden, who had been president and CEO of Alcatel-Lucent’s Genesys Telecommunications Laboratories unit.

Advocate Home Health Services, the home care and hospice division of Advocate Health Care, selects Misys Homecare for their 250 home health associations and 225 support employees in the Chicago area. It is interesting to me that, despite all the turbulence among the physician and hospital divisions, the home care group has kept such a low profile.
McKesson announces a new Web-based BI tool for health information management departments.

Since joining HIStalk I have come to the realization that there is an award for everything. (Guess it is kind of like all the kids on all the soccer teams getting trophies.) McKesson and Kaiser Permanente are two of nine organizations receiving the Electronic Product Environmental Assessment Tool (EPEAT) Green Electronics Champion awards. The winners have moved to EPEAT-certified equipment, which is more energy efficient. Between McKesson and KP, the energy savings is enough to power about 5000 homes per year. (Which actually is pretty impressive.)

Hyland Software will provide a document management solution to integrate with Epic EMR at Texas Children’s Hospitals and clinics. Maybe this is a silly question but doesn’t Epic have a DM system as part of their offering?

E-mail Inga.

Microsoft To Announce HealthVault PHR

Microsoft will announce this morning its HealthVault personal health record. From the site’s beta page, the service will also include a search engine and device drivers that will allow uploading information from home monitoring equipment such as blood glucose and blood pressure monitors.

Quovadx Acquires Healthvision

Integration vendor Quovadx announced this morning that it has acquired health information exchange vendor Healthvision of Irving, TX. Quovadx CEO Russell Fleischer says the company will make further acquisitions, saying “We anticipate this transaction will be the first of many.”

News 10/3/07

From Seth Maxwell: “Re: El Camino Hospital. This discussion triggered by a routine board seat newspaper story is full of venom.” Wow – anonymous accusations of board corruption, conflict of interest, and substandard care, some of which involve IT. A compelling read, although as fiction and for entertainment purposes only since nothing is substantiated.

From The PACS Designer: “Re: Total Recall. Another new feature of Oracle Database 11g is Total Recall(TR). This feature allows users to view queries for specified time periods, which will speed data analysis and reduce the need to write custom programs to retrieve the data to be analyzed by database users. TR also aids information lifecycle management by highlighting data that can be compressed due to its age and lack of inquiry activity. Still another added feature is Flashback data archive that permits change tracking to improve retrieval times.”

In response to my “who’s developing an EMR” question, Dr. Quiz says Henry Ford Medical System is. p_anon says ditto for MD Anderson. More information, please.

My newsletter editorial this week: “I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming.” Shell out a few measly bucks and you’ll get a big old weekly load of me at my best plus a great newsletter besides.

Microsoft and Allscripts are making some kind of announcement Wednesday morning.

This week’s Brev+IT. Get it hot off the press in your e-mail inbox next time by signing up here.

InfoLogix, the mobility and RFID company that just started trading on Nasdaq, acquires consulting firm Healthcare Informatics Associates (WA) for $16.5 million.

Microsoft is offering Office Live Workspace, its Office-extending answer to Google Docs. TechCrunch isn’t impressed: “Microsoft has failed to understand the real power of Google Docs – easy, no hassle document creation, collaboration and access from the browser. And it will take them another two years of fidgeting before they really get scared and react properly. Microsoft is falling into the classic trap of failing to realize the disruptive nature of a new competitive technology, instead focusing on the massive revenues it generates from their aging Office suite.”

Hot conference. November 5-6. Beverly Hills. Harris, Sands, Holmquest, Kennedy, Marchibroda, Wade, Miller, Bush, Tullman, Eckert, and other industry leaders. Former CEO attendee comment: “The most useful conference I have attended in a long time. The rich mix of perspectives and experience in Healthcare IT made for the best of conferences.” Discount code HISTALK2020 will get you a $750 registration rate because I’m a “media partner”, which got HIStalk mentioned in a press release. I’ll have a report from there, I think.

Sounds like a good read: How Doctors Think.

GE Healthcare, taking heat in India for pushing sales of ultrasound machines for illegally (in that country) determining fetal gender, says it will listen to suggestions. Indian culture prefers breadwinning sons to dowry-requiring daughters, which has led to the selective abortion of millions of female fetuses.

Siemens Medical Solutions signs a joint venture deal with a 40-employee Japanese hospital EMR vendor, hoping to get a piece of the clinical systems action over there. Says the company has 30 hospital customers, which seems like a heavy support load for 40 employees.

Henry Schein continues its tear of software acquisitions, this time picking up Software of Excellence International, a New Zealand dental software vendor.

A senator urges the VA and DoD to speed up integration of their respective EMR systems, not scheduled to be finished until 2015.

Merge Healthcare announces its April user group meeting. It will be held in a Las Vegas casino, reminding attendees of a reasonable alternative to buying Merge shares that at least offers free drinks while watching your bankroll disappear.

E-mail me.

Inga’s Update

Félicitations to dbMotion for being selected to provide an interoperability platform to extend the Franche-Comté regional health information exchange.

Iron Mountain, the information storage and protection giant, acquires RMS Services, a $27 million records management company that provides outsourced file room solutions for hospitals. Terms of the deal were not disclosed.

Eclipsys Corporation announces the appointment of Victoria Bradley as the company’s Chief Nursing Informatics Officer. Bradley is an RN, DNP, and a HIMSS fellow, and the current vice chair for HIMSS. She most recently has been director of patient information for the University of Kentucky.

Thanks to Polly, obviously a baseball purist, who pointed out that the thing with the baseball jerseys/team names in not universally true. So, I restate my comment to say “traditionally” this is what they do. And I remain amazed that it took me until the ripe old age of 29 to figure that out.

Monday Morning Update 10/1/07

From EMRNurse: “Re: Epic. Reporting from the Emergency Nurses Association conference in Salt Lake City. Lots of IT vendors, most of the big ones that have ED or Health System wide products. One seems to be missing – Epic. There is also a group forming to write a best practices document on ED applications. See the ENA technology listserv for details in the next few weeks. It can be found at ENA.org.”

From Phillip Elliott: “Re: tamper-proof prescriptions. I disagree that the tamper-proof paper script mandate is anti-EMR. Making paper harder to work with should drive people to e-prescribe, no?”

From Mike Bossy: “Re: Siemens. Bobby Orr wonders about Siemens’ focus with MS4, Soarian, and INVISION. What about their relationship with NextGen? Is NextGen their partner du jour until they toss them aside when their EMR is finally ready (or they think it is ready)? Where does Soarian Clinicals end and NextGen EMR start for Siemens customers?”

From The PACS Designer: “Re: iGUARD. iGuard keeps you updated on the latest findings on drug interactions and their side effects along with any new safety alerts. There’s a live webcast October 4th on this subject.” I tried it and was less than impressed. You enter your list of drugs and then wait for an e-mail back on each one, but most of mine said to wait several days for a response. All I could figure out that it does is flag a “risk rating” once you finally get the e-mail, but I’m not sure exactly what benefit that offers. Ask your pharmacist, look up your drug on any of thousands of patient information sites, buy a drug reference book — all provide more actionable information. I don’t see the point of it at all, but that’s just my opinion.

From HITman: “Re: HIPAA. What Ivinson Memorial Hospital is doing is right on track with HIPAA. Employees, when it comes to their own medical records, are no different than any other patient under HIPAA. They must follow the same policies and procedures to request access to their records. The reasoning that they have a computer password or the key to the file room doesn’t make them exempt from HIPAA. Covered entities must protect PHI. They must treat every record the same and every patient the same. Accessing records outside the scope of the minimum necessary or the need to know the information in order to perform job duties is not allowed under HIPAA. Kudos to IMH for sticking to their guns and HIPAA!”

From Philip Rivers: “Re: Ted Borris. Ted came to QuadraMed with CPR. We are excited to have him.”

John has a summary of this week’s AHRQ meeting. Nuggets: research hasn’t proven that healthcare IT improves quality, NHIN is a pipe dream, PHR privacy is getting no attention, and AHRQ-sponsored studies show that e-prescribing doesn’t reduce adverse drug events. I’m not surprised since AHRQ’s HIT studies are usually inconclusive at best. Could it be because it’s the user and not the system that drives the results, especially when looking at an unrelated marketbasket of healthcare organizations as though it were a population-based healthcare study? IT, if deployed wisely with process change, can sometimes make good organizations better. That’s it. Anyone who expects more is being naive. It isn’t what you have, but how you use it, a concept that somehow seems lost in the pre-purchase optimism of hospitals convinced that their carefully aimed checkbook can painlessly cure all organizational ills.

Scott Shreeve opines on athenahealth’s IPO. I like reading his stuff because he’s so energetic and positive. It’s like the standard war movie scene where the wisecracking fresh recruits are marching excitedly off to battle and pass a returning group of battle-weary veterans whose gaunt faces show the horrors of war they’ve witnessed and possibly committed. I realize I’m in that latter group.

Advice from a BI consultant to providers: “Stop thinking like a healthcare company. Providers are notorious for making known vendors and established consultants their trusted advisors. Instead, they should think like retailers. ‘Cerner and McKesson don’t have all the answers,’ one HMO administrator confided to me recently, as if it were a secret. ‘What we’d really like to know is what McDonald’s and Target are doing.'”

Thoughts on the healthcare IT vertical market from the perspective of Microsoft channel partners: “Moreover, some larger hospitals are hiring partners to build their EMR applications from scratch. Once you factor in annual maintenance fees, Velu says, some packaged EMR products can actually cost more over their lifetimes than handmade systems do … Hospitals, for example, tend to be wary of risk. ‘They’re followers, not leaders’ … Doctors can be tough customers too. ‘They’re notoriously cheap’, says Summers.” I don’t know of any hospitals building EMR applications from scratch. If you do, let me know, because I’d be interested to learn more.

A hospital CFO blames its new Dairyland system for not getting bills out on time. From the article: “The hospital has had many problems getting its issues solved with the software company.” Somehow I doubt it’s all Dairyland’s fault since they’ve installed quite a few systems in their time, but every patient accounting implementation starts out rough.

Strange: a UK government official was late for a hospital construction group picture, so his image was Photoshopped in (not all that skillfully, judging from the result). The kicker: he’d just scolded the press for faking footage.

The Australian Medical Association wants airlines to pay doctors who treat fellow passengers or upgrade physician passengers upfront for being “on call”. Once doctor was refused an upgrade for helping vomiting fellow passengers, so she sent the airline a bill.

A big UK hospital will use Sentillion for single sign-on and context management.

Thanks to these sponsor supporters of HIStalk. Please click their ads to your left and consider their offerings. I admire their bravery in convincing the beancounters to send money off to some anonymous blogger. Anyway, these vendors support HIStalk, so I appreciate your support of them in return.

Design Clinicals, LLC
EHRConsultant
EnovateIT
eScription
Hayes Management Consulting
Healthcare Growth Partners
Healthia Consulting
Inside Healthcare Computing
Intellect Resources
InterSystems
John Muir Health
Lucida Healthcare IT Group
Medicity
MedMatica Consulting Associates
Noteworthy Medical Systems
Novo Innovations
Picis
Premise
Pring|Pierce Executive Search
R. Gaines Baty Associates
SCI Solutions
Sentillion
SolCom
Stratus Technologies
The White Stone Group, Inc.

Inga’s Update

Sue Ellen Mischke: Ever noticed there are two HMAs and they couldn’t be more different except their names are exactly the same? Health Management Associates, the hospital chain. For-profit to the nth degree. Then, Health Management Associates (www.healthmanagement.com) the consulting firm, which specializes in public hospitals, public health departments, and Medicaid agencies. They couldn’t pick customers with less money if they tried. Actually, I never quite put that together, but that is a great observation. I’m learning that I am not always great at observing little details. Like I just found out yesterday that when a major league baseball team plays at home, their jerseys say the team name (e.g., Yankees), but, when they are away, the jerseys say the name of their city. Who knew?

The market for physician financial information systems is expected to grow from $3.5 billion in 2006 to an anticipated $6.22 billion by 2013. This according to a Research and Markets study.

Susquehanna Health, the first facility to go live on both Soarian Clinicals and Financials, has signed on with Siemens for additional technology and service solutions. The Williamsport, PA-based health system plans a “facility revamp” project to be completed over the next five years.

E-mail Inga.

News 9/28/07

From Bobby Orr: “Re: Siemens. There were some positive postings about the old MedSeries 4 a week or so ago. If they are now developing MS4 again, along with Soarian and Novius, and supporting their huge Invision base, doesn’t that make them a little bit unfocused? Where is the R&D really going for the future? Is anyone else confused by what they are doing?”

From Brad Majors: “Re: tamper-proof prescriptions. How’s this for punishing EMR users? New York mandated ‘official’ prescriptions two years ago, giving hospitals using EMRs two options: use double-tray, secure printers, or put ‘official’ state stickers on the printed prescriptions. Hospitals mostly went with the sticker option to avoid replacing printers. CMS regulations go into effect October 1 and those stickers won’t be available until the end of October or in November. How could they not have considered hospitals with EMRs?” The Senate stepped in at the last minute to delay implementation for six months. Stickers on paper prescriptions? Only in healthcare. We might as well drip wax to seal parchment scrolls.

