Monday Morning Update 3/17/08

From Irwin M. Fletcher: "Re: Interactive Care. Do you or your readers have any knowledge and/or opinion of Interactive Care? They are a newer entrant to the telemedicine arena." I don’t think I’ve heard of them. Website here.  

From Terry Tate: "Re: consultants. I can’t believe I am saying this, since I have never been a fan of them. However, over the years I have learned that few hospitals have the people and skills needed to make the process improvements needed to optimize their HIS systems, and MUST turn to consultants. Since most will work on a percentage of the savings, this can be a win for everyone." I didn’t realize that most would work for a percentage. If so, I can still see some hospital folks still balking because they aren’t comfortable placing a value on even those improvements that involve critical success measures (maybe because they’ll be unable to actually capitalize on them or because reimbursement quirks mean they really can’t). Example: a hospital says its #1 priority is to reduce medical errors. I’m selling systems and services that I claim can help you do that to the tune of a 50% reduction and I want $500,000 or $1 million or whatever. What’s it worth to you? How many hospitals would happily write the check even when benefits exceed that amount? It’s as shortsighted as a vendor that thinks paying sales commissions is bad.

From Scot Silverstein: "Re: CMIO war stories book. I am one of those CMIOs. Expect stories a bit more PC than at my website on health IT difficulties, but with more analytics. I kept detailed analytics out of my web site, because 1) the lessons are obvious to all but the most obtuse; and 2) the best techniques for avoiding project failures cannot be learned from a book or website. You have to live it. But first, you have to accept that clinical computing projects are complex sociotechnical endeavors in unforgiving medical environments that happen to involve computers, not IT projects that happen to involve doctors. The book will be a good step in giving ‘gut understanding’ to those words to a wider audience."

From The Shelton Shadow: "Re: NPfIT. The NPfIT has started to prove that the effort to computerize healthcare in the UK is providing savings that will be significant in the years to come and attract attention from all over the world." Link.

Robert Miller, a director of QuadraMed, is named to the new board of Grady Memorial Hospital (GA), along with the CEO of Waffle House (if you’ve ever eaten in one, and I’m certainly not suggesting you do, you might be surprised to find that a corporate structure exists behind the equally tattooed short order cook and waitress who run the entire place.)

Physician, health thyself: a Westborough, MA psychiatrist loses her medical license for good after assaulting hospital police officers and hospital staff. She was taking psych call for UMass and refused to leave a party when paged. The medical director relieved her but she came in later and refused to leave when security guards told her. She was arrested screaming and kicking the officers involved. She was committed but released after two days.

E-mail me.

Blogger Boy on Exhibiting at HIMSS

Blogger Boy, a vendor person who thinks I know his identity even though I don’t, took a three-year hiatus since last describing his HIMSS conference experience. Here’s his account from Orlando.

Another HIMSS has come and gone. Here are some musings from a small vendor on the main aisle.

Thanks to all of you who came into our booth. Although most of you were there searching for items to take home to your kids (or to prove where you were) instead of a new Hospital Information System, we still appreciate it. All of you who registered at our booth either for the drawing you failed to attend on Thursday morning or because you felt bad just taking our giveaways (yes, all both of you), we still appreciate it. We love meeting new people who may one day remember when the need arises that we have a marvelous, function-rich system written entirely in the newer languages (even IF Mr. HIStalk is not impressed by that!). Silly me, I always thought mumps was a virus.

Traffic was light for us this year. We are always trying to find that combination it takes to get you into the booth for something other than a free pen. Again, we love having the opportunity to show our products even if you are not in a buying mode. This is such a small market that one day we figure you’ll give us a shot after the big guys make you mad with their ridiculous license fees, drawn out and overpriced implementations, and poor customer service.

On another subject, any one who thinks contracts are signed at HIMSS is misinformed. Oh, I am certain that decisions are set based on expensive gifts, dinners, and more exposure than most potential clients will see at any time in the future of their relationship with that vendor. But no one, and I mean NO ONE, comes to HIMSS to select a system. It continues to be our belief that most of you come to spend a few days away from home (and/or the family) at the hospital’s expense having a good time. Yes I know YOU actually come for the sessions and to see all the new stuff at the exhibit hall. I am talking about everyone else.

That is why there is not a single vendor who will complain about the show being in Chicago next April. Hell, we’d like them to have it there in February! Then instead of chasing Mickey or Shamu, maybe you guys would come into the exhibit hall and buy something from us. Oh wait, that’s right — you don’t do that either! But seriously, we do figure the number of people we’ll lose to golf during exhibit hall hours will decrease next year. While you can play in the snow, it takes an awful lot of mercurochrome to coat the balls so you can find them for 18 holes (related from drunken experience). Our biggest fear is that we will get snowed in and not be able to get home for Good Friday, the real reason HIMSS was moved to a Sunday start date for Chicago.

For just a second, place yourself into our shoes. Even the smallest of vendors is spending several hundred thousand dollars to exhibit at this show. So we come there and spend a pile of money, all the while hoping against hope that we’ll get some good leads. Then we spend the time and money over the next 18 months cultivating those leads, doing demos, meeting with the 15 different selection committees at each location, only to find that a salesman from one of the big vendors came in, planted some scary thoughts with key decision makers (AKA lies) and they wind up going with the big overpriced vendor because it is "safe". I guess it depends on how you define safe!

I see more and more often, high-profile CIOs are losing their jobs because of implementations that either never happened or never seemed to have an end in sight. Maybe next year we’ll get that one lead that we close before the end of the year! If I sound cynical, I apologize, but you guys are tough!

We did enjoy searching out all of the HIStalk ribbons. Many in our booth had at least four. I was only able to get three for my badge. It generated a lot of conversation. I hope HIStalk will do something similar for the next show. Sorry we missed your shindig. Let me know if it needs a sponsor next year. Do you give HIMSS points?

And to wrap up, trust me, we vendors know how you feel about being bugged. I swore I would move out of the country if one more offshore development person came by our booth to speak with me. I am now fielding no less than 10 calls a day from other vendors to whom I was simply cordial at the show. It is funny to hear them describe to me how enamored I was with their products. I simply don’t remember it that way in most cases! So when you get the letter from me thanking you for visiting our booth, just indulge me a little. Read it, then toss it. Who knows? One day you may want a vendor who has a great product, gives terrific service and does this because they love what they do.

Inga’s Update

You knew it was only a matter of time. UCLA Medical Center will fire 13 employees and suspend another six others for checking out Britney Spears’ medical records. Six physicians also apparently took a peek and face discipline as well. I can’t decide if I would have done the same thing in their shoes since I’m the nosy type. I might have just waited to read all about it in the juicy rags at the grocery checkout stand.

Mike Leavitt was in Pittsburgh this week stumping for the expansion of EHR systems in physician offices. An interesting number I hadn’t heard before was that the Medicare P4P project he promotes could provide physicians up to $58K over five years if they meet certain benchmarks of quality care. It’s not a ton of money, but for a primary care provider making $150K a year, that equates to a bonus of about 7.5%.