From Janet Weiss: “Re: KLAS report on nursing adoption. The lead clinical system vendors had pathetic scores, with the highest score 23.3 out of a possible 40. EMRs pretty much suck for nurses. All that rush to market and to re-create the paper chart while meeting Wall Street numbers. Well, this is what we get.” Someone sent me a copy of GE Healthcare’s internal response to the KLAS report, in which the company seems collectively embarrassed for the whole industry: “None of the vendors evaluated performed above the level of a ‘D’ grade. The overall results of the vendor scores speak to the fact that as an industry we are not sufficiently focused on how IT supports the nurses’ work in delivering patient care. No vendor should be pleased with the results.” Kudos to KLAS for doing the study and GE for coming clean, even thought it only bought the problems along with IDX. Now would any of GE’s nursing system competitors care to take the same level of public responsibility by admitting that they’ve done a lousy job in meeting the needs of healthcare’s largest and arguably most important constituency? On the other hand, it might not have mattered: in most places I’ve worked, nurses were frequently asked for input on software and project plans, but were invariably overrruled by a CIO who could not accept the fact that collective user wisdom might exceed their own. I honestly can’t recall even once when nursing’s choice ended up being purchased, always for some CIO-friendly reason like hardware platform or resume-building cachet.

Oldie but goodie: Neal Patterson on David Brailer, circa November 2005: “He wants to create new entities without true business models … That’s not sustainable … His model [is that of] Beltway bandits – a group of people who live off government grants. He’s aligned himself with the grant babies.” Could he have been any more correct, or any ballsier saying something as outrageous as that in the RHIO hand-holding frenzy two years ago?

More good Cliff and Neal quotes in IBD, although one isn’t true: Neal claims the last time the word ’employee’ was used at Cerner was when he met with pharmaceutical bigwig Ewing Kauffman, who called them ‘associates’. Only if that meeting came after the infamous “tick tock” e-mail, in which Neal used it repeatedly and sarcastically (and capitalized for extra effect).

Heard: Ted Borris, assistant general counsel of Misys Healthcare, has left the company.

Listening: new H.I.M and Entwine. Both from Finland, coincidentally.

DTE Consulting (stands for Down to Earth), started in 2005 by former Lourdes Hospital (KY) CIO Gary Wood, will work with Optio on forms projects.

The voting public, not surprisingly, isn’t really all that interested in healthcare IT. Mitt Romney’s domestic policy director was honest: “I think it’s fair to say that’s not the sexiest issue in the world.” Do what vendors do: bring on the booth babes!

Johns Hopkins will install TeraMedica‘s Evercore clinical content manager.

This doesn’t sound right: looking at your own medical records is a HIPAA violation? This hospital is putting the fear of God into employees, using Meditech’s HIPAA auditing capabilities to scare them into confessing for looking at their own records online. Sounds like a compliance officer on a power trip.

An Indianapolis in-store retail clinic chain backed by Cardinal Health is kaput. Corner Care locked the doors and left creditors unpaid.

New York’s state health department offers $106 million in grants for RHIO-type projects. I’ll defer to Neal on that one.

The University of North Carolina’s Institute of Pharmacogenomics and Individualized Therapy implements a genotyping analysis system from InforSense. Cool: it analyzes information from DNA analyses, EMRs, and other databases to individualize drug therapy. How it works otherwise: the drug company SWAGs a dose that seems to work when given to a bunch of patients, then hopes no one dies when lots more people start swallowing it after free-lunch docs start cranking out the scripts. Now you know why progressive health systems are working to integrate genomic information into their clinical data repositories (and why the next step will be to use it for clinical decision support). See if this doesn’t sound like a clinical system.

My editorial this week over at the newsletter: “Lay Your Hands on the TV to Be Healed: The Emergence of the Superstar Remote Physician.” I may not be the most insightful editorialist, but I bet I’m the only one working a Suzanne Somers reference into a healthcare IT paper.

Lucida Healthcare IT rolls out a new Web site, which includes an Express Application for consultants looking for opportunities and a Resource Request Form for hospitals that need resources.

PSS World Medical, which picked up 4.6% of athenahealth pre-IPO, sees its investment go from $22.5 million in July to $52.2 million two months later. The market cap of athenahealth: about $1 billion, a little less than Allscripts and Eclipsys. Sweet.

E-mail. I’ll read it, but the rest depends on what you have to say.

Inga’s Update

This article didn’t surprise me too much. Few women hold high academic positions at the top science and engineering research universities. And, women have more advancement barriers than men in the corporate world. The chancellor of UC Berkeley notes that this puts the US at a competitive disadvantage worldwide. Discrimination, lack of female role models, and lack of corporate champions were some of the reasons cited. Just this week I happened to be looking at the web sites of a couple of the major computer vendors – one had no women executives (14 men) and the other had just two women out of the 16 execs. I doubt it is because women aren’t interested in the jobs.

Mr. H listening to Megan McCauley? I have shoes that look older than her. Try some Paolo Nutini. He may not be much older than Megan, but he sure looks adorable. Something for the ladies to enjoy while working to take over corporate America.

Bassett Healthcare in Cooperstown, NY selects McKesson for additional products for its four hospitals and 23 community health centers. Bassett is already using Horizon Patient Folder and Medical Imaging solutions. The latest contract is for CPOE and clinical decision support, bar-code medication administration and a Web-based business intelligence tool.

GE Financial Services and the Healthcare Financial Management Association (HFMA) release a study suggesting that hospitals will make themselves more competitive if they make strategic investments in technology. Furthermore, hospitals shouldn’t wait around for policy changes or public or private funding for projects such as EHR. Don’t you just know that GE Financial was dying to add something in the press release saying how much they would love you to borrow money from them to finance all those technology projects?

Surescripts announces a Prescriber Vendor Advisory Council made up of 10 EMR/eRx vendor executives. Their mission is to advise SureScripts on programs designed to increase the adoption and use of e-prescribing.

Health Management Associates (HMA) has contracted with NextGen for the purchase of software licenses for EMR and enterprise practice management. This is a second phase purchase of the NextGen products for HMA, which owns and operate 59 hospitals and medical centers. Earlier this month we mentioned that a class action lawsuit had been filed against HMA, charging it with insider trading.

MedComSoft announces year-end financials through June 30th. Revenues went up 59% over the previous year, expenses grew 27%, and their net loss increased by 18% ($4.5 million.)

From the Archives of Internal Medicine: a new study by the RAND questions the value of preventative health exams. It doesn’t say stop going to the doctor – it just suggests we can’t assume the value outweighs the costs for every patient.

Here are IBM’s predictions for the top healthcare industry trends over the next five to 10 years:

• Secure sharing of patient data with interoperability
• Fully-informed diagnosis (shared between all care-givers while preserving patient privacy)
• Speeding drugs to market
• Stemming the spread of pandemics

And of course IBM has announced all sorts of radical innovations that will address the changing landscape.

E-mail Inga.

HIStalk Interviews The PACS Designer

Hardly an HIStalk posting goes by without an insightful commentary by The PACS Designer. TPD always seems to be up to speed on various emerging technologies, particularly in the PACS world. I was curious to learn what made him tick and was able to have a chat with him recently. Thank, TPD, for sharing your story.

Inga:  How did you select the name The PACS Designer?

TPD:  Since I have been working in the medical field for years and designed a PACS system in the mid-90s with some great partners, I thought, why not use the name as a blogger? I am also trying to promote PACs. Shahid Shah encouraged me to blog. I am an electronics engineer and wasn’t really working in the PACS area but found an opportunity. I got to like what I was doing and some good things happened out of it.

When did you first begin reading and posting on HIStalk?

I first started about two years ago, when Shahid Shah from Shahid’s Perspectives and creator of HITsphere told me about it. I decided to get involved with blogging. I love teaching people. In my prior job, I taught courses in PACS and other medical technologies and even did SAP software teaching.

What was it about HIStalk that interested you?

I thought the style was good, because sometimes you see blogs where the posts are very infrequent. But HIStalk had the right formula to get people to respond to the posts in the Web 2.0 sense. It promotes 2.0 through interaction. Bloggers are becoming an important part of society, as everybody knows.

What about your background has made you an expert in HIT in general and PACS specifically?

I worked with PACS behind the scenes in design. Before that, I was a purchasing manager and I always knew the latest technology. The combination of purchase evaluation decisions and designing helped me, development-wise.

I love technology. It is a small point, but in 1958 my mother bought me a transistor radio that came from Japan, made by Matshushita, now better known as Panasonic. I got so fascinated with the transistor radio that I decided to go into an electronics engineering program. I’ve been an electronics buff ever since. It is really becoming a digitally connected world and that is where healthcare needs to be.

So, what really got me into PACs goes back to the 1980s, when hospitals were using telephone technology with PACs and it was a very slow teleradiology. In the late 1980s, a company my employer partnered with discontinued their product line, so it killed our product line. I was looking for ideas for the next version of PACs and eventually hooked up with a company to design the next generation of radiology PACs.

What did you do after helping to design the radiology PACs systems?

I looked at how we could help cardiology. I designed a cardiology PACS that has had good success and is used all over the world. I am proud of both things, the radiology and cardiology products, but I am proud that the cardiology images in the cardiology PACS I designed can be viewed all over the world with the PACS I designed.

What do you do professionally today?

Today I am an independent healthcare software developer, working with major universities and vendors on the next generation of software.

PACS software?

Not just for PACS, but Web-enabled software solutions that are available by accessing a Web browser. No software is loaded on your PC. It’s downloaded to you just like YouTube is. Healthcare is going to see a lot more of that technique in the next 10 years.

So you are hired by the different universities to develop applications? 

Yes, to do integration of DICOM, HL7, and Java technologies to create Web-based solutions for healthcare.

Do you find your current job rewarding? Fulfilling?

I love delighting my customers and really like innovation and like to pursue it with excellent partners that will make customers happy with the end result. I will be starting a major project with a Top 10 university next month. 2007 is turning out to be a transition year for technology that is going to excite end users.

I am also a member of the ASTM International. I’m a member of the E31 Health Informatics Committee that developed the Continuity of Care Record. The E31 Committee that created the CCR used the Massachusetts Patient Care Record that had been used for many years as the basis for the CCR. I am still on the committee and another health informatics committee called Privilege Management Infrastructure to design enhanced security for HIPAA so users only see information that they’re entitled to see.

HIPAA is great, but there is a lot of structure out there that needs improvement, security-wise. The ASTM PMI standard will be coming out within the next year or so.

Do you actually meet with your fellow ASTM members?

We work remotely, but I get all my information sent to me over the Internet. I approve or disapprove information online. It is very interactive, but it is all done remotely. They do meet in person, but I’m very busy and don’t have the time and funds to travel all over the place.

I believe I have noticed that you have posted on other blogs.

I randomly contribute to others.  Do you want to know some of the other blogs I read and post on?

Sure!

The Healthcare IT Guy, Shahid Shah. He got me started. LabSoft News. Dr. Friedman is very good at presenting concepts and I like his highlighting techniques. Dalai’s PACS Blog. He is a radiologist who is a very good blogger. Candid CIO. Will Weider lets us know what’s happening in the real world of healthcare IT, which I enjoy reading, and then I post comments on his blog to educate his readers. Scott Shreeve, MD. I also like Scott’s blog and we’ve seen his HIStalk interview and the numerous posts about him. Christina’s Considerations. Christina is not as well known yet, but she covers RHIOs, a controversial subject today. HealthBlog from Dr. Bill Crounse at Microsoft. He tries to let us know what Microsoft is focusing on next, like Azyxxi.

HIStalk is the best one, right? [laughs]

Of course! Actually, HIStalk is more consistent about their format. There is a lot of interaction with readers. There is Inga, Tim, and other posters, I was so happy when you joined. It made it better.

Thanks. Well, there are some amazing posters. Next question, how is the PACS world going to change over the next few years? What companies will survive and what will the hot technology be?

PACS is becoming a vital modality as far as hospitals are concerned. PACS takes away the cost of X-ray films, which is a very expensive thing. And PACS is expanding to include a mini-EMR through HL7 interfacing techniques and open software solutions.

Everything is going digital. The patients are becoming more involved. Here is a new term – Digitally Connected Patients (DCP). The patients from home will be able to be wirelessly monitored by the hospital. That will be the next big wave over the next 10 years. Patients who live alone with health problems would definitely want to be connected. We’ll actually see that in less than five years. We already have the ability to send heart rate, blood pressure, and other vitals information from remote locations, such as ambulances in route to emergency departments, and also remote digital storage for redundancy.

The infrastructure of companies will change a lot. With EMR companies, they will be bought up or go out of business because everything is going to be Web-enabled. If you are not Web-enabled, you won’t survive. The EMR and PHR will be a partnership involving the patient, hospital, and doctors all submitting information into the combined record. It will be Web-based and a lot of the EMR companies will need to change their business plans to go Web-based, or go out of business, or merge with larger companies.

EMR/PHR will be viewed similar to having an online bank account. You can call up your account any time as long as you have an ID and password. If you can do it in banking, why not do it in medical?

I didn’t mention this earlier, but XML, Extensible Markup Language, will become a big part of how we capture information. Any time you enter information via a Web browser, you can capture it in XML and store it in an EMR or PHR. Currently I can’t talk much more about this because I am in the middle of a patent application. I have developed a new technique for this.