Bill Gates appears before the US House Committee on Science and Technology and makes some interesting technology predictions. The future includes tablet devices in place of textbooks in schools, natural user interfaces with sophisticated voice recognition software, and computers with the ability to recognize objects and people. Additionally, data centers will need less human intervention and software development will require less code.

HHS and AHRQ hand out $5 million of your money to Brigham and Women’s Hospital and Yale University School of Medicine to help develop and implement best practices using clinical decision support.

Mdical transcription and workflow software provider MedQuist supposedly had a nationwide system failure this week. For about a day, system issues prevented received transcription to be properly routed internally. Will vendors promoting in-house systems use this anecdote as a reason to avoid ASP software providers?

Investor’s Business Daily interviews Allscript’s Glen Tullman, who claims Allscripts’ stock price drop (almost 50% since the first of the year) is a result of not properly managing the Street’s expectations. He also indicates analysts are still predicting more than 40% earnings growth.

By adding MedBasics Family Health Centers to its network, CIGNA gives a thumbs up to retail health clinics. Other carriers will likely follow CIGNA’s lead, despite opposition from some medical organizations that believe the retail clinics should have more restrictions.

Coincidentally, Las Vegas-based Medical Marts just closed a dozen clinics last month after losing VC backing. Unlike most of the other retail clinic models, Medical Marts were staffed with physicians rather than nurse practitioners.

The 300-physician Carle Clinic Association selects D2 Sales’ new My Patient Passport ExpressT kiosk system for patient check-in and payment.

Not to have Mr. H outdo me at everything, I wanted to point out that I also have a profile on Linked In. Not surprisingly, his profile is far more witty and well-thought out than mine, but connect with me anyway. It makes me believe you care.

E-mail Inga.

News 3/14/08

From Gesundheit: "Re: CHW. Ben Williams, CIO at CHW, is changing the IT outsourcing model. They will insource part of the operations from Perot and eventually bring 40-50% of the functions in-house. With 800-900 Perot people on the account, major changes are coming."

From No Name in PA: "Re: UB. Any truth to the rumor that University of Buffalo has just signed with Epic as an EMR?" If it’s Epic and a rumored sale involving a hospital of over 400 beds, it’s usually true, but maybe someone will confirm. In fact, a second reader asked the same question, so there’s your smoke. Fire, anyone?

From Former High Level Exec: "Re: Eclipsys. I just heard that ECLP is going to outsource to India their Sales and Marketing responses to RFIs and RFPs. Can this even be possible for a sane executive to consider?"

From Mikey Likes It: "Re: consultant survey. Poorly worded question: does your company typically lay off or bench people when there is a gap in business? It should be multiple choice, not yes/no. Some companies will lay off immediately, some after a month, etc. Some will keep consultants on the bench for quite a while, maybe send them to training during that time. Whether and how long you’ll be on the bench is a BIG indicator of the company’s loyalty to their employees and their overall corporate culture. Good question when evaluating firms: ‘What’s the longest any consultant has been on the bench in the past 12 months?’ The longer the time compared to other firms, the better the attitudes, mutual loyalty, and likely the happier and more productive the consultants. Would you fire a bunch of nurses if the inpatient census dropped for a couple weeks?"

From The Real Deal: "Re: consultant survey. What every consultant should want to know is what percentage of the hourly rate goes to the company. It appears to be between 30 and 50%, which seems like a lot for job placement. Consultants eventually make their way to independent consulting to get a larger slice of the pie. You start out at more than you made at a facility or vendor, but over time, after you’ve developed knowledge, spent years on planes, and disconnected with family and friends, you start to question how much your time should be worth. The company values you at a high price when selling you to the hospital, but doesn’t place that same value on you as their employee."

Listening: The Concretes, Swedish pop. Mazzy Star meets The Supremes.

Unrelated: one of the funniest phony news stories I’ve read.

Great Red Hat Summit speaker lineup: BIDMC CIO John Halamka and a writer for The Simpsons.

McFarland Clinic (IA) picks Epic. Does anybody else ever win a deal any more? Of course, it’s kind of like taking candy from a baby when most of your competitors voluntarily carry the smothering baggage of being publicly traded.

Sounds interesting: NVivo qualitative research analysis software, which now handles media files. Free trial download. Costs a few hundred dollars. There are lots of cool, cheap data discovery tools coming out that can read just about any data source.

Big numbers for QuadraMed, but with an asterisk: revenue up 31%, EPS $0.68 vs. $0.05. Without a one-time tax treatment, earnings were flat. The company projects a revenue increase of 6-10% for 2008. The stock is down 4% after hours, a little above its 52-week low.

CDC issues $38 million in NHIN trial grants: Indiana University School of Medicine, SAIC, and Health Research, Inc.

Allscripts signs a deal to distribute its product to 1,000 physicians in Hawaii. Shares are still down 4% on the day.

Odd lawsuit: a fired hospital employee is suing her former employer, claiming she was fired because she was shipping out to Iraq with the National Guard. Her job: chaplain. Go ahead and make out the check.

E-mail me.

Art Vandelay on IT and Process Change

Mr. HIStalk has a great editorial in the latest Inside Healthcare Computing electronic update. The tagline is, "Everybody Hates Their IT Department: Where Alignment, Control, and Honesty Collide." The two-line summary is that IT is in the position to execute leadership’s vision, within a set timeframe and budget and usually with imperfect technologies. IT’s typical approach lacks the finesse to deliver in the middleman role between the users and leadership.

In the current Information Week, there is a short article about Jeanne Ross’ current thinking on IT. She is part of the IT Governance study team. If you haven’t read that book, I highly recommend it. She comments that systems will never deliver full-value without process change. CIOs are uniquely positioned be strategic execution officers responsible for delivering the change. The article stops short of providing advice about how to get the job done.

Two thoughts. To Mr. HISTalk’s point, IT organizations with expertise in process change that can effectively influence the users can get the job done. Those who don’t or can’t always have an uphill battle. The only means of getting through this challenge is highly involved and influential senior leadership; drafting cross-silo thinking users into the project; supporting them with process analysis staff who back recommended changes with hard data (i.e., turn-around time is "x" hours); and lastly, with incentives.

Second, the problem is intensified in this time of enterprise clinical systems, where change is required across business silos. The most difficult changes involve cross-silo handoffs, communication, and accountability. Implementing a department-based system is always easier.

How will organizations who are in the middle of implementing enterprise systems handle the current economic challenges? Will they back-pedal and focus on departmental systems? Will they try and eat the elephant faster to just get ‘er done? Will they try to eat the elephant slower, focusing on high-value processes? That still requires bigger bites when the system changes business processes.

Another option: focus on revenue cycle through the small systems that improve their aging systems. Somehow they have to cover the recurring costs of the enterprise clinical system they bought.

Inga’s Update

The University of Michigan selects McKesson’s Horizon Medical Imaging PACS for its three-hospital, nine-clinic health system. Expected go-live is early summer 2008.