2007 is becoming a year of major transition because a lot of things are happening and it is exciting for the healthcare field.

You have been in this business a long time. Any plans to retire soon?

I love the healthcare field so much that I plan to do software development as long as I can, no matter how old I am. I am not inclined to retire in the immediate future. I love being independent. I have a great group of partners ready to work with me. Being free and independent lets me innovate the way I want to innovate.

Thank you for interviewing me. Hopefully HIStalk readers will enjoy some of my comments and I hope readers will benefit from them in the coming years.

News 9/26/07

From John Stryker: “Re: Wal-Mart. Any speculation on who Wal-mart will choose as a vendor? I hear that they are down to three and plan to decide this week.” Maybe a Chinese software firm willing to sell systems for $200 each? Actually, I have no idea. If you do, spill. I bet Eric Fishman knows since he dropped hints when I asked him about retailers and the new wave of vendors.

From Desert HISer: “Re: QuadraMed. QuadraMed’s long-time customer, Sun Health in Phoenix, may be at risk with the recent announcement that Banner Health would be acquiring  them. In an article in the AZ Republic, Banner Health was quoted that IT upgrades would be a high priority for Sun Health under Banner’s ownership and Banner is not a QuadraMed customer.”

From PTSD: “Re: CE. Illinois passed a new Nurse Practice Act requiring professional nurses to have CE courses to maintain their license. Almost half of the states out there do not require nurses to take CE to maintain their license.” Surprising. I assumed all states required CE.

Vince Ciotti checked in to drop some kudos about two small but innovative clinical systems vendors: VisualMED and IntraNexus. On VisualMED, Vince found their system functional, robust for nursing documentation, and designed by a great MD, Art Gelston. I’ve seen their system and have met Art and agree on both counts. Vince mentions that one hospital is using VisualMED as a clinical front-end to Meditech and it was apparently designed to work that way for any other system. I interviewed CEO Gerard Dab last year. I know less (nothing, actually) about IntraNexus, the keepers of the old SMS Allegra system, but the company is introducing a new system called Sapphire. There are few clinical systems to choose from and fewer still that don’t cost gazillions, so give these a look if you’re so inclined.

While I’m talking about Vince, I’ll give him a plug: H.I.S. Professionals will be having its “Mini-HIMSS” in Chicago on October 3-4. He invited Inga to cover it for HIStalk, but I don’t think she’ll be able to go.

Listening to now: Megan McCauley.

Found: Kim Pederson, former Excellian VP at Allina. I wanted to see what she’s up to after Allina won the Davies Award for the Epic implementation she led. She left Allina in June (right after I interviewed her) and has hung out a consulting shingle as KP Healthcare Consultants, she told me in an e-mail. On the Davies win: “I’m thrilled about the Davies Award. I had a great team that gave it their all and they deserve the recognition. I couldn’t be more pleased.” On her new business: “I’m focusing in healthcare. My two big experience areas are large scale implementations and revenue cycle. The work I’m doing to date is around project assessment & improvement, strategy, planning and budgets, executive level coaching, project governance, risk management, and scope management. I’m looking to help organizations at the start of their implementations get set up to succeed and to go to troubled implementations to help get them back on the right track.” She put in Epic in a 11-hospital, 350-employee, $250 million program and won the Davies doing it, so you might want to contact her if your project needs help.

Amazing: Microsoft wants to buy 5% of Facebook for $500 million, thereby valuing the three-year-old, teen-heavy social networking site at $10 billion. The founder and CEO is 23. Too bad we’re wasting our time working on systems that save lives.

The folks at eScription tell me they’ve earned their first speech recognition patent. Their AutoScript background speech recognition uses “adaptive playback speed” to intelligently adjust audio speed based on the transcriptionist’s editing proficiency, their efficiency with that clinician, and their preference for playback speed. It was developed under code name “The Lucy Chocolate Factory”, referring to the Lucy episode where she’s unable to keep up with the assembly line. User quote about the system’s ability to learn the preferences of transcriptionists: “The speed increments are slowly introduced so you are not even aware of them until you notice your gain in productivity.” Nice.

Frank Pecaitis and Medsphere have parted ways, I hear. He’s working for GE Healthcare as GM/VP of Sales.

In the UK, a newspaper runs some examples of NHS errors. One of those listed: “A further incident involved a software company failing to activate a neonatal screening system, leading to a series of false negative results.”

Confirmed: Epic will start work on a Web transition shortly, but has yet to choose a development tool. Their previous switch from character-based to GUI wasn’t too smooth, I’m told (hearing the words “hyperspace transition” apparently causes early customers to seize involuntarily), so they’re taking it slow.

QuadraMed closed its Misys CPR acquisition yesterday, so that’s probably why some San Bernardino CPR staff were let go.

Stock of RFID vendor InfoLogix began trading on Nasdaq Monday. Market cap is $91 million, not bad.

Duplicate patient records caused a Nightingale Informatix health department system to delay some test results in Nova Scotia.

Cardinal Health CEO Kerry Clark will replace founder Robert Walter as chairman. A painful tidbit in the announcement, since I owned CAH stock in the 1980s: “An investment of $10,000 in Cardinal Health stock at the time of its public offering in 1983 would be worth $8.2 million in 2007, an appreciation of more than 80,000 percent.”

Inga’s Update

I heard Epic invited 3500 of their closest friends to an open house to tour the new facility. Since I didn’t make the guest list, I was wondering if any readers were invited and if they cared to share their impressions.

And speaking of Epic, I was amused by a blog I came across called, The Rantings of an Angry Security Kitteh. (I know “kitteh” is some sort of urban lingo, but I don’t get it.) Anyway, the writer is apparently an Epic employee who sat in on some of the recent user group meetings and was less than impressed with one of the speakers.

Mr. H suggested we might want to “wangle” an interview from Isacc Kohane of Children’s Hospital Informatics Program of Boston. This is the organization that is taking over development of the personal health record program for Dossia, after Omnimedix and Dossia split sheets. I asked “Zak” Kohane for his impressions, to which he commented: “Many years ago, when I was single and dating, I found that it was not a good idea early on in a relationship to probe too deeply into prior relationships. Also, even I knew enough to not ask her why she had chosen me. I might not like the answer.” Obviously this does not give us any more insights into the issue, but it sure makes me wish I had dated Zak back in the day.

A study by the Center for Studying Health System Change (HSC) found significant variation in IT adoption exists across specialties. Highest usage specialty: oncology, followed by internal medicine and family practice. Lowest IT adopters: ophthalmology, followed by psychiatry and orthopedics. If you are an EMR vendor, this study provides some good insights.

What does this suggest about the state of RHIOs? The Patient Safety Institute (PSI) is closing shop. PSI was founded six years ago to provide the healthcare industry with a commonly owned, inclusive network utility to support RHIOs and provide ready access to patient healthcare information. PSI promoted a private sector self-funding model similar to that used in the financial services industry, but claims that in the end the model proved to be ahead of its time, pointing to lack of cooperation between parties as a primary issue. So what, if any, RHIO business model(s) will ultimately prove financially successful and widely embraced?

E-mail Inga.

HIStalk Interviews Eric Fishman MD, President, EHRConsultant

I ran across Eric Fishman, MD a few months back when I stumbled onto his EHR Scope, a compendium of information about physician system and speech recognition. Ambulatory systems continue to be very hot in the marketplace and it was interesting to find a practicing physician who was putting so much time and expertise into that market.

Since then, Eric has decided to put his full time and attention into his business, which also includes a free service to help physicians choose an EMR/EHR and a package of products and services related to speech recognition for physicians (based around Dragon NaturallySpeaking). Note: I’ll mention as a disclaimer that Eric’s company recently decided to sponsor HIStalk, although our plans for the interview had already been made by then.

Thanks to Eric for bringing me up to speed on the complex world of physician practice systems. Big changes are happening.

Give me some background on yourself, the company, and how you got interested in physician automation.

I’m an orthopedic surgeon. About 14 years ago, one of my secretaries came to my office and said, “I know you like computers. I just took my son to a pediatrician and he was talking to a computer.” He was using a voice recognition product from a company called Kurzweil, which had been started by Ray Kurzweil.

I decided to buy it. Ours was a three-physician office at the time. The $26,000 cost was hard to swallow, so I opened a company to sell voice recognition software 13 years ago. And so the rest is history, although I didn’t want to say that because it sounds overly grandiose. [laughs]

I always refuse to use the term EHR since vendors started using that name in talking about their old EMR products without changing anything. Am I being too much of a stickler?

Yes. I have a treadmill in my garage with a wireless mouse and keyboard and I do a lot of Internet surfing. I don’t call it by the time, but rather by the mile. When I surf, I can do five miles.

John Naisbitt is the author of Future Trends. He made the rational conclusion that what is important to the present and what will be important in the future can be measured by how often items come up in newspapers. I compared “electronic medical record” and “electronic health record” to see how often they showed up in Google. I wrote in an article that the term “electronic medical record” would have become less prevalent when the lines met. Right now, “electronic medical record” is 46 million in change in Google hits and “electronic health record” is 71 million. Three years ago, it was exactly the opposite.

There are subtle distinctions. An EMR is used by a physician in the office to take care of patients. An EHR is more connected and takes care of the community. Connectivity is the distinguisher.

The manufacturer calling it so doesn’t make it so. The terms are very frequently interchanged. I changed the name of my company from EMR Consultant to EHR Consultant in recognition of that change, although you’ll see Word changing EHR to HER. [laughs] In EHR Scope, we talk about how Microsoft Word versions can be corrected to stop doing that.

Notwithstanding all the above, I frequently use the terms interchangeably.

What’s holding back widespread adoption of practice automation?

It’s a few basic issues. Physicians are the ones who pay for it, both with cash and, more importantly, blood, sweat, and tears from the angst of changing how the office functions. Third parties are the ones that benefit, like government and patients. That disequilibrium is disconcerting to many physicians.

I’m a strong proponent of using voice recognition. It substantially minimizes the inconvenience of electronic recordkeeping. It allows physicians to alter the way they interact with patients to a lesser extent.

Despite the significant amount of time and cost, essentially every physician who has been involved with a successful implementation says they would never go back to a paper office, myself included.

I saw recently that a physician insurer is offering a discount for EMR users. Is that common and will that benefit be attractive to fence-sitters?

I believe it’s common. It’s probably not a sufficient amount of money to pay for the software, but it could be meaningful. I was pushing that idea in 1994 with insurance companies to use Kurzweil and structured reporting systems. Physicians who prove they can provide greater quality of care will not only have greater gross revenue due to pay-for-performance, but will also be offered more meaningful malpractice insurance discounts.

Can a one or two physician practice implement a good EMR with reasonable cost and effort?

You used the term EMR either intentionally or not, so I’ll speak to an EMR specifically. Yes. But, you can’t implement a state-of-the-art, easily interconnected EHR with all the bells and whistles and billing capabilities for $5,000. However, if you want to take a substantial step in the right direction and automate reports, absolutely. In fact, a number of those systems are CCHIT-certified, surprisingly.

Speaking of CCHIT, is it accomplishing what it was intended to accomplish?

I’m not positive that I know what it was supposed to do. I feel badly about specialty-specific programs that were not offered the opportunity to be CCHIT-certified. If you wrote a state-of-the-art, phenomenal program for OB-GYN or ophthalmology, you won’t be certified because you don’t have the features they require. Certainly that will change.

I’ve heard scuttlebutt about the $28,000 certification fee and the hundreds of thousands of dollars needed to bring products up to CCHIT specs and whether that has caused a material increase in the cost of software. It probably does weed out some of the mom and pop operations.

I spent a substantial about of time and money developing what I called an EMR that was more of a documentation product. I stopped developing it about three years ago, so I can feel the pain of someone who spent years to develop software that helps people accomplish what they need to in their specialty, but because of CCHIT certification, may be put out of business. Over time, under-funded companies will go out of business.

If its purpose was to give comfort to physicians buying software or to make it easier, I’m not sure it accomplished that. I’m not seeing it. One of the bits of data I maintain from people going to EHR Consultant and telling us what they’re looking for is whether they want a product that is CCHIT-certified. Maybe 20% of our clients say they won’t look at non-CCHIT certified programs. That means that 80% will. Many say it’s of no consequence to them. Smaller offices seem to care less and larger offices care more, but that’s a subtle trend.

You offer a free EMR evaluation service. How does that work and are other companies offering something similar?

I went to HIMSS 3½ years ago and rapidly realized that most mortal human beings would be incapable of learning about the wide variety of programs in order to support them, which is what is consultants do. I decided to do an evaluation. I devised a vendor questionnaire of 600 questions and then asked doctors 200 to 300 questions.

If you look up electronic medical records on Google, a surprisingly large number of responses are from companies that will gladly help you find the proper EMR. My experience is that many of them ask name, address, phone number, number of docs, when purchasing, and not much else. They’ll say, “Here are the top five products.”

Our methodology is that there are dozens of qualified products and not all are appropriate for an individual office. There are a number of cars, Mercedes and BMW, all of which have different styles in the marketplace.

By matching the 200 to 300 questions the physician has answered against the 660 the manufacturer has answered, we can make a qualified match of the appropriate technology. It’s a matter of judgment, but we give large positive grading for EMRs designed specifically for one specialty for somebody of that specialty. In that way, we’re best able to give a good number of very appropriate software program recommendations to each individual physician.

Is speech recognition software underrated in its ability to help physicians save time?

Absolutely. I’ve been doing it and selling it for 13 years. You’re not supposed to take returns of open software, but if someone returned it, I took it back. In 1994 to 1995, I had a 50% return rate. Nobody asks me to take it back any more. You get 99% accuracy. You can speak like a New Yorker. It’s like transcription with no fees.

The sweet spot is a rich EHR. I can click through the physician exam, click through the review of systems and family history, and social history. I dictate the history – how the accident happened, what restaurant they were at when they started choking. The specific factors that make each individual’s history unique are important. Speak those first two paragraphs. Minimize the transcription cost and let the EHR do what it’s supposed to do, which is get good data capture.

I have some confidential information as a distributor. It used to be a meaningful event when a medical group would buy five or 10 Dragon licenses. With increasing frequency, we’re quoting and selling 100- and 500-license opportunities. If somebody bought 10 licenses, then 50, by the time they’re buying 500, they know it works.

What’s the penetration of speech recognition in practices?

Tens of thousands of physicians use Dragon NaturallySpeaking. That’s probably still single-digit percentages, but it’s increasingly rapidly. I have no visibility into the market of companies not selling Dragon NaturallySpeaking. They’re clearly the market leader, but I don’t know the percentages of the others.

We’re a distributor, so we sell to 100 Nuance-certified solutions providers. At the present time, I’m doing an ambitious project, which is finding out from each reseller which EMR packages they’ve installed Dragon with. I’m putting together a series of Google Maps. I can point them to a page on the Web that will have a map point for each qualified, certified Dragon reseller that has experience with their particular EMR program.

I just sent an Excel worksheet to 160 resellers with 362 EMRs listed down the left hand side and a dozen different qualifications across the top: have they used it, have they developed macros, do they help install it, etc. We’ll tabulate that onto Web pages to display that data.

What do you think about AcerMed’s situation?

As I understand it, there was an intellectual property infringement lawsuit that led to substantial legal fees. That was the immediate cause of the demise of AcerMed, not the fact that the program didn’t work. I’ve spoken to people who liked it and people who didn’t.

Functionality didn’t lead to AcerMed’s demise. I don’t believe that CCHIT is in the business of looking at the financial aspects of companies.

Will that event change how doctors look at software?

If you’re a single doctor spending $10,000 or $15,000 on software, I don’t think you need to pull out all the stops. Larger installations spending hundreds of thousands should get financial information and do a Dun and Bradstreet or Hoover’s check.

What changes would you predict in the physician office system market over the next 3-5 years?

There will come a time where a specialist is no longer getting referrals from their general MD because that doctor has an interoperable software program with the specialist across town. When that happens, you’ll see rapid adoption because they’ll need to stay competitive.

You’ll see greater use of non-MDs putting medical information into the history, either the patient or less highly paid people to enter the data, whether a physician assistant or nurse practitioner or medical assistant. I think that’s an inappropriate use of an MD’s time. They should be spending their time diagnosing people. It can be a substantial change of physician time to document an encounter and I think it will be attacked in different waysE

The EMR industry seems to be polarizing, with legacy, expensive vendors on one end and modern, inexpensive products on the other. How will that shake out?

That’s absolutely an accurate depiction. I am somewhat surprised, and I’m not politician, but hospitals are permitted to pay 85% of software costs that are compatible with hospital legacy systems. I was expecting to see a sea of change where legacy systems would run over these new companies. I haven’t seen the new companies being quashed like I expected.

What does that mean?

New companies that are selling 10, 20, 50 million dollars of software a year in to medium and increasingly larger practices have a very bright and rosy future. As I think should be self-evident, I do analysis for physicians for free, but I have some referral agreements with a very few vendors. I’ve been doing this for 3½ years and I used to get an intermittent check from these companies for sales to a one -or two-physician practice. Now I’m seeing small companies selling to 10-, 20-, or 100-physician practices.

Are they taking away business from the legacy vendors or selling to first-time customers?

In 2010, they’ll be taking their business away. I don’t think that the current sales being made in physician offices for a few thousand dollars would have been made for $75,000 if the smaller companies weren’t there. Those sales would not have been made.

If I were a large public company with product installed in hospitals, I’d rapidly provide an inexpensive offering to the local physicians to stay competitive.

So you like the Misys-iMedica deal, where Misys will resell the small vendor’s product instead of developing their own so they can get to market faster?

From Misys’s perspective, it was the proper thing to do. I have the pleasure of having thousands of offices telling me what they like or don’t like. Misys will likely benefit from having a new, up and coming, recently written, capable software program. They’re a billion-dollar company with long marketing reach and having a product that physicians are happy to use will be a welcome opportunity for them.

Will the smaller vendors be bought by the larger ones who worry about the competition?

I don’t think big companies will buy them because they’re a threat. They will buy them because they provide an opportunity.

I live in the same county that Dr. Notes was headquartered in. I was appointed by the bankruptcy court to sell the company’s source code to its .NET version. They had a Windows-based program and were allegedly 90 days away from shipping a .NET program. They went into bankruptcy and I’m helping sell the 400,000 lines of code.

I sent 360 e-mails at 9:00. By 9:01, I started getting responses. People from the up-and-coming companies wanted to buy the code. They wanted a billing module, which Dr. Notes didn’t have, or wanted their customers, or wanted their code.

Then, I noticed that the people calling me were saying things like, “Well, Dr. Fishman, since you seem to be in the business of buying companies, can you find someone to buy mine?” That happened dozens of times. Others said it wasn’t exactly what they wanted, but wanted to hire me to find them an ASP CCHIT product within 30 days.

There will be a lot of churning of these 1, 2, and 5 million dollar companies in the near future. That’s a particular interest of mine. In next EHR Scope, we have half a dozen pages about recent transactions written by an investment banking firm.

Was it a surprise that McKesson bought Practice Partner?

Andy Ury did a great job having a company of McKesson’s stature helping them do the marketing. I don’t have any insights into McKesson. The phenomenon of having billion-dollar companies snapping up EMR companies with eight-figure revenue will continue.

Do doctors like the idea of personal health records?

I don’t think it’s happening in doctors’ offices. Companies are interested.

I’m potentially involved with a PHR company and a clinical practice guidelines company interested in getting more entrenched into the personal health records. I think it’s something that will be very important and I’m surprised it hasn’t taken off more quickly. I stopped practicing 3 1/2 months ago and had zero patients express interest in interacting with me in that way. It’s not happening yet.

What about Google Health’s rumored PHR project?

It amazes me what Google knows. I think if they set their mind to it, they will do it. I understand they had some change in staffing at that level. I’m not qualified to offer an opinion as to whether they will or won’t do it, but I spend money advertising on Google and thinking about their algorithms and how much they know about people.

They certainly have the computing power to enter this space and pharmaceutical companies spend tens of billions of dollars in advertising their products. Google would certainly be willing to accept some of that.

A magazine just released its 100 Most Powerful healthcare people. If someone asked you, “Who are the most powerful and influential people when it comes to physician use of software,” who would you say?

The CEOs of those dozen up-and-coming EMR companies that I refuse to name. [laughs] They are involved in determining what the software that they’re producing will look like. They are profitable companies with millions or tens of millions of dollars of free cash flows without the shackles of having it burdened to something from their past.

They will decide whether to encourage or discourage interaction with patients, like personal health records or smart cards or thumb drives. They have the resources and knowledge and motivation to be in the doctors’ examining rooms around the country showing how healthcare will be delivered. They have the wherewithal to acquire technology, like clinical practice guideline technology, and integrate it in their software.

I know a little about nanotechnology. A friend asked me where to buy a portfolio of nanotechnology stocks, but they’re mostly privately held. If I could invest in a portfolio of smaller EMR companies, I’d do it in a heartbeat. You could reasonably choose a handful that will be successful, though I can’t pick them all, but the small ambulatory EMR industry will do very well financially.

My specialty is the smaller office, but two weeks ago, I got call from hospital CIO with 525 physicians on staff. He mentioned two legacy EMR systems they were interested in. I mentioned a couple of smaller systems and there appears to be some interest. Some of these up-and-coming players may play a role in hospitals

What about retail medicine?

I don’t want to grow old and decrepit in this country because healthcare won’t be as good as it is today. Retail healthcare is here to stay. Healthcare should be touching and care, but it’s clear that retail clinics aren’t going away any time soon. I don’t get my care at one.

Will retailers develop their own software or buy from those sexy companies?

I have made successful introductions between retail pilots and one or more of those dozen hot, sexy companies I won’t name. I don’t mean to be evasive, but I have relationship with those companies.

If an HIStalk reader is interested in ambulatory EMRs, what information do you provide?

EHR Scope is a free publication, over 150 pages, and the next issue is in October. It has a meaningful amount of information on over 200 ambulatory products. It comes out in a PDF and if somebody’s a cardiologist, they can search cardiology and find systems appropriate for them. They can quickly get their Web sites and contact information. I think it’s a very valuable resource. The electronic version is free.

Any final thoughts?

I love what I’m doing.

Monday Morning Update 9/24/07

From Dr. Lisa Cuddy: “Re: Philips entering the European HIS market. A likely target may be Agfa. No revenue growth, no big sales, but solid installed base. There are rumors about divesting the Agfa healthcare group and potential bidders are GE, Philips and 3M.”

From The PACS Designer: “Re: Oracle 11g Advanced Compression. The subject of compression stirs a lot of debate when discussing digital image files and what degree of compression to use without destroying the technical composition of the reviewed file. Oracle isn’t addressing image compression in 11g, but they are addressing compression techniques to speed overall system performance, such as cache memory and I/O query/retrieve from your database archive. Oracle 11g has the capability to do table compression to more efficiently use storage resources and, at the same time, improve overall access time to satisfy the ever-increasing demand for faster results from large databases. Another new feature is to store frequent transaction requests in cache memory so that the next request is processed sooner by requiring less information from the archive.”

From Art Vandelay: “Re: Joel Diamond of dbMotion interview. How is your product different from 3M’s Clinical Data Repository with configurable workstation, health data dictionary, and alert writer?” Joel was gracious to provide a response. “First of all, let me congratulate you for your fantastic HIStalk interview. I wanted to respond to your ever-insightful commentary and question. While we don’t comment on specific competitors in the public domain, I would like to answer your question in a general sense by pointing out that the dbMotion product is unique in that it is one of the only solutions on the market today which addresses the interoperability problem in an end-to-end manner. Other products can provide partial solutions, such as a centralized patient view (portal), messaging, or result delivery. dbMotion, on the other hand, provides a complete platform that doesn’t stop there — it goes a few steps further by enabling its customers to maximally leverage their existing IT infrastructure to address current and future needs. Our SOA architecture and sole focus on interoperability allows us to address all aspects of this complicated arena, including security, vocabularies, and semantic knowledge. We often find that alternative solutions involve assembling together a set of tools which are normally sold and thus often operated independently. Even then, most companies still need to add components from external vendors to provide necessary functionality. We also pride ourselves in the fact that our solution is pragmatic in that it was built to serve imperfect environments– not just those that have ideal interfaces and harmonization of technologies.”

From Dave Unger: “Re: Bronx-Lebanon. I saw ECLP announced the deal. Any idea of deal size?” You heard it here first, of course, from Inside View, although In the Know was wrong just a few weeks earlier when he/she called Cerner as the winner. I haven’t heard the contract size so far, but I bet I will.

From EMR Guy: “Re: CCHIT. I heard the 2007 CCHIT certification process was much more difficult than previous years, and that one of the reasons why so few vendors entered the certification process was because it was so difficult. In other words, that many vendors could ‘get away’ with promoting their 2006 certification, leaving the impression that they were recently certified.” For that or other reason, 2007 certificants are in far fewer supply, with many vendors still displaying 2006 stickers (or none at all). Some would say that’s what CCHIT intended – make it easy to get that first stamp of approval, then rely on competitive pressure to move vendors up the ladder to meet increasingly tough standards. It’s interesting that newer, smaller, cheaper vendors have already nailed the 2007 standards, while older, larger, more expensive ones haven’t. The guard is indeed changing.

From Bud Kruger: “Re: Quovadx. Likely based on the Latin quo vadis, which means ‘where are you going?'” Good name for an interface engine company like Quovadx if so, although their product name Cloverleaf is better.

From Joe Seluchi: “Re: Eclipsys. Are you hearing anything about Sunrise XA performance or how the early adopters of Sunrise Pharmacy are doing?” I’ve spoken to one Sunrise user and one Sunrise Pharmacy user (not the same hospital). The first said they were having performance issues, but didn’t elaborate. The second seemed pretty happy with pharmacy, but also didn’t elaborate. First person reports are welcome.

From Steven McCroskey: “Re: Rep. Murtha. John Murtha of PA, the guy who brings home all the bacon to the Johnstown area, including government money for HIT research through a Conemaugh Health System spin-off, is named one of the most corrupt in Congress by Citizens for Responsibility and Ethics Washington.” Murtha was already identified as having more earmark projects (i.e., wasteful pork barrel projects) for his home district than anyone else in Congress. He moved up from “dishonorable member” to “corrupt” after charging across the House floor to threaten a fellow Congressman for questioning a $23 million Murtha pet project, the National Drug Intelligence Center, to be located in the high tech mecca of Johnstown, PA. I knew about Conemaugh subsidiary InforMedx Group, which was doing some kind of simple research for the DoD using grant money (i.e., your federal tax dollars) that Murtha arranged. One company employee, I notice, is named Murtha. Probably a coincidence.