Mark D. Barner is named Ascension Health’s new CIO after serving almost a year as interim CIO. He has had several leadership roles within Ascension and spent 19 years with EDS.

The Ohio State Medical Society releases the terms for its Standards of Excellence Program, plus the list of participating vendors. Allscripts, e-MDs, Greenway, iMedica, Misys, and Sage have all agreed to include OSMS’s "physician-friendly" terms and provide OSMS members with preferred pricing. Some of the special terms: the inclusion of upgrades in service agreements, a cap on maintenance fee equal to the CPI index plus 3%, stepped payment plans, and compliance with OSMS’s e-Rx requirements.

The U.S. Chamber of Commerce hosts an HIT forum bringing together stakeholders from government and private industry. The focus was on how businesses could improve healthcare quality and value for their employees with investment in healthcare IT.

I have been skiing for the last few days (with a very cute boy, I might add) and thus have been blissfully out of touch with much of the news of the world, much less the HIT world. Fortunately I had no need for direct contact with any healthcare facilities, though I do have plenty of aches and pains. Back to reality next week…

E-mail Inga.

Don’t Look Now, Your Loop is Open

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

Three babies dead in Indiana, overdosed with the wrong heparin product in a hospital not using bedside barcode verification of meds. Technology failed them, plain and simple.

Ten years ago, nursing and pharmacy systems didn’t talk to each other (pharmacists and nurses didn’t either, but that’s another story.) Finally, everyone agreed that was pretty stupid, so vendors did a little bit of integration to make systems look like they did. The electronic Medication Administration Record (eMAR) was born, although most hospitals stuck with once-a-day printed versions for a several reasons, most of them illogical.

Along came CPOE, usually hung awkwardly off of those same nursing and pharmacy systems. It was (and is) expensive, rarely used, and inefficiently designed for physicians, but it caught the eye of well-intentioned hospital executives who were blissfully unaware that all those CPOE-preventable errors weren’t the ones harming patients anyway. I like to think of it as the Job Security Act for Chief Medical Informatics Officers, who, like the painters assigned to the Golden Gate Bridge, have job security because their work will never be finished.

Even if you buy the ubiquitous vendor buzzword “closed loop,” don’t kid yourself. The dent in harmful medication errors has been slight. It may have even gone up. Why? Because nurses still walk a tightrope without a net, armed only with limited drug knowledge, paper records updated with pens, and a wide-open candy machine of increasingly dangerous drugs … uhhh, I mean decentralized medication distribution cabinets.

We bought the technology least likely to be used, that addresses errors least likely to be harmful, and deployed it in patient care areas least likely to make serious errors in the first place. And while we’re still making payments on that stuff and trying to strong-arm clinicians to use it, we’re still harming patients.

But let’s look on the positive side. Technology is the only hope of improving the situation.

If you’re a vendor with an integrated bedside verification system, get those sales guys on the road because I guarantee you’ll sell a bunch of them in the next year if yours is any good. Guarantee, I said. The Indiana errors will be the pin that pops the CPOE bubble, making even the big-picture types understand that they’ve been chasing the wrong solution.

If you sell add-on tools for electronic MARs or have the expertise to consult in that or any other patient safety area, polish up your shingle. Plenty of organizations need your help.

If your company is one of few selling medication distribution cabinets, get some real informatics people designing improvements instead of those engineers more concerned with servo motors and drawer design instead of intelligent software.

And if you’re Cerner, congratulations! You bought Bridge Medical and their bedside technology just at the right time and announced plans for your own line of medication distribution cabinets. You’ve got a widely installed customer base who wanted closed loop meds. If you don’t mess it up, you could build a huge business on the other half of the loop, the one that isn’t closed. I guarantee that, too.

But for goodness sake, let’s all of us agree not to dawdle. There are already too many parents out there who won’t get to celebrate their baby’s first birthday.

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

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

News 3/12/08

From Buffy V. Slayer: "Re: consultant survey. The items don’t really reflect what’s good and bad about being a consultant other than the hours. Performance expectations are really the killer with each manager trying to meet sales goal and people jockeying for credit on the same account. Those with the sharpest elbows get the credit and those who don’t make the goals are pushed out. The responsiveness of IT support and publications is remarkable and none of the firms I’ve worked for skimped on accommodations or per diem, which is important when you’re exhausted and need a quiet room and something decent to eat. What I liked best is the change to work with really, really smart people, but we had little or no time for education. Very Darwinian." The consultant survey has 73 responses, so jump on if you’d like to see the individual responses with company names (but not those of respondents, of course – add your e-mail address at the end and I’ll remove that and send it out blinded). Least liked aspect so far? New hire training. Sends consultants on engagements unprepared? 34%. Average salary, billable hours, and whether the consultant would recommend working for his or her employer? Fill out the survey and you’ll find out. Obviously the reader who asked me to do this (and who provided the questions) has struck a nerve. Some of the companies sound kind of suck-o to work for, but that’s life.

From Tupac Addae: "Re: MagicJack. Now that I’m working from home with only a cell phone, I dreamed to be able to plug in my old desk phone somewhere other than a money-wasting landline. I’m SO PLEASED to have been clued into MagicJack by Mr. HIStalk’s mention. It arrived a couple of days after purchase, the phone number goes with me wherever I go, it comes with voice mail and even 911 service, and it works with my desk and cordless phones. They’re working on richer features now, like the ability to change your phone number at will. Very, very cool and I appreciate your cluing me in. It’s hard to imagine how landline companies can compete with $20 a year."

From Andy: "Re: GPS. Considering that non-DoD GPS systems are accurate to one meter, I wonder what is actually going on in this article from China?" Link. It says a US surgeon will show visiting Chinese orthopods how he uses GPS to "precisely measure legs and make sure they are even." Either something got lost in translation or it’s our leg that’s being pulled. Why would you use an orbiting satellite to measure a leg instead of a tape measure?

From The PACS Designer: "Re: virtual appliance. What a nice article posted by Shahid Shah. In essence, a virtual appliance can be an ‘enterprise cloud’ that provides numerous services to clients while simplifying the IT maintenance issues. TPD has been posting about clouds as a way of improving service offerings at a lower total cost once implemented. While there may be some backlash from users, it can quickly disappear once the user gets accustomed to this new concept. The virtual appliance can be a win-win for provider and users with a well defined roll-out plan that is gradual in nature and allows users to adjust to a different operating platform."

I had played around and put a Mr. HIStalk entry on LinkedIn just for grins awhile back, which I promptly forgot about until a couple of readers recently found my profile and connected. I’m not sure how much value an anonymous contact with a guy using a profile picture of The Unknown Comic will have for your business or social prospects, but I’ll approve any invitations that come my way if you’re interested. Maybe I’ll need a job one of these days.

Speaking of surveys, please fill out my HIStalk reader survey. Thanks.