From D. C. Simonton: “Re: Epic. Epic reported at their annual conference that they’re planning to move to a web-based client from their current Windows/Citrix approach. They claim it will take them 5-7 years to complete the transition!” Appreciated, unverified, confirmation welcome.

From Ted Striker: “Re: QuadraMed. San Bernardino layoffs rumored – several project managers, developers, customer support people, managers, and a director.” Unverified.

Want to help kick some crippling disease ass? Click here and watch the four-minute “Augie’s Quest” video on ALS. For your time, Allscripts CEO Glen Tullman will donate $1 to ALS research, along with another donor who will do the same. Your four minutes thus contributes $2, each and every time you watch the video. Pass it on – it’s Glen’s money going toward a good cause.

I got a fun e-mail from Danny Sands of Cisco after our interview. I’d told him that, based on the experience of others I’ve interviewed, he’d hear from lots of folks quickly, and likely some who had been out of touch for awhile. He e-mailed today: “I was on the road and finally had time to read the interview. Thanks. Based on e-mails I received, I am impressed with how many read HIStalk. Someone I hadn’t seen in years happen to run into my mother and told her about it!” That’s cool. Made my day.

I haven’t recently mentioned my weekly editorials for Inside Healthcare Computing, a long-time HIStalk sponsor and, as I’ve said before, the only HIT (or IT, for that matter) publication that I’ve ever paid to receive. Good news, opinion, and fact-finding. The only place I know of that you can get a detailed description (pricing and terms) of what hospitals paid for Cerner, McKesson, Eclipsys, etc., nimbly pried from reluctant fingers using state and federal open records laws for journalists. Anyway, what I’ve opined recently on their platform:

• Healthcare Software: No, You May NOT Have It Your Way
• The HIT “Trendulum” Starts its Swing Back to Administrative Systems
• Private Investors Will Create Competitive Newcomers
• Google Health: Does Anyone Still Care?

Several folks responded to the “Judy in a wedding dress and mock ceremony with new customers” rumor. Fact: the Wedding March is played over Epic’s PA system when someone signs. That’s it. The point missed by those who e-mailed me to decry this as a ridiculous rumor: Epic’s so quirky that non-employees didn’t bat an eyelash at the idea. That’s the trouble with eccentricity – it isn’t always selective. (Say, maybe I just coined a new GE product name – Eccentricity. Or, what you could call a deinstall: Ex-Centricity). And as one reader offers, “Epic sees customer relationships as marriages. But, as Phillips found out, Epic is usually pretty good at writing pre-nups as well.”

A couple of new Picis deals: Mercy Medical Center of Baltimore chooses perioperative automation and Kennedy Memorial (NJ) goes with ED PulseCheck.

Killer IPO: athenahealth. Shares were priced at $18 (above the expected $14-16 range), but demand pushed the IPO-price to over $35, a quick double and the best first-day gain of 2007. Great news, unless you were an insider and noticed that your big-name underwriters obviously set the open too low and let early buyers take the profits. In their defense, the company is losing money with $80 million in revenue, so maybe the unexpected share demand was irrational. Jonathan Bush has $25 million worth.

Cerner co-founder Cliff Illig on entrepreneurship: “Impatience is a virtue. Have a constant sense of urgency.” The article included a tidbit I didn’t know: the founders renamed the original Paterson, Gorup, Illig and Associates to Cerner, which they took from the Latin cernere, meaning ‘to sift or understand’. Cliff again: “We had a list of things we knew something about, a list of things we didn’t know anything about. One of the things we didn’t know anything about was health care.” And this statement, which some would say still reflects reality: “And to us it always seemed like if you were going to start something you needed to go sell something. So very early on, we went and sold a lab system that didn’t exist.” Good article, good thoughts.

Seton Family Hospitals (TX) outsources infrastructure management to Dell. Seems odd, although cynics might point out that one of Seton’s hospitals is Dell Children’s Medical Center, named for the Michael & Susan Dell Foundation that paid for it. Probably a coincidence.

Here’s the press release announcing the November 5-6 conference I mentioned in a text ad to your right. An executive-level HIStalk reader has already let me know he’ll be attending, so I hope to get a report. The speaker lineup is “sick” (I heard that word used by a college student at a football game this weekend and it apparently has a superbly positive connotation, so I’ll throw it out there as a hip nod to young readers not likely to be attending a C-level conference like this anyway). HIStalk is a media sponsor (we swap ads, in other words). I wouldn’t have done it if the agenda wasn’t strong.

I tried to get an update from Kim Pederson after Allina’s Davies win, but the e-mail address I have isn’t working. A couple of readers asked what she was doing now, but it looks like I won’t be finding out after all.

Welcome to new HIStalk Gold Sponsor Premise of Farmington, CT. The company’s products deal with the urgent hospital issues of patient throughput and business analytics. Products: Bed Management Dashboard, BedXPress Dashboard, Transport Dashboard, Executive Dashboard, and Asset Management Dashhboard. Great case studies and testimonials are on the site. I mentioned a couple of weeks ago that the company doubled its customer base in the last year and had a 100% “would buy again” customer ranking from KLAS. I’m really interested in products like these (having worked on a throughput project in the past), so I hope to interview CEO Eric Rosow about best practices. I don’t know of any hospital that doesn’t have all these problems. Welcome and thanks to Premise for supporting HIStalk and its readers.

Epic’s user group meeting is over. Report, anyone? A Judy quote to users on the $150 million Phase I campus cost: “We try to be extremely careful with your money. (But) sometimes, it’s counter intuitive [because of private office productivity gains] … In five years, the buildings are paid for. The buildings, parking, artwork, everything. In five years, we’re rent-free.” Also mentioned: a PHR project code named Lucy, Epic’s first international customer in Netherlands (home of Philips), and the company’s 2006 revenue of $370 million.

Speaking of Epic, Fletcher Allen Health Care wants to spend $57 million on Epic. Ironic: IDX founder Rich Tarrant is a big wheel there, although he’s downplayed his influence after some of its management went to jail over lying to regulators about construction costs.

Misys says revenue was up, although healthcare’s only mention is to once again label it as underperforming and losing ground with a 2% drop in revenue.

For the ten people who still care, Leapfrog announces its CPOE-centric top hospitals. Even Leapfrog says only 10% have implemented CPOE, which is a testament to its lack of clout. If the CPOE pioneers weren’t coming back with arrows in their backs, Leapfrog wouldn’t have to arm-twist.

MedAvant will provide claims connectivity with Aetna.

Siemens gets a Soarian sale in Germany.

The federal government awards $4 billion in CMS IT contracts to the same vendors it always chooses, although none them are in Johnstown, PA.

E-mail me.

Inga’s Update

Skeptic posted a note that was critical of the many excesses at HIMSS. Skeptic’s opinion was that all those big costs ultimately damage healthcare. “It’s never made sense to me,” Skeptic says.

While I agree that there may be too many wasted dollars being spent at HIMSS (and other shows), I am not convinced it is all money wasted (though it goes without saying that a far better use of a company’s marketing dollar would to be an HIStalk sponsor, but I digress …) Here are some reasons I believe a vendor can justify an “investment” in HIMSS sponsorships, exhibits, and the rest:

• The least expensive booth is $2,700. Last year over 24,000 folks attended HIMSS. There are many, many smaller shows out there that charge a similar amount and have only a few hundred attendees. Less than $9 a body is pretty cheap. (Yes, I do realize there are additional costs above the booth rental.)
• The exhibit fees subsidize the cost of the conference. The attendance fees are already high – how much higher would fees be without the sponsorships? If the fees were significantly higher, would attendance be affected? I think so.
• Last year there were over 900 vendors. Sometimes it takes more than free pens to differentiate yourself from the pack and attract people your way. Is it necessary to host big extravagant parties? Perhaps not necessary, but it can make some sense when you have so many clients and prospects all in one place at one time with nothing better to do than go back to a hotel room and order room service.

I suppose an argument could be made that there should be rules restricting vendors from giving away any items worth more than $5 and not allowing complimentary espresso or cocktails (sounds boring). And, maybe it doesn’t all have to “make sense.” If some people have moral objections to the excesses of some vendors, it is their right not to do business with them. I think generally people are smart enough not to be swayed by big marketing dollars when it comes down to making the most important business decisions. If the vendors want to spend big money, then all the more fun for the masses. (I just want to make sure I get an invite to some of the really good parties).

A reader forwarded me a note about a new website being launched, www.medziva.com. It’s still in its early stages, but it appears it will be a site where consumers can inquire about particular labs and lab tests. In terms of addressing the growing trends of consumer-driven healthcare I think the concept is good. I suppose sites such as WebMD provide information about different types of tests or recommended tests for particular diagnoses, but, this site will also allow discussion of the benefits of the labs themselves. Will this be a trend we see more of?

eClinicalWorks has opened a new office in the Big Apple. In April, eCW signed a $19.8 million deal with the NYC Department of Health and Mental Hygiene to provide EMR/PM to 1,300 physicians. eCW will have about 30 employees initially in the new facilities in order to better manage the NYC project.

ACS announces the promotion of Kevin Kyser to CFO. Kyser had previously served as the VP of Finance. He replaces John Rexford, who will remain an Executive VP over key corporate development initiatives, including mergers and acquisitions.

E-mail Inga.

HIStalk Interviews Daniel Sands MD, Cisco Systems and Harvard Medical School

A couple of readers suggested I talk to Danny Sands. He’s an assistant clinical professor of medicine at Harvard Medical School and senior medical informatics director for Cisco Systems. If anything interesting happens in the industry, he will hear about it while wearing one of those two significant hats. I have to figure out what whole bicoastal, two paychecks thing since he seems to be having a ball.

Dr. Sands earned his medical degree from Ohio State and a master’s from Harvard. He did his medical residency at Boston City Hospital and an informatics fellowship at Beth Israel Deaconess Medical Center. He’s also on AMIA’s board and is a fellow in both the American College of Physicians and the American College of Medical Informatics.

Thanks to Danny for spending time with me.

Describe your job at Cisco.

My position is as the senior medical informatics director. I work in a part of the organization called the Internet Business Solutions Group, or IBSG.

Cisco has always been organized around engineering and sales. There was no verticalization of the organization at all. Five or six years ago, the company started to understand how it could do verticals better and created IBSG. We have maybe six to eight verticals and healthcare is one of the most mature.

IBSG can be thought of as the global, no-fee consulting organization of Cisco. We’re vertical-specific. We do consulting in a limited way with important customers around the world. In healthcare, our job is to help Cisco understand healthcare in a very deep way and to let our customers know we understand healthcare.

Given our size, our consulting engagements aren’t like Accenture’s. They’re just six to eight months. We work with CxOs to understand business and clinical problems and develop solutions, often employing technology. We think deeply about the industry, always thinking about what’s happening in healthcare and healthcare IT and how we can effect change in healthcare through our writings and working with Congress and ministries of health around the world. We’re transforming health to practice in the most clinically safe and high quality and cost-effective manner possible.

Everybody’s talking about Cisco’s recent announcement about its healthcare growth. What’s driving that growth?

Healthcare is an industry in which organizations have under-invested in technology for so many years. Back when computers were just becoming ubiquitous, every industry that viewed itself as information-intensive was investing in infrastructure to put in the fundamental applications. Now, they’re investing 8-10% of revenue and doing very sophisticated things.

Healthcare has not viewed itself as an information-intensive industry, which is quite a shock to those practicing in it. It hasn’t viewed itself that way, except for billing, and hasn’t built up infrastructure and put in fundamental applications and databases to deliver care effectively.

Healthcare is investing 2.5% of revenue and still falling behind. For years, it was even less, under 2%, and there’s a lot of catching up to do. Many organizations are behind the eight ball and it will take awhile to catch up. They’re beginning to understand that this is an information-intensive industry, and for quality metrics, they will need technology.

There’s a huge market in healthcare. What we’re interested in doing isn’t just selling stuff, but helping people do business and clinical work effectively. Cisco started investing several years ago because we saw the technology was underutilized and we could really help the industry.

Does Cisco manage healthcare the same as other vertical markets?

Yes. The IBSG has verticals in retail, public sector, entertainment, financial services … so we have a bunch of these things. In this consulting group, we have 225 peple around the world, so it’s not a huge organization. Intel has more than 200 in just their digital health organization.

My counterparts do similar things to what we do. Some of them do more traditional consulting instead of the thought creation we often do. So, healthcare is pushing into areas that not all the verticals have done yet. We also have a sales force dedicated to healthcare.

I think we go about things differently because we’re offering to be a partner that understands healthcare. In our group, we have expertise across the spectrum: healthcare consulting, nurses, nurse practitioner. People who understand networking, homecare … someone from life sciences, someone in the payer market. We have a breadth of expertise becaue we’re coming at it from so many different sides.

What are the biggest technology challenges in healthcare?

The biggest challenge is the lack of capital to invest. Still today. If we look at organizations, larger healthcare organizations will spend more money and will be more forward-thinking. Intermountain, New York Presbyterian, those centers of excellence. We have these name brand organizations that have clearly spent a lot on IT and have done neat things.