I’ll not be posting new entries to the old Blog City site going forward, so if you’re reading on the new one for the first time, make sure to put your e-mail address in the "Subscribe to Updates" box at your upper right so you’ll know when I write something new (and the Brev+IT one just below that if you’d like the weekly e-mail newsletter, which several folks on the survey have said they like).

Jobs: Sales Executive – Workflow Solutions, Systems Analyst – Clinical Applications, Senior PR Copywriter. Gwen will e-mail you openings each week if you sign up. This week’s had Gwen with a Photoshopped leprechaun hat and a caption of "Gwen Darling, Irish Lass."

This is fun: Spencer Hamons, CIO of SLV Regional Medical Center (CO), is doing a Weekly News sort of podcast about healthcare IT. He’s also a professional voice-over guy, so it sounds great. I told him I was really sprawling back and relaxing since his voice is so soothing and so is the piano music he uses in the background (say, you don’t suppose he’s actually playing and talking at the same time?)

Update on the HIMSS Stage 6 EMR hospitals: Meditech has two customers in the 11: Citizens Memorial Healthcare (MO, home of one of my favorite CIOs, Denni McColm) and St. Agnes Healthcare (MD). Now if the Meditech folks could just hook a brother up with a Neil Pappalardo interview …

Deborah Peel, an AARP lobbyist, and an ONCHIT person debate federal privacy legislation in this video.

Another sign that Cerner is scrambling for growth: now it’s in the drug development business, sponsoring research into a dry powder inhaler technology, for which it has an option to become the exclusive licensee. Sounds like they want to become Cardinal Health or McKesson with their med cabinets and life sciences stuff.

Nice award, but an odd quote about a FirstHealth (NC) nurse who an ED award: "His work with McKesson (a health care services company) is just one example. He also built a beautiful chart rack, and his ability to work with multiple people and personalities in the ED has made him a true leader in our department." First thing I thought of: it’s odd to mention his carpentry skills. Second: was Sybil in their ED?

Red Hat announces that Florida Hospital is running Linux, JBoss, and several other technologies.

Patient throughput systems vendor PeriOptimum will partner with Sonitor Technologies for marketing a combined RTLS, being installed at Women’s Hospital (LA).

Washington Post runs an article on PHRs. Nothing new, but mainstream.

This is a little freaky: a sensor necklace detects magnet-implanted pills as they traverse your esophagus, time-stamping the med you took and reminding you of those you missed.

Massachusetts hospitals line up against a privacy bill that would allow people to block access to their medical records, inspect access records, and block their use for marketing. Ostensible reason: nobody will buy EMRs if they can’t just sling PHI everywhere. We’re getting into a touchy area here: if experts say your health could be jeopardized by your not approving records access, is it still your right to opt out? I’m going with yes. That just smacks of what should be an obsolete concept: "we doctors and hospitals are way smarter than you, so we’ll decide no matter what your personal wishes are." Maybe that’s what all the fuss against privacy bills is about: trying not to cede control to patients.

Who knew that Meditech owns a historic horse farm?

An RN turned malpractice attorney describes the "positive force of litigation" by enumerating the huge judgments she’s won against providers. Now she’s advocating expanded training for pharmacy technicians, even though their work is checked by a pharmacist and training doesn’t prevent doctors, RNs, and pharmacists from making similar errors. Quote: "We would all agree that the technician should be be held accountable." In other words, pharmacy technicians make too little money to be worth suing, so with more training, maybe malpractice insurance will become standard and lawsuits against them will become more lucrative. She was a nurse only while working her way through law school, so I’m sure she never made a mistake even without the positive force of litigation.

Speaking of litigation, the patient whose heart was cooked by an overheated cardiac catheter with known problems is awarded $40.1 million. Oddly enough, Providence Everett Medical Center (WA) was awarded $310,000 in the suit, claiming the monitor company damaged their reputation. I always weigh these awards by thinking, "Would I suffer what the litigant did for the amount of the award, and if so, maybe it’s excessive?" In this case, no way.

Kudos to CSC staff in the UK, who donated money for a children’s hospital there.

E-mail me.

Inga’s Update

Parkland Health and Hospital Systems (Dallas) partners with Affiliated Computer Services for a seven-year, $41 million contract to outsource its IT services. ACS will supply infrastructure support including data center operations, network monitoring and management, asset tracking, and help desk support. ACS also won a contract renewal with the Missouri HealthNet Division to provide HER and pharmacy benefits management. That contract could be worth up to $57 million over 10 years.

Children’s Hospital Boston is implementing RFID for inventory management for high cost devices and supplies within the surgical department. The selected product is Mobile Aspects’s iRISupply.

iSoft becomes Sentillion’s first European healthcare channel partner to distribute its SSO, context management and user provisioning solutions.

MediNotes is named the Technology Association of Iowa’s Prometheus Award for top software company in the medium-size category. MediNotes’ CEO and President Donald G. Schoen received the organization’s CEO of the Year award.

Picis announces the availability of a podcast of “Forward-Thinking CIOs Debate Hot Issues Facing Hospitals in 2008.” Panelists include multiple Picis CIO’s including HISsie award winner Judy Middleton of Osler Health Center.

E-mail Inga.

Monday Morning Update 3/10/08

From Katie Jane: "Re: specialty hospitals. Congress wants to create a bill making insurers equalize physical and mental health benefits, which will in turn increase some government health programs. Since the bill will effectively ban specialty hospitals, they go ahead and assume those hospitals cause higher healthcare costs and the ‘savings’ of closing them will pay for the budget gap. Insanity." Link. Here’s a snip: "Big hospitals say specialty hospitals drive up costs because the doctors who own facilities have an incentive to over treat patients with expensive procedures. Specialty hospital proponents disagree. They counter that if smaller facilities were banned patients would be forced to go to big hospitals, which they say deliver lower-quality and thus costlier care."

From Lazlo Hollyfeld: "Re: EMR. This was reported today in regards to the pending Medicare physician payments cuts (10.6% as of July 1, another 5.4% on of January 1). ‘MGMA members reported that they will suffer further operational damage as a result of payment instability and the projected double-digit reductions to Medicare physician payments … More than two-thirds of respondents described how they will sacrifice or postpone information technology (IT) and equipment investments.’ While it is highly unlikely that these cuts will actually be enacted, even a portion of these cuts could pose a huge problem for the ambulatory HIT market in ’09 and beyond. Arguably the most important thing looming over the market right now." 

From Bignurse: "Re: EMR. I took my family member to a new specialist, where he was handed six sheets of paper and asked to hand-write his demographics, medical conditions, allergies, and medications. Funny, he had just written all of the same information on paper earlier this week in the previous doctor’s office who referred him! Imagine my surprise when I learned that the specialist has one of the top-name, expensive EMRs (overkill in a single-physician office?), but after three years, the patient history is still on paper. In fact, the entire time I was there, the doctor never turned the EMR monitor on. What’s wrong with this picture? It will never get better until patients like my relative walk into a doctor’s office and refuse to fill out another paper form!" Want to bet that it was a hospital that provided that expensive and unused EMR? That Mass BCBS article that Inga quoted says it all: doctors don’t get much EMR benefit, so requiring EMR use for bonus programs doesn’t make sense. You can’t make a small business buy software that doesn’t pay its way no matter how much society might benefit. It would be great if paint stores recorded your custom colors on an electronic personal profile that was shared among them all, allowing you to stroll into any Home Depot or Sherwin Williams and have your records immediately available, but that’s not happening for exactly the same reasons. Unless enough customers demand it, of course.

From TenaciousD: "Re: Stanford and Legacy. I heard that the Epic Stanford project is running at $180M for total costs. I also heard that Epic is telling potential clients (specifically an academic in the northeast) that Stanford is their beta for anesthesia. I will be curious how the implementation delays will affect Epic delivering anesthesia. Regarding Legacy, the article said that they expect Epic to cost about $10M over the next 3-4 years. That is the biggest Bull SH**. I know for a fact they told the CIO straight up it would cost $200M to replace Cerner and implement across all facilities." I wondered if Epic would bother with a $10 million deal. Wouldn’t it be great, knowing that software has zero incremental cost for a new customer,to still turn your nose up at a customer who only has $10 million to spend?

From Janie Lane: "Re: Midland Memorial’s EMR Stage 6. Somebody needs to talk about this when talking about the Epics of the world, where customers drop $10 to $50 million when OpenVista could do the job at a fraction of the price. If there were enough folks who lined up behind VistA to move it forward as a true open source project, it would be the default system of choice." Note the list of 11 Stage 6 hospitals and the conspicuous absence of nearly all of those big-spending hospitals. All the poster children academic medical centers haven’t made the cut, but 74-bed Citizens Memorial Hospital and Denni McColm have. We’re worshiping the wrong HIT role models. It’s kind of like translational medicine — choose a vendor for results achieved, not far-reaching vision. If you’re a CIO, you’ll be long fired before that vision ever ships.

From Bodie: "Re: Park Nicollet. They’re going from GE to Epic. It will take place over a couple of years, but it’s a done deal. They are running LastWord. Perhaps they figured they might as well take the pain once rather than moving to Centricity."

From Inside Outsider: "Did you catch any of the news following Apple’s announcement of their Software Development Kit for the iPhone yesterday? Looks like they’re going to release a really slick SDK that is easy to use and allows for rapid development. One of the companies that received the SDK early was Epocrates, which created a drug lookup app using the SDK and SQLite. They created it in less than 2 weeks. It will be  interesting to see if the medical industry jumps on this new platform." I’m betting yes. Never underestimate Apple’s ability to create an entirely new market by doing the opposite of what most tech companies do: giving geeky stuff mass appeal and style while hiding the nuts and bolts. I wish they’d build clinical systems. Mark it down: iPhone apps will be everywhere at HIMSS09. Here’s a link to the Epocrates story.

From Jack Ripper: "Re: your 2/18 mention of MagicJack. Perhaps you should refrain from endorsing products. I purchased it and still haven’t seen it and there is no support information." I wouldn’t say I endorsed the VoIP phone gadget (since I haven’t used it)  but I did say it looked cool. I’d give it a little more time, then contact your credit card company and dispute the charge. I’ve gotten my money back every time I’ve done that. And if you ever receive it, it just won a PC Magazine Editor’s Choice award, so I wasn’t the only one that liked it. 

From Steve-O: "Re: Brailer. Believe me, he’s smug every single day."

From CPR CIA: "Re: QuadraMed. Signed Quadramed as a sponsor, huh? I hope that you stay as open / honest about the state of CPR going forward as you were before taking their cash." No problem there. I liked CPR the last time I saw it years ago, but it was a train wreck even before Misys got its fumbling fingers on it. The years of neglect haven’t been kind, so let’s hope QD is up to the challenge. It does have superb user design and strong physician support. QuadraMed at least got it off its oddball database and onto Cache’. The offshoring decision is a gamble, but QuadraMed has some urgency in getting the job done and throwing low-cost Indians into the fray may provide the troop surge needed to make CPR sellable. Upgrading Affinity users is important, but if CPR’s big academic medical center users feel neglected, they’ll bail, so QuadraMed will need to develop an ivory tower worship competency to mollify them. As everyone knows, the biggest pain-in-the-ass IT customers are (1) academic medical centers, followed by (2) children’s hospitals, both for the same reason: they are irrationally convinced that their bizarrely inefficient and sometimes safety-endangering practices are better than everyone else’s. So, you have to hack your application to shut them up even though every other customer uses it just fine.

From Kate Bradley: "Re: consultants. Quite a few consultants read HIStalk. Would you consider running a survey of them to see what it’s like working for their current or previous employers? It’s sometimes tough to find out the nitty gritty from people already working there." I’m a sucker for taking on more work when it sounds fun. If you’re a consultant, please take my two-minute survey about your current and previous employers and I’ll e-mail you the survey results.

We spring forward tonight. Good luck to you IT folks on call.

Kleiner Perkins Caulfield & Byers creates the $100 million iFund to invest in companies developing high-impact ideas for Apple’s iPhone and iPod touch. Apple will be involved as well.

Cerner says KLAS has ranked Millennium as #1 in overall value proposition scores for CPOE and #1 in "deep" physician CPOE usage. Also from KLAS: 100% of Cerner’s remote hosting clients recommend that option.

Jobs: Senior PR Account Executive, Siemens Soarian Consultant, Network Analyst, Senior Business Analyst.

Privacy warrior Deborah Peel has an opinion letter in the Atlanta newspaper. Excerpts: "Most Americans think HIPAA protects their health data. Wrong. Those Americans should read the fine print issued earlier in this decade by rule makers who, reversing the intent of Congress, eliminated the right of patient consent over how their data is used for treatment, payment or health care operations … The foremost beneficiaries of widespread availability of health data will not be patients. It will be employers who will use that data in helping to determine hiring. It may be credit firms. It will be the data-mining firms that will use that data to push their wares on consumers." What I would do if I were her: hire a researcher to reference the source of every claim she makes. She’s a doc appealing to a medical and technical audience, so it would be nice to see the same factual rigor that you might expect in a journal article. The ‘can you prove that?’ questions are distracting from her message.

Article tidbit: MD Anderson used iRise visualization software to design its homegrown EMR, claiming it cut development time by half.

E-mail me.

Inga’s Update

Go-live for Cerner Millennium at Barts and the London NHS Trust is rumored to be pushed back again due to supposedly outstanding issues with the software. The trust has been testing the product since August 2007.

The Greater Rochester RHIO launches online sharing services enabling medical offices to access patients’ lab reports, radiology results, and medication history. Patients can’t view their own information (yet?) but can request an audit to see who has accessed their record.

From Political Pundit: "Re: Beacon Survey. I like it. Execs are torn over whether to vote for the person who will subsidize their field of industry or the person who will exchange fewer personal liberties for the soup kitchen of the welfare state. Maybe the question should have been: which candidate do you think will bully for the most taxpayer dollars to be thrown at HIT projects?"