You have others that big who have the margins to invest. You have others that are struggling financially. Hospitals are running near-negative margins. If you’re in a business with no margins, you’re just trying to keep your head above water.

It’s similar in practices. They mirror hospitals in that larger ones have infrastructure and staff and revenue, but in the smaller practices where most care is delivered, no margin, no infrastructure. The biggest problem is appropriate investment in technology.

One barrier is a misalignment of incentives. Who is investing the money and who is benefiting? Clearly, if a hospital invests in technology, they need to see some return on investment. Some may come from reduced cost of handling records. It’s a lot harder for practices to make these justifications. Larger institutions are doing better in being able to step back and look at their issues. We’re focusing on large enterprise users for that reason.

We have a very hands-on business in healthcare. We can’t replace people, but we must keep them in mind all the time. We need to remember that people have a limited capacity to change, so you have to help people apply the technology in their work. Healthcare is hands-on and so is introducing technology into it, so we want it to be done appropriately. There have been too many situations where hospitals have invested money and their projects haven’t been successful, often because they didn’t involve clinical staff from the beginning.

Is “medical grade network” a technology or a marketing approach?

That is a technology. When I talk about setting an appropriate infrastrucrtre, that’s what I’m talking about. It is an architecture for building a network that is resilient and reliable and secure and has survivability, those things we need in a mission-critical environment.

You can’t afford to have a network go down in healthcare. It must be hardened and tough. This is like plumbing or running water and electricity and needs to be that reliable. We say the fourth utility is a converged network. It brings together all the low-voltage circuits into a very reliable, robust network that’s expandable and can be managed. You need to be able to grow a network as you add more functionality and nodes. Sometimes that means adding to it, sometimes shutting parts down without bringing down the whole network.

You were at Beth Israel in 2002 when network failures caused what might be the biggest patient-impacting systems outage in history. Is it ironic that you’re working for Cisco?

It’s a great point. I tell that story often. Fortunately, I had no responsibility for the network management there. [laughs] The situation was that nobody was minding the infrastructure.

A network is a living, breathing entity. One needs to not only create an architecture, but maintain it to ensure it performs well. At Beth Israel, we weren’t investing in maintaining the infrastructure. Not only was it no longer architected correctly, it wasn’t managed over time, so it was vulnerable.

That sort of travesty could not occur with what we’re architecting now. I’m sure that will never happen again at Beth Israel. [laughs]

Wireless networking in hospitals is suddenly prevalent. Have caregivers and clinical software vendors embraced the concept that computer users aren’t chained to desks any more?

That’s one of the big waves that’s coming. We no longer have to think in terms of desktops, but can think of devices. Whether tablet or desktop or biomedical engineering equipment, everything becomes a node on the network. That’s the way that more progressive IT groups are thinking about things. That doesn’t mean there’s no role for the desktop PC, but there are roles for other wireless devices.

We need to think more about untethering hospital personnel from walls so they can interact with their hospital information system while sitting at a patient’s bedside. It could be a wireless phone so patients can communicate with them. Because it’s an IP phone, it’s part of the network and can share any information from the network. We can ID a patient, get a test result.

It shouldn’t matter what kind of device it is, whether it’s a wireless phone or tablet computer or PDA or desktop. All of these can interoperate on the medical grade network. The last mobility trend in hospital was COWs. Those are fine, but there are a lot of places you can’t wheel one in. It’s nice to have something that’s truly portable. The interoperability becomes important.

As we introduce new varieties of devices, whether phone or PDA or tablet, we’ll need to reinvent some of these applications, creating applications that are customized to that form factor. We have already seen some of this, like PatientKeeper and MercuryMD. We will have to see more hospital information systems that run on a tablet computer, for example.

Cisco is building unified communications. It doesn’t matter what device you’re using. You can communicate with all. Open a directory and communicate with anyone in whatever manner they want to be communicated with. Dr. Smith may say they’d like to be text messaged first. Everybody can have their own preferences. That’s a more effective way to start communication with people, by not annoying them by contacting them in a way they don’t like.

They can seamlessly move from a text sesson to a phone system or a collaborative session on the Web where we’re sharing a screen. Unified communications will change healthcare. So much of what we do in healthcare is communicating, yet our technologies are primitive.

Give me the Cisco perspective of the Cisco-sponsored HIMSS Community for Connected Health.

We wanted to form a community of people thinking about the connected health concept. That’s almost the form of a user group, but it’s a community. People can share ideas with each other and with us. I don’t know how this worked with HIMSS, but we’re really just trying to reach out and think about community.

As an aside, Cisco has embraced the idea of Web 2.0 and groupware and collaboration. We’re trying to experiment with that in many different ways, like wikis and a new directory that’s almost like Facebook. We think the future is collaboration. When I watch my teenaged daughters on the computer, they’re collaborating all the time. They don’t use traditional means, even e-mail. They skip that and go right to Facebook and MySpace. We’re trying to do these things in Cisco.

Cisco tries to do the things that it gets other people to do. If we think it’s a coming trend, we try in on ourselves first. Another example is Second Life. We have a community there, where we’re trying to push the envelope. We don’t think we can continue to grow the way we’re growing unless we’re collaborative.

John Chambers says he wants us to reduce our travel 20% over the next year using the technologies we sell. TelePresence is a totally game-changing technology. It is totally unlike videocoferencing. It does what videoconferencing promised to do. You really hear people in high definition, see people and even see them sweating, and feel like you met the people on the other side of the table. It’s almost entirely transparent to the users. We’re not really aware it’s there. The problem with videoconferencing is that you’re always aware it’s there, with jerky motion and synchronization problems.

We’re using TelePresence internally. The first customer was Cisco. We put it in all our major offices all over the world and we’re encouraged to use it so we don’t have to fly anywhere. I’ve been able to avert flights all over the country by using TelePresence.

Are today’s electronic medical records systems too tied to the paradigm that physicians have to enter their own data to give and receive value from those systems?

There are many potential sources of information. Some are machines, some are people, and some are people and machine at other institutions. We have to figure out what is the most efficient way to get information from these places and present ot to the clinicians.

There is a large amount of information that we acquire in the course of interaction with patients. Much of it has to be entered by us, one way or another. There’s a large body that clinicians are responsible for entering that should come directly from the source. It would be preposterous to look at a printout of a lab test and type that into a computer. Likewise, why is it that we interview a patient and enter their information into the clinical information system? There’s a practical barrier if the patient is lying down with a gunshot wound, but in many situations, we can take advantage of the patient. The patient is the most important yet underutilized source of information in healthcare.

We’re often very keyboard-centric. There are lots of ways I can interact with a computer – a stylus on a tablet; dictating and having it trabscribed by computer or human; and typing, which can be templated or free-texted.

There’s another aspect to your question, which is that our information systems tend to be very doctor-focused, or let’s say clinician-focused. Just as we don’t ask our patients to enter information into a computer to help their health, we often don’t share the information in the computer with our patients. Patients need to play a bigger role in healthcare.

We don’t think of them this way, but patients are our customers. That leads to problems where we don’t share information and don’t make it easy for patients to make an appointment or get a referral or get test results. We should do these if we’re truly patient-focused. When patients have access to information, it can be more satisfying to both doctor and health.

The physician brings a complementary skill set. You’re an expert in you. If we have a common database and bring our expertise together, we can make tremendous things happen and improve the way we deliver care. There’s some preliminary evidence that patients engaged in this way have better health outcomes.

What about other information types, such as video and voice?

We need to be storing more rich multimedia information about our patients. The first wave was the PACS movement and that’s terrific. It’s amazing as a doctor to be able to see the image instead of just reading the text report. We need more of that. PACS was developed separately from the HIS.

We need a convergence of text and multimedia and it shouldn’t just be radiology images. Cardiology images, photos of a wound, video of a patient walking, pathology images, voice files -– all should be part of the record.

That necessitates data acquisition that we don’t have right now. We’re lucky in a clinic if there’s a digital camera around. We need to think in terms of multimedia acquisition devices. There are digital ophthalmoscopes and otoscopes. We need to acquire that information, capture it, and store it in the record. That requires a new set of input devices and interfaces to the hospital system so that multimedia objects can be stored and retrieved as part of the record, not as a separate system.

A digital image is not only far more effective at delivering information, you can manipulate it. It also requires efficient storage and an efficient network to convey those large objects. Those last two areas are what Cisco is interested in. We do storage area networks to store information more cost effectively. We’ve also pushed network convergence, where video can travel across the network. We’re partnering with some of the big HIT vendors to develop new functionality.

You were an advocate of electronic patient-physician communication. What’s the status of those projects?

A lot of doctors haven’t yet embraced the technology for the same reasons – time, liability, and reimbursement.

An exciting trend is the number of practices and institutions offering patient portal services that offer patient-provider communication. Kaiser rolled out Epic MyChart to millions of patients. That’s huge. It’s far and away the largest deployment of that kind in the world.

We’re seeing adoption among larger practices and more enlightented healthcare institutions in deploying patient portals that provide secure communications. I choose to look at it as a positive trend, even though figures haven’t taken off like I would have thought. The volume of messages a doctor gets from patients is very modest, even when you’re not charging a fee. At Beth Israel, for every 100 patients registered on the system, they’ll generate less than one e-mail a day to the doctor.

What IP-connected devices will have the most impact on healthcare delivery in the next 5-10 years?

Home care. I think there is no question that we need to be reaching into patients’ homes. That’s where patients are sick with chronic conditions. I think we’lll go beyond that and catch patients earlier in their disease or when they’re pre-symptomatic. It will be commonplace to interface with your set-top box or glucometer.

Home care, along with nursing homes, is quite technologically backward. It’s a real shame because these are our most vulberable and sickest people. These will be new markets where we can make a huge impact.

Location-based services, like tracking of things in a hospital,will be successful. Once you’ve deployed a robust wireless network, you have two ancillary benefits. One is the ability to do tracking, or location-based services. I can put a tag on my wheelchairs and infusion devices and code carts and track them throughout the institution through the wireless access points. It’s exciting that you can find out where the equipment is that you need.

You can also create a second wireless network for guest use. When you’re going to visit someone, you can connect your laptop to a public network that’s separate from the secure internal network. Most hospitals aren’t set up this way. They have one wireless network that’s for staff. Offering this for patients, especially for those in units like cancer units where they’re in for a long time, is a great service.

Any final thoughts?

This is a very exciting time to be in healthcare IT. Because of the robustness of the technologies and the ability to implement them effectively, it’s a tremendous time and I’m excited to be part of the industry and Cisco.

I really salute all the people working in this space. We need to remember that we need all kinds of players to effectively implement these systems. It’s not something an IT department alone can do. Vendors, C-level executivess, providers …  it’s an important collaboration pushing IT out to physicians, nurses, and patients. If we do this intelligently, we can make a huge difference. That’s why I’m in this business.

News 9/19/07

From The PACS Designer: “Re: Oracle 11g partitioning. Oracle has a new feature in Database 11g which they call Enhanced Partitioning. Through this new technique, you can create large object files (LOBs) for things such as resource scheduling and other institution activities. The LOBs can then be encrypted to protect them for HIPAA and other security purposes and also give management a view of the organization’s activity daily, weekly, or for other time periods. For example, you can create large object files for the summer vacation periods of July 1 to Labor Day for each year using Oracle’s new enhanced security option SecureFiles to do trend analysis on the efficiency of various departments during the peak vacation period of the summer.”

From Kesuke Miyagi: “Re: CCHIT. Here’s a chance for your readers to put their money where there mouths are and participate in the CCHIT public comment period. Stakeholders can share their opinions with the groups that are actively developing the 2008 certification criteria. I’m new to CCHIT, but have really been impressed at the openness and integrity of the certification development process.” Link.

From Yancy Derringer: “Re: Kaiser Permanente. Adrienne Edens is out at KP and replaced by Diane Comer, CTO from Firemans Fund. Looks like the second of mass changes by CIO Phil Fasano. He is a major proponent of outsourcing and Comer got all her name recognition from doing a major outsourcing at FF.”

From Rogue: “Re: Siemens MedSeries 4. It still runs on an AS/400, though ones much more powerful than those of yesteryear. You’d be surprised how it’s grown from green screen through Web-GUI to Web-capable. When I worked with it for awhile earlier this year, I was very impressed. One nice option – you own/manage the hardware or Siemens hosts it and all you need is a fat T1 or T3 line. Practical for the small IT departments.” Thanks for that update. I thought Siemens nearly sold it off a few times over the years and I’d heard nothing. I’m not claiming I hear everything, but it doesn’t seem like Siemens is very good at getting the word out.

From Ali Mills: “Re: MS4. Siemens has been investing in MS4 clinicals. Growth on top of 425+ customers, huge R&D, 21 new hospitals last year. MS4’s mantra is ‘three clicks to patient information’. MS4 beat out Meditech, McKesson, Cerner, and Epic at Texas Scottish Rite. IBM has pumped over $1 billion into iSeries (formerly AS/400) in two years. Glad to hear the story getting out.”

From Daniel Larusso: “Re: Epic. I’ve heard that when a new customer signs, there’s a mock marriage ceremony in Madison, complete with Judy in a white dress and with wedding cake. That’s just plain weird if true.” I’ve heard that, but not lately. Seems gauche to wear white in more than one wedding. Confirmation, anyone? Maybe some wedding pictures or the little happy plastic couple from the top of the cake?