Check out Neil Versel’s podcast interview with Jonathan Bush. I found it both informative and fun. I love how Jonathan rambles back and forth between the serious and the insane. He also mentions Mr. H and me at the start, which of course made me smile.

E-mail Inga.

Shahid Shah on Using Virtual Machines for Easy Open Source Deployment

Shahid Shad is the CEO of Netspective and writes The Healthcare IT Guy.

The open source movement in healthcare technology is growing by leaps and bounds from where it was only five years ago. However, open source software is often difficult to install and get up running, so "trying it out" is not so trivial. I know many CIOs and senior executives who would love to try out open source, but the knowledge required causes IT staff to push back. Most open source software today needs web servers, application servers, database servers, etc. all working in tandem, just to conduct a trial. On the commercial side, things are a little better, but still complicated.

Given how hard it is to install open source solutions, I strongly suggest that the use of virtual machine software like VMware, which is now free for many licensing options, would make it significantly easier for customers to try out software. Other options like Microsoft’s Virtual PC 2007, which is also free, might also be beneficial.

A virtual machine (VM) engine is a piece of software technology that dates back from the mainframe era. It basically allows multiple logical operating systems (a "virtual machine") to operate on a single physical machine. Assuming you have enough memory and processor power, you could have a Linux or Windows "host computer" that would allow multiple Windows 95, 98, NT, XP, Linux, etc "client virtual machines" to run as separate windows at the same time. On my workstation, I often run several virtual machines at the same time. The technology is stable, almost ubiquitous, and very slick.

For almost a decade, I’ve been advising my clients, most of which develop software for a living, to use virtual machines to help improve quality, test multiple operating systems on a single machine, produce "snapshots" of an operating environment for installations and training, and many other uses. I also started suggesting as early as a few years ago that software vendors should create a "virtual machine image" of a system that has their software, database, network, etc. all pre-installed and pre-configured.

VMware has a free version that can take a machine image and launch it on any modern computer. This bundling of an operating system with a pre-configured, special-purpose application is called a "virtual appliance". Cute name, but virtual appliances take literally minutes to run (it usually takes longer to download them than to actually run them). In a virtual appliance, there’s no installation step. You just turn it on and you’re ready to run the software immediately.

For Windows-based offerings, there might be licensing issues from Microsoft (a vendor can’t just create a virtual machine client image with Windows without licensing it appropriately). However, for any software that runs on Linux, that’s not a problem – just bundle the operating system fully configured to run your software along with whatever else is needed and give your customer a "single click" launch and test capability.

The folks from Medsphere, VISTA, ClearHealth, and other open source groups should take this advice. The virtual machine client model forgiving a trial version would change the trial deployment model dramatically and give you leg up on your competition. You could offer a "five minute" install regardless of how complex your software is.

There are already hundreds of other virtual appliances out there in the broad non-healthcare market. It’s time for the healthcare IT sector to create its own virtual appliances to ease the management and maintenance burden on already tired staff.

News 3/7/08

From Caryoutsider: "Re: Allscripts. What’s going on? Stock keeps going down, down, down." Shares closed at $9.82 today, dropping the market cap to $553 million. You voted Allscripts Most Likely to Be Acquired in the HISsies, maybe showing some psychic ability if the trend continues (although I’d bet they would go private first). The PE’s still at 31, so it’s not necessarily cheap even at that low price. It was well over $25 a share in November. The old-line PM/EMR companies are getting pounded by eClinicalWorks and others like them (cheap and fast to implement) and Stark hasn’t had the impact everyone expected (because free isn’t cheap enough if a doctor doesn’t want an EMR), so despite lots of interesting ideas and technologies and great leadership, they’re playing on someone else’s home field.

From Nasty Parts: "Re: Allscripts. I’m hearing a lot of news from a variety of sources regarding a potential acquisition of the Misys Ambulatory division by Allscripts. I’ve heard it from different high level sources which leads me to believe there is something afoot. Of course, with Allscripts stock under $10/share, I’d think *they* would me an attractive target right now." I heard that before, but it hasn’t panned out yet. Allscripts needs to get its own house in order before buying the fixer-upper next door. Misys seems happy to sell relabeled iMedica, so I’m not sure they’re looking for new worlds to conquer either. I can’t what to hear what eCW’s Girish Kumar has to say when I talk to him next week given how accurate his predictions two years ago were.

From Greg Tourniquet: "Re: CIS failures. AMIA keeps talking about the value of publishing CIS failures and lessons learned. There is a formal initiative that we can look forward to: A group of battle-scarred CMIOs is writing a book; they recently put out a request on their listserv for ‘tales from the trenches.’ This was the request: ‘We are going to share our multidisciplinary IT stories in a book called ‘Gain Wisdom From Failure – Lessons from HIT Projects that Missed their Marks’. I will ask the CMIO leading this effort if he wants input from our peeps." That’s what the industry needs. That plus an assessment tool that I’ve advocated previously: a readiness checklist that would tell a hospital how high it should set its sights, i.e. if the culture and change management capability is primitive, don’t run off and buy a $50 million clinical system – stick with ancillary department task automation, data analysis, and integration and call it a job well done. The money wasted by the hospital industry on ineffective IT implementations is embarrassing. It’s not the vendors’ fault – nobody made them buy – but they consistently underestimate the challenge despite ample available evidence. I’d buy that book.

From Mr. Underhill: "Re: discussion comments. I truly enjoy HIStalk. I don’t think there’s anything like in healthcare IT and your numbers and popularity just seem to keep climbing. One interesting observation, and you might agree, is that for all the site traffic, news, and rumours, it is predominantly you keeping us informed. What I’m saying is that with all that traffic there seem to be very few comments made in the discussion area.  It seems that so many people use it as a one-way communication tool. I’m as guilty as anybody, as I can’t wait to read the latest edition when it arrives." That used to bug me, but I realize I’m the same way. Most of the time, I wouldn’t want to interact either. I’d just want a quick read, summarized by someone who knows what’s important, with a little humor and rumor to keep it interesting. I’m happy to get comments, but I don’t count on them. Inga and I are flabbergasted at the number and quality of readers we have and we take our responsibility seriously. It’s a lot harder than it looks, but a lot more fun, too. And yes, the visits are off the charts after HIMSS, I’m happy to say (thank you, Fake Ingas and sponsors).

From Mrs. Peele: "Re: ROI. I noticed the student looking for help with an ROI on an EMR. The HIMSS book, Medical Informatics: An executive primer, has a good intro to the technique for an ambulatory EHR in chapter 6." Thanks for that.

From The PACS Designer: "Re: Jott. TPD has found another new web-based tool that may be of value to mobile and other system users. It’s called Jott and allows users to record voice messages that can be converted to text much like HIStalk sponsor Dragon Naturally Speaking. Jott converts your voice into e-mails, text messages, reminders, lists, and appointments." Link.

My annual reader survey is here if you’d care to opine.