From Terry: “Re: Craneware. The company has IPO’d in London.” Link. I’m familiar with their charge master maintenance product and it’s good.

This conference sounds cool: Transforming Healthcare through Health Information Technology, The Most Exclusive Summit for Healthcare Leaders on November 5-6. I got a flattering e-mail asking HIStalk to be a media sponsor, which caught me by surprise because I’ve never been asked. What that means: I let you know about the conference (which I would have done anyway) and they mention HIStalk (looks funny up there with all those real companies). What caught my eye in the first place: the speaker lineup, some of whom I’ve interviewed: Martin Harris of Cleveland Clinic, Danny Sands from Cisco, Don Holmquest from CalRHIO, John Wade from St. Luke’s, Holly Miller from UHHS, Neil Martin from UCLA, Jonathan Bush from athenahealth, Jeff McCaulley from Wolters Kluwer Health, Glenn Tullman from Allscripts, and Andy Eckert from Eclipsys, among many other big names from notable organizations. I’ve been to intimate conferences like these a couple of times and they’re a blast, with upscale amenities, personalized presentations, and casual access to industry bigwigs (it’s like a VIP pass to HIMSS). Sweet location, too: the five-diamond Peninsula Beverly Hills (great spouse trip). Another part of the deal was a discount for HIStalk readers: use code HISTALK2020 online or by phone and you’ll get a $750 registration rate. I put up a text ad to your right to remind you. Maybe you could write it off by turning in a first-person HIStalk report.

Clarification: I said that Visicu was dropped from the Inc. 500. True, but misleading. The original newspaper article said, “Other companies dropped off the list entirely due to going public, not being able to maintain the rapid growth or some other reason. That occurred to Visicu.” A couple of readers pointed out that the poorly worded sentence was trying to say that Visicu was dropped because the company went public, which I breezed right over.

Those who signed up for Brev+IT got it by e-mail Saturday. If you like what you see, sign up for your own free copy each week.

I knew Isabel CEO Jason Maude would respond better than I could to the reader who mentioned the lack of PubMed articles about the company’s diagnosis product. “So far, around 20 articles have appeared in peer-reviewed journals, including a study entitled ‘Validation of a diagnostic reminder system in emergency medicine: a multi-centre study’ which appears 5th on PubMed if you enter ‘Isabel’ as the search term. I would argue that Isabel is, in fact, one of the most validated healthcare IT products around. You can see the full extent of the published work on our website … in 10-12% cases that a physician uses Isabel, he/she is reminded of an important diagnosis that he had not thought of. When done live across three hospitals, it was found that, in 25% of these case,s it turned out the be the actual final diagnosis.”

Now here’s a story I bet you haven’t heard elsewhere. A reader clued me in that the ambulatory EMR products of several legacy vendors are not eligible for the Stark exception because their CCHIT certifications are over a year old (they didn’t earn 2007 certification yet, in other words). The only 2007 certified ambulatory products are Medent 18, eClinicalWorks, e-MDs, Greenway PrimeSuite, McKesson Practice Partner, NextGen, and Purkinje CareSeries. Hospitals can’t provide doctors with any other system under Stark unless they earned 2006 certification less than a year ago. That means you can’t, at this moment, give doctors Allscripts Healthmatics and TouchWorks, Cerner PowerChart, Epic Ambulatory EMR, GE Centricity, McKesson Horizon Ambulatory Care, Misys EMR, and Sage Intergy EHR, among others. Check CCHIT’s page for products with a date more than a year ago and not listed on the 2007 page. According to HHS, “The exception and safe harbor provide that EHR software will be ‘deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the [physician/recipient].'” Bet you won’t read that in the certification-bragging brochures, especially since these are the kinds of legacy vendors that hospital CIOs flock to.

Heard: Phreesia gets $10 million in funding. The company offers free (adware-supported) wireless touch-screen devices to physician offices that replace clipboard check-in forms for patients.

A eHealth Vulnerability Reporting Program study questions the security of EMR systems. Among the issues: systems allow penetration with standard tools, vendors don’t tell customers about security holes, and no industry watchdog creates and monitors standards.

Big employer healthcare coalition Dossia, after falling out with Omnimedix Institute, turns to Children’s Hospital Informatics Program of Boston to pick up development of its personal health record application. That’s Isaac Kohane’s shop. He e-mailed me once as an HIStalk reader, so maybe an interview can be wangled.

Everybody’s piling on the big guy. First Google threatened Microsoft Office by offering an enterprise version of Google Apps for a low price. Now IBM will offer a free download of Lotus Symphony, apparently developed from Star Office/OpenOffice.org. We old-timers remember the DOS version of Lotus Symphony/Jazz from the 80s, although not all that fondly.

Interesting thought: could MP3 recorders replace stethoscopes? Apparently the sound quality is higher, the files can be computer analyzed, and of course you have a digital record for later review (assuming legacy EMR vendors had a way to integrate MP3 files with other clinical data, that is).

Congrats to HIStalk reader (and occasional commenter) and Penn researcher Ross Koppel, PhD, who has published a new article in JAMIA on the unintended consequences of healthcare information technology. Ross and colleagues worked with AHRQ in developing guidelines for identifying those automation-induced safety issues. His 2005 JAMA article had vendors howling, mostly Eclipsys because the problems he catalogued were TDS-related even thought he was making a general point, but you’d be hard pressed to find anyone today who would disagree with the overall idea that HIT can cause new problems even as it’s solving others. My comments on a similar article remain the most-read HIStalk piece ever.

A hospital director in Japan who implemented the first hospital EMR system in that country has been arrested for accepting a contractor’s bribe of a plasma TV.

The CEO of the informatics group of Philips says the company may offer an EMR product, but only in Europe because competition here is too stiff (as Epic taught them). An acquisition is likely, he says.

Internet-based hospital report cards have old, incomplete, and conflicting data, a new study says.

Orion Health says the company is New Zealand’s largest developer of exported software.

E-mail me. I sound knowledgeable on occasion only because smart readers tip me off.

HIStalk Interviews Art Vandelay, A Reader Who Knows His Stuff

by Inga

HIStalk has a surprising number of great posters who provide thoughtful commentary. One such reader is Art Vandelay, whom I decided was a genius after he provided a terrific analysis of how healthcare would be impacted by Wal-Mart. I had to think of a creative excuse to talk to this great mind, so I convinced Mr. H that Art would be a great interview subject.

Inga: Art Vandelay is not your real name. How did you select it?

Art: I really enjoy Seinfeld and saw a few references to it in HIStalk, so I took it to see if anyone knew what I was talking about. Art is not a real person. He is an artificial character, so I can relate it to my alter ego.

How long have you been reading and posting on HIStalk?

I have been reading since mid to late 2006 and never really went too far back on old posts, but definitely read it as soon as it comes out. I find it interesting and timely. An interesting phenomenon is that some of my old colleagues have left healthcare. HIStalk replaces some of the old shop talk I used to have with my colleagues. It’s a good bridge for that.

What can you share about your background? What do you do besides write interesting commentary on HIStalk?

[Laughs] Right now I am working for a large delivery system. Essentially, I am responsible for a lot of their different initiatives. It’s a lot of project-based work. It involves pieces and parts of an enterprise architecture, but they really don’t call it that.

Prior to that, I was working for a large healthcare outsourcer and had done some cutting edge development work on that. It was really interesting work. I got to work with some old legacy systems and integrated them with newer technology using Web services.

Before that, I worked with a Big 6 consulting firm, back when there was a Big 6, primarily helping with system selection, organization strategic reviews, and package system implementation. I burned out on that really fast. You do double the work you do with other organizations. But it was a great experience.

I graduated with a Masters in healthcare management and was really intent in landing on the business side of healthcare, but the money was on the technology side and I’ve really enjoyed it.

What would you say is your primary area of HIT expertise?

Wow, I never really thought of that. I have a very strong understanding of the vendor space and a general understanding of the architecture. I am more of an apps person than an infrastructure person. I operate more at a business interface level and have worked more with business unit sponsors on the projects I have worked on.

Some of your postings are fairly technical.

Yeah, I have gotten to know a lot of that because of a lot of the things I was involved with before. You can’t work with all the vendors without knowing all the blemishes around them. But I consider myself more on the business side.

Do follow other HIT blogs?

Actually, let me check my RSS reader [Inga laughs because it is such a techy thing to do – even if Art is just on the “business side.”] Shahid Shah The Healthcare IT guy, Medical Connectivity, Neil Versel, Candid CIO, Ignacio Valdes, MD – Linux Medical News, NeoTool Healthcare IT, Running a Hospital, and LabSoftNews.

You are well read.

Yes. I like reading little snippet things. The blogosphere is good for that.

Are there any HIT companies that you believe are doing things right?

I think overall that some of the niche vendors are more innovative. Companies like SCI. They have made a good niche for themselves, but need to more aggressively market themselves. They need to promote their value proposition, to get in there and push their story better. I have heard really good things about them.

NeoTool has an interesting niche around interface delivery using BizTalk. Offering a competing product is a bold move because it may cause channel conflict. Medseek has done some interesting work and is addressing some unfulfilled niches. Emergin is very innovative, have a great niche. It will be interesting to see what do they do next, if they will they take their product to the next level. They have a very strong position from which to build.

The biggies aren’t doing a lot right now or at least not showing a lot of value. Cerner, Eclipsys, Siemens, Epic. They are trying to be too many things at one time right now.

Are there any up and coming trends that you think are going to be big?

A lot! [laughs]. I could talk about that for a long time. Retail, I think, diverse delivery locations and anyone doing medical storefront. Consumer-driven health plans. With high deductibles, consumers will have more control over where they go if they have a particular condition and they can choose their specialist. Medical tourism will probably pick up because of consumer-driven healthcare. It might be overseas or in a vacation spot.

So, what I really see being pushed is more continuity of care record, CCR. There will be a bigger push because you are going to receive your care in different places and you need to bring your medical record back with you.

You are definitely going to see a lot of virtual alliances, like people partnering with Wal-Mart locally to meet referral patterns or Cerner working in Dubai and Cleveland Clinic in the Middle East. A lot of health systems are trying to take their brand images overseas, essentially putting their Good Housekeeping seal of approval on the overseas facility. From a practicality standpoint, that means more network linkage. Some growth of teleconsulting will come with that.

Really, when you start to look at consumer-driven healthcare, it might lead to patient liability estimators. If I go to health system X, I can expect to pay $10,000 on a surgery and $12,000 at health system Y. Then I can decide how I spend my money.

There is going to be a big push on outcomes information, high-level stuff. Everyone defines an outcome in a slightly different way. When we capture it, we discretely capture it, but, each entity defines it differently.

With consumer-driven healthcare, you probably will see more push for access statistics. How quickly can you can get into a location? If you can’t get in to see a physician, who cares how good he is?

The pay-for-performance trend will drive the need for more metrics. There needs to be a lot of work to define things and there needs to be standardized data definition. I could keep going …

Great! Keep going.

Direct contracting will make a comeback. Health systems will try to directly work with employers to get the every last bit of margin out. But they will have to watch what they are getting into. I can see payers trying to prevent entry of providers, which will affect costs even more. Managed care contracting, referral management, decision support around cost modeling – all will make a comeback.

Increased consolidation among payers and providers. Who would have thought someone would partner with Wal-Mart?

Another big trend is centralization. You see this within organizations and in a technology-enabled way with remote monitoring. A lot of people are making moves in the home monitoring space. Folks are discharged as inpatients, but need some monitoring at home. Monitoring elderly folks with RFID to make sure they are eating, not wandering, going to the bathroom.

PACS, allowing remote diagnosis. As that becomes more prevalent in other specialties, you will see a push for some health systems trying to brand themselves. Wouldn’t you want a Mayo doctor to look at your EEG?

With that, a lot of the remote consults would come up. Get a second opinion with Cleveland Clinic. Within organizations, I see consolidation between clinical engineering and IT. The medical device manufacturers are introducing mainstream technology with a whole new slew of challenges in terms of maintenance, integrating, and day-to-day maintenance. Integration is a new skill set that IT companies can bring to them.

Labsoft News talks about convergence between lab and radiology departments. That will definitely come about. Nicholas Carr, a Harvard professor, talked about “IT doesn’t matter”. In my mind, it gets down to our IT departments. Will they deliver commodity services, or, will they become partners with the business side? Organizations are expecting their investments to show return. IT departments either will step up or will be relegated to utility.

Because of the economy, I think there will be a big focus on value. How do I squeeze the most amount of capability in all the technology I have invested in? Which goes back to IT partnering on the business side. IT has to really get involved in the business.

I would expect a growing number of organizations to have CIOs take over the business function. You are seeing it a little in other industries and I think it will come out in healthcare. CIOs are ready to take another step. For CIOs that have made promises, they are going to be asked to step forward and show ROI.

I think we are going to see a return of some best-of-breed. As purse strings get a little tighter, I think best-of-breed will come to show the best ROI, rather than a full Cerner or Epic system.

There is focus on squeezing the value out of investments and a lot of vendors are acquiring because of that. They will go for some of the niche vendors that can add value to their systems. Around revenue cycle systems, who really has done anything new? No one has any investment in R&D that is showing anything. The big vendors will buy small niche players to tap on to the maintenance stream and fill the product gaps.