I’m a huge fan of Snag-It, which captures screen shots but does about a zillion other things for next to nothing. Their newsletter has an article on its use in radiology at Cincinnati Children’s, where the rads use it to capture PACS images for PowerPoint and teaching files. I’ve only run across a handful of life-changing computer applications and Snag-It is definitely one of them (non-profits get a discount, by the way, and I’m not a compensated endorser since I bought my copy like everyone else).

The Healthcare IT Transition guys report that the HISsies cartoon has been downloaded over 1,400 times. Maybe next time we’ll do a reality film a la Blair Witch Project, featuring some hospital people hopelessly lost in the HIMSS exhibit hall and stalked by a salesperson.

Speaking of the HITTGers, they videoed a Webinar they put on last fall that addressed "surprise" ROI that came about when implementing systems for patient safety. Per Marty, "We did a study of the literature and found scads of examples of HIT systems that paid for themselves. We only looked at provider-reported stories. If it even smelled like a vendor PR fish was hiding under the paper, we pitched it." Marty’s offering our grad student Jerry Rivers a peek, so Jerry, e-mail Marty while he’s feeling educationally benevolent.

Shares in athenahealth nosedive after the company announces Q4 numbers: revenue up 35%, EPS $0.06 vs. -$0.58,  beating analysts’ estimates but not their expectations. The stock finished down 22.2% today. Ouch.

I always like the objective analysis of Vince Kuraitis, so I recommend his comparison between Google Health and HealthVault.

Joe Conn of Modern Healthcare writes about the Cerner HIMSS pullout, confirming from HIMSS that Cerner wanted to run what HIMSS CEO Steve Lieber admits would have been an "innovative" education program, but one he denied nonetheless because HIMSS policy doesn’t allow vendors to hold events unless they exhibit. I know what Cerner was planning and it’s a darned shame that HIMSS is so terrified of losing its boat show cash cow that it won’t allow education as an alternative (check the schedule: you can go all day long, yet still only attend five hours or so of actual education because that interferes with forced trinket-harvesting and tire-kicking). HIMSS locks down the entire Convention Center ground zero – every meeting room in every hotel – using its Exhibitor Point system (warning: PDF) to ensure that financial homage is paid. It’s entirely non-coincidental that there are 30 education sessions going at once, then suddenly a big block of empty time that compels you to Neon Gulch. At least it keeps the dues cheap.

Speaking of bad HIMSS decisions, how about that "Chicago next April" idea? I checked weather records for April 4, the opening day of the conference next year, at the 8 a.m. opening session time: 2007, 31 degrees and snow; 2006, 39 degrees and snow; 2005, 30 degrees and no snow; 2004, 23 degrees and no snow. I’m not sure who loves Chicago enough to look forward to that, but I suspect they already live in Wisconsin or Minnesota (or work in the Chicago headquarters of HIMSS). Coat check girls can’t wait and neither can exhibitors, who hate to see a sunny, warm day because people don’t hang around those mission-critical booths for hours at a time (say, you don’t suppose that HIMSS would intentionally … no, surely not).

I’m with Cerner on this one, but I still like the potshot Todd Cozzens of Picis took in Joe’s article, speculating the same as I did earlier: "To me, it’s a sign that their growth in the U.S. market has tapped out; they don’t see a lot of green-field hospitals in the U.S. The fact that Neal is not being there and being in Europe means he’s run out of runway here." I think that’s most likely true, still another reason to avoid selling your soul to Wall Street. It’s tough to run an R&D intensive business that sells mostly to non-profits and still keep the money guys salivating.

E-mail me

Housekeeping and Sponsor Updates

Bon Secours Health Systems (MD) attributes EnovateIT’s mobile solutions for helping improve patient safety across several of its hospitals.

Jobs: Sales Executive – GE Healthcare, Healthcare Technology Senior Specialist – American College of Cardiology, System Director of IS – Manatee Memorial Hospital, Epic Consultants – Vitalize Consulting Solutions. Those who sign up for weekly job alerts hear from the ab-fab Gwen, who writes a fun letter with each one.

Thanks to the companies that sponsor HIStalk. Please click their ads, consider them if you’re in a buying mood, and tell them you appreciate it. I know some of them have a real challenge getting their corporate bean-counters to loosen the financial chastity belt to send money off to some anonymous guy’s PayPal account, so give them credit for being cool enough to try. Some are large, some are small, all choose to support HIStalk because of you.

Inga’s Update

Prior to HIMSS, I mentioned Beacon Partners was conducting a poll at HIMSS to determine which presidential candidate healthcare execs thought would best represent healthcare. Over 600 people participated in the survey and the majority indicated Hillary Clinton would be the biggest advocate for healthcare IT and would have the most impact on empowering providers to deliver the best possible healthcare through the use of healthcare IT. However, Clinton came in third after McCain and Obama when these same participants were asked which candidate they would vote for. While the Beacon folks said they found the results “fascinating,” my take is that even healthcare execs see the presidential race to be about more than just healthcare. (Kind of reminds me of the recent McKesson/Quadramed conversations over how you can lose even if you have a better product.)

I registered for all sorts of exciting prizes last week at HIMSS (iPods, Wii, etc.) and am now getting a bunch of e-mails back from those vendors. Unfortunately I didn’t win anything yet, but have learned a few things NOT to do when sending emails. For example, I got this email today: “We met at the HIMSS event in Orlando last week. You had stopped by [company’s] booth and we spoke. We were discussing your current IT environment and any current or planned applications development initiatives coming up in 2008.” Well, let it suffice to say that I didn’t mention HIStalk’s (or anyone else’s) current IT environment to this guy. Why send out a spamming e-mail that makes you and your company look amateurish? A simple, “thanks for stopping by” would be more appropriate.

BC/BS of Massachusetts announces physicians won’t be required to install EMRs in order to participate in its bonus programs, though health systems will be required to install CPOE by 2012. The insurer has determined that the financial benefits of an office-based EMR are not worth the costs, which usually take five to six years to recoup. CPOE has been shown to provide payback in about 26 months. Additionally, a recent study found that CPOE could prevent 55,000 medication errors in Massachusetts and provide annual savings of $170 million ($2.7 million per hospital.) It will be interesting to see if other insurers follow their lead. The study results also suggest physicians will continue to look for outside funding for EMR purchases since the ROI provides them with limited financial benefit.

E-mail Inga.

If Clinical Systems Were The Space Shuttle, Would We Keep Launching Despite Frequent Crashes?

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

Michigan’s Trinity Health has put their seemingly successful $315 million clinical system implementation on hold. Their announced reason: they are fine-tuning their plan to drive clinical improvements and implement evidence-based medicine.

The industry has been hard-selling “clinical transformation” for years. Hospitals repeat the mantra dutifully (although none ever seem to declare themselves transformed – like vendors’ claims of integration, it’s always just around the corner.) Post-implementation hospitals aren’t necessarily improved clinically or financially. The only predictable transformation is that hospital dollars unfailingly get transformed into vendor dollars.