Who do you admire in the industry ?

Mr. HIStalk, because he makes some very good observations and has great commentary. It’s true. I think I have made some comments about Emergin’s CEO. It’s going to be interesting to see what they do next.

I admire the Epic leadership team. They have created a brand around themselves. I don’t know if it was meant to be that way, but I think it gets them a lot of attention. Among a lot of the biggies, they have delivered the best and kept promises.

Anything else you would like to add?

One question that you forgot to ask, my dream job. A consultant who really didn’t have to travel that much. What drugs am I on – no travel? Think tank analyst. I’d love to be able to what-if all day, debate with someone, and get paid for it.

Realistically, it is anything where I could feel I am making a difference that would provide a solid standard of living so I could consistently be with my wife and kid.

Monday Morning Update 9/17/07

From Dusty Wong: “Re: Quovadx. How in the world it THAT pronounced? Is this the company where Superman’s impish pest, Mr. Mxyzptlk, works?” Kwo-VAD-ix. Guess they didn’t have to worry about taking a name somebody else already owned.

From An HHC Employee: “Re: CPR. As a Misys CPR user (NYC HHC), I am stunned to see Quadramed’s optimism about the product, especially being tied up in Cache’. Misys has been promising the Cache’ transition for many years, but never came through with it. Is Quadramed lacking in due diligence, or just talking up the same game Misys was? The CPR product is good for integration, but is years behind in other features – not Web-enabled, no way to easily integrate decision support, the list goes on.”

From Lester Golub: “Re: Isabel. I’ve never seen a product with such a huge popular press vs. biomedical literature imbalance. I’ve never seen a peer-reviewed article on Isabel and the stuff on their website, though positive regarding the product, doesn’t appear to have made it to anything indexed in PubMed.”

From John Winger: “Re: Misys/West Michigan Physicians Network. From the hospital side, it’s largely a Cerner/McKesson town. I seem to remember hearing recently that there’s a collective effort underway to subsidize physician technology adoption, but I thought that was a Cerner-based effort. Curious how Misys will do. I do know they had already lost one big account in that area.”

Investors are supposedly excited about next week’s athenahealth IPO, mostly because of the company’s recurring revenue model that’s based on a percentage of physician collections. We’ll know for sure soon.

Those same investors are also supposedly bullish on WebMD, speculating (no pun intended) that Adam Bosworth’s departure from Google means the company will shift its strategy to buying market share (i.e, WebMD) instead of building its own healthcare products.

HIMSS announces the 2007 Davies Award winners: Allina Hospitals & Clinics, Minneapolis, MN (organizational), Valdez Family Clinic, San Antonio, TX and Village Health Partners, Plano, TX (ambulatory), Illinois-National Electronic Disease Surveillance System, Springfield, IL and Institute for Family Health, New York, NY (public health). Kim Pederson of Allina talked about their Epic implementation in this HIStalk interview.

West Penn Allegheny Health System (PA) chooses Allscripts for its 165 physicians.

Revenue cycle vendor MedSynergies names John Payne CIO, coming over from Perot.

Jobs:

CIO, Bethesda Healthcare (FL)
VP, UPMC (PA)
Sales Executive, PM/EMR
Senior Implementation Project Manager (PA)
McKesson Horizon Clinicals Consultants (AL)
Patient Care Informatics Officer, Methodist Healthcare (TN)

Philips consolidates into three organizations, one of them being healthcare, and sells its stake in Nuance Communications.

This physician’s practice was at a loss when its PM/EMR system went offline because of a server problem, “.. going back to the dark ages. Paper receipts. Paper-only records. Vestiges of a bygone era.” That would be a great, feel-good EMR testimonial showing that not all docs are paper-bound. Except that he’s a veterinarian.

GE Healthcare gloms off the questionable US News & World Report‘s Best Hospitals issue, or actually the Honor Roll subset of it. It says GE is “humbled”, although that’s a bit of a stretch since that claim was made in an entirely self-serving press release. Does anyone believe that Centricity had anything to do their success? What’s the percentage of the also-rans using Centricity?

A CNN article on hospital infections and TheraDoc’s infection and antibiotic software contains a buried fact I hadn’t heard: TheraDoc customer UPMC has bought 22% of the company.

IT workers with server virtualization experience are in high demand.

Visicu falls off Inc.’s list of the 500 fastest growing businesses.

I didn’t know it was even still being sold: Texas Scottish Rite Hospital for Children buys Siemens MedSeries 4. I assume it’s still running on an AS/400.

Loma Linda University Health Care will use open source OLAP business intelligence software from Pentaho, replacing Access and Excel for that purpose. I’d never heard of the Orlando company, but I liked them instantly because of the founder’s two-sentence intro that includes: “you can usually find him near an empty Captain Morgan bottle or wandering around in the woods with his GPS receiver.” Ditto the title of one founder: “chief geek”. Or, this FAQ snip: “What do the Dodo, Hispaniolan Edible Rat, and the Syrian Wild Ass have in common? They are extinct. Like the Dodo, Hispaniolan Edible Rat, and Syrian Wild Rat; competition, innovation and choice will become extinct if Microsoft Corporation hit their goal of attaining 100% of the Business Intelligence market.”

E-mail me.

Inga’s Update

Thank you, Big Nurse, for forwarding me this note: “Not sure if this is of interest to you, but here’s some information on a recent report from the University of Rochester that appears to provide evidence of ROI associated with an Allscripts (Touchworks) EMR implementation. I hadn’t seen this information mentioned elsewhere (maybe I missed it), but it seems to offer valid evidence, though I am only able to read the abstract. It was cited in an article in Crain’s Health Pulse as a rationale for North General Hospital in NYC to go forward with its plans to implement an EMR, even though they are nearly bankrupt.” I found the original study, apparently first published in the Journal of the American College of Surgeons. The study involved 28 physicians across five offices and looked at the capital investment, plus various administrative tasks (chart pulls, support staff salary, and transcription costs) and efficiency aspects (days in A/R, etc.). The bottom line: the system paid for itself in 16 months and provided an ongoing annual savings of $9,983 per provider with a neutral impact on efficiency and billing.

First Consulting Group, Inc. completes the sale of its FirstGateways product business to MedPlus. FCG is selling off this segment that has been losing money and expects to realize approximately $8 million of after-tax cash proceeds from the transaction.

Nigerian officials are ordering their banks to stop using attractive women to persuade customers to open accounts. Apparently the unacceptable practices include employing beautiful ladies and giving them targets to meet. I wonder what would happen if HIMSS banned vendors from hiring beautiful women to increase booth traffic? Would there be a revolt from all those techy types?

Make Inga happy.

News 9/14/07

From The PACS Designer: “Re: Oracle Database 11g. It takes quite a bit of innovation to get TPD excited when it comes to healthcare IT. Oracle has just done that by releasing a new database solution called Oracle Database 11g. It appears to be just what the doctor ordered (no pun intended) when it comes to bringing healthcare some new exciting solutions for its diverse population of databases. One key feature is the ability to store DICOM image files along with other data parameters, such as XML, 3-D spatial data, and any other multimedia data to give users a central location for all of their data. TPD will be highlighting other new features in upcoming posts.”

From Health CIO: “Re: North Shore. I hear that North Shore Long Island Jewish Health System is looking for a new CIO. Anybody know who’s interested?”

Google’s main healthcare guy, VP Adam Bosworth, has left the company. It didn’t sound amicable, but you never know.

And speaking of Google, the company is working with Stanford and NASA to map the human body by scanning cadavers, with the possibility of an eventual Google Body that would be similar to Google Earth.

Sentillion announces its expreSSO single sign-on product for healthcare. Key points: “plug and go”, lower cost, graphical intelligent agent creation, support for graceful single sign-off, fast user switching on shared workstations, support for proximity authentication, password reset, and appliance-based deployment with five-nines uptime. I hope to get more info soon. Sounds pretty cool, especially if the price is good.

Rumor heard: Healthvision will announce the sale of the company in the next few days. I contacted CEO Scott Decker, who confirmed that Healthvision is in the final stages of negotiating a sale to a new investor. He couldn’t name that company, but I’ve heard it’s Quovadx, which went private in its own April sale to private equity firm Battery Ventures. Supposedly Verisign’s investment in Healthvision never panned out and employees have left in significant numbers after a June layoff. My February interview with Scott is here. I hope it works out for all involved.

When doing some vanity Googling, I ran across my own comments in Healthcare Informatics. I’d forgotten that I gave them permission to run some stuff I wrote awhile back called “Guide to RHIOs for CIOs in ten easy steps”. I appreciate the quote and the link.

Parkland’s use of ER kiosks from Galvanon makes MSNBC.

A Canadian company brings medical services to cell phones: dietitians who analyze meal snapshots sent in by users, on-demand conferencing with freelance nurses and doctors, and a baby application. Pulse and temperature can be transmitted and conversations are archived.

Scott L’Heureux, formerly of SIS, is named CEO of Jackson Therapy Partners, an Orlando-based therapy staffing firm. I didn’t realize until I looked at their site that they’re a sister company of throughput software vendor StatCom.

Rush-Copley Medical Group chooses athenahealth along with Eclipsys Sunrise Ambulatory Care.

Good Samaritan Hospital (CA) will use Medseek’s portal services.

Optio announces Q2 numbers: revenue down 2%, EPS -$0.05 vs. -$0.02.

Even newspapers can’t spell Misys. There’s just no excuse for spelling it “Mysis,” any more than there is for typing “gentamycin”.

Capgemini wants to profit from offering support services to enterprise users of Google Apps Premier Edition. That’s odd enough, but now Microsoft jumps into the fray, bashing the product and thereby instantly lending it credibility, like all competitors it tries to squash with trash talk. MSFT criticizes Google’s “perpetual beta,” which I would counter-argue is at least labeled as such, unlike Microsoft’s far-from-free trial balloons labeled as production-ready software instead of a series of desperately scheduled service packs. Actually, the version that Cap is pitching isn’t free; it’s $50 a year. Overall, I’d buy (or keep) Office instead unless I had rock-solid and limitless bandwidth (who wants to be called with the Internet is slow?) and didn’t have any Excel or Access power users. You could probably buy Office for what that $50 a year adds up to, although you’d still have to support its local installation. That doesn’t count Cap’s charges, either.

Midwest Medical Insurance Company will offer a premium credit to physician policyholders who use electronic medical records. Requirements for the 2-5% credit: the EMR must be CCHIT-certified, software updates must be current, 75% of docs in the practice must use it, it has to have been running for at least a year, and at least two of six listed EMR functions must be used.

A UK hospital is embarrassed when a hard drive containing patient information is sold on eBay. And speaking of breaches, here’s a first-person description of how a bored hospital visitor did some innocent hacking.

Miss Nebraska is a senior in bioinformatics at University of Nebraska-Omaha, which I thought was noteworthy enough to warrant a pic from her site. Some enterprising vendor could sponsor an appearance in their HIMSS booth, you know.

Inga’s Update

I feel I have arrived because I received my first email from Matthew Holt. Unfortunately, he was making fun of the fact that I am just now discovering Sermo, a company that he claims he practically made famous through his multiple mentions in THCB (he is making it hard to feel like a diva).

On the other hand, Mike H. was very appreciative of my “insights” on Sermo (Mike seems to understand that divas need appreciation). He also said: “Just read your post about Sermo.  I’ve been reading about them a bit lately and also think their business model is intriguing.  I ran across what appears to be a similar site that makes a similar claim about size (we’re the biggest …) You might be interested in looking at their site as well. It’s www.within3.com.” I did check out www.within3.com (I like the name) and it reminds me a bit of LinkedIn, but for physicians (and those in related fields.) It will be interesting to see in time to see if either of these models (or other similar ones) is sustaining.

eClinicalWorks is selected by the Sisters of Charity of Leavenworth Health System (SCLHS) to provide their EMR/PM solution, as well as their Patient Portal as part of the Ambulatory EHR initiative. The ECW system will be made available on a voluntary basis to its 200 employed physicians and the 5,000 physicians on staff. The ECW solution will interface with SCLHS’s existing GE Centricity hospital system. The ECW press release doesn’t really say if there is any dollar commitment involved or if the health system is providing the software to any of the physicians for free and/or a reduced cost.

In another vague press release, Misys announces that West Michigan Physicians Network (WMPN) in Grand Rapids has endorsed Misys EMR, Tiger, and Connect for their 450 member physicians. WMPN will be eligible for “pre-negotiated contract terms and favorable product pricing” for the solutions. No mention if the endorsement is exclusive.

And, in less vague EMR selection news, HealthPort announces that Biloxi, MS based Coastal Family Health Center and the Mississippi HealthSafeNet High Impact EHR project have selected HealthPort EMR for its regional EMR system. HealthPort is the company that was formed after Companion Technologies and SDS merged. The Mississippi project is made up of seven organizations and recently was granted $1.4 million by the Health Resources and Services Administration to fund the EHR and related projects.

Zotec Partners and EmPhysis Medical Management announce a merger. Both are in the practice management and billing fields, primarily focused on hospital-based physicians. As others have mentioned recently, the billing side of healthcare IT is not dead!

E-mail Miss HIStalk.