Who do you blame? Surely not all vendors and hospitals are incompetent. Is clinical transformation (assuming such a thing exists) simply impossible to manage successfully? Maybe the best analogy is the space shuttle.

The space shuttle orbiter is supposedly the most complex machine ever built despite its now-antiquated technology (there’s a parallel right there). It’s not just a flying machine – it’s an industry of pork barrel politics, fat cat contractors, jobs, and national pride. Somewhere in the mix might be a smidgen of science that bears little resemblance to the original promise of an inexpensive fleet self-funded through technology commercialization (Tang, anyone?) We walked on the moon but settled for a scientifically irrelevant low-orbit taxi.

Like the space shuttle, clinical system projects rarely unfold as optimistically planned. They require painstaking planning, unerring execution, outstanding change management, and unwavering focus. None of these are the long suit of the typical healthcare organization. Instead of a handful of astronauts, thousands of busy employees have to be convinced to change their comfortable routine. When the going gets tough, the formerly committed VPs disappear and leave the battle to the IT techies.

Sometimes the project explodes while you watch, like Challenger or Columbia. Even when it doesn’t, interest wanes once the flashy launch is over.

If the shuttle crashed 90% of the time it took off, would we keep launching and irrationally hoping for success? We’d send the engineers back to the drawing board, or maybe even get some new engineers, or ground the program. Or, perhaps we’d just declare the whole thing undoable and settle instead for a high-value subset of the grand plan more within the scope of our capabilities.

Where hospitals are different from the space program is that we don’t learn from the industry’s widespread failures. Hospitals quietly shell out precious millions and unreasonably hope that they’ll find the success that has eluded a long string of predecessors buying the same short list of products. Reality eventually sets in, expectations are lowered, and attention moves on to something else.

Sometimes imaginary victory is declared at HIMSS, proclaimed by ventriloquist vendors whose lips barely move when their customer speaks. One thing’s certain: you’ll seldom hear a discouraging word from consultants, member groups, or rah-rah magazines. They make money from the illusion of mass success.

We need success stories that go beyond a glitzy lift-off. We need someone to actually be transformed, not just implemented, and for those who weren’t to tell us what went wrong. The path to clinical transformation is lined with the smoking debris of earlier missions, each of them offering lessons for those willing to listen.

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

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

News 3/5/08

From Bill Shatner’s Ham: "Kaiser said it added 13,000 total members in 2007, which includes an unpublished addition of 20,000 new ‘Charitable Coverage’ members added during the year (the biggest annual increase in that program’s history). Had it not been for the new 20,000 unpaid members, Kaiser would have posted its first annual member loss since 2003. Giving coverage to poor, uninsured people is a noble thing. Using that coverage to hide true membership losses is a new level of dirty." Link.

From Paul Pott: "Re: Stanford. I heard they’ve delayed their Epic go-live over two months and sacked Perot Consulting despite a long-term agreement. Accenture won the job and it will be interesting to see how they handle it. Stanford continues to cut parts of the project out (surgery, barcoding, ED) to see if they can get something live." Unverified, updates welcome.

From Jerry Rivers: "Re: ROI. I’m a grad student and hadn’t heard of you prior to the Ingas thing at HIMSS. I’m hoping you can point me in the right direction. I’m interested in learning about models of ROI for adoption of EMR. Ohio State University Health System posted a paper about their own ROI, but I can’t find anything else like it. Thanks for your beautiful Ingas at the conference." Can anyone help with some citations? I haven’t seen much. Glad you liked the Fake Ingas, although you missed the best one of all (Real Inga).

Listening: The Red Thread. Sadly defunct, but "Wax Museum" makes them immortal in my book.

Vista is a failure in terms of both technology and sales, so does that mean that Windows XP was Microsoft’s last decent OS? I liked Computerworld‘s arguments until they got into that Steve Ballmer "wave your hands over the coffee table" thingie from last year’s HIMSS as the next generation. Still, Microsoft can’t lower the Vista price enough to unload copies because of driver problems, resource hogging, and lack of benefits. Looks like another Windows ME dog.

Palomar Pomerado has a video about its Second Life hospital project.

Legacy Health (OR) bails out of its five-hospital Cerner implementation and goes with Epic. I’m beginning to feel uneasy about Cerner’s prospects. The stock is doing poorly, they’ve laid off staff, projections have been reduced, and the HIMSS booth thing may have had more of a back story (I’ve heard rumblings that they had planned to pull completely out this year). Hospital finances aren’t good, the clinical systems market is surely near saturation, and Cerner’s desperate search for growth in other markets and overseas won’t feed the Wall Street wolves in the near term. Cerner is the industry’s bellwether, so if they have problems, so does everyone else (although being publicly traded makes theirs much worse).I hope they do well, but the signs aren’t good.

Speaking of that, I weigh in tomorrow in Inside Healthcare Computing: Clinical Systems are Cooling Off: What Systems Will Drive the Market Now?

My reader survey is here if you’d like to set HIStalk’s direction. Thanks. Speaking of voting, Cerner’s HIMSS pullout is running 73% "Good Idea" in the reader poll to your right.

A couple of vendors who exhibited at HIMSS say they’ll write something up to describe the experience (cost, traffic, problems, etc.) Your thoughts are welcome, especially if you run the company and can assess value received (I’ll use only de-identified info, of course).

MUSC picks Oacis for its data warehouse.

The New York Times runs a piece (This Blood Test Is Brought to You by …) on the ad-sponsored Practice Fusion EMR, with a screen shot showing an ad. The company selling ads for them says they can get ten cents per view or more, making it possible to keep giving the app away. Trivia: the product is written in Adobe Flex, which sounds interesting. It doesn’t seem to exactly be selling (or not selling) like wildfire with only a couple of hundred docs using it to some unknown degree.

Optical imaging vendor Optio Software will be acquired by financial transaction solutions vendor Bottomline Technologies. You probably saw Optio at HIMSS since they have a big healthcare customer base. Or did.

Meditech will open its Fall River building next month, spending at least $40 million the new home to 500 employees. They’ll stick with the plan of open seating, but the water view is nice.

A nurse violates hospital policy and avoids using her hospital employer’s medication barcoding system, killing a patient with another patient’s medication, this time at Marion General Hospital (IN). I think they’re a Meditech shop and a Most Wired hospital in the rural category.

The president of the Massachusetts Senate is pushing a bill that would set aside $25 million for a statewide medical records system and would make it illegal for drug reps to offer gifts or for physicians to accept them.

Sponsor Updates and Housekeeping

Welcome to surprise new HIStalk Platinum Sponsor QuadraMed. I say "surprise" because it came out of the blue after they did an HIStech Report about their Care-Based Revenue Cycle. I nearly turned them down because not all of the conversation about them here has been positive after their recent offshoring decision (or any other broad vendor, but they’re the first to sponsor) and I wanted to be aboveboard about that with them. I give them credit for signing the standard sponsor agreement that spells out that we’ll keep saying whatever we think and believe, sponsor or not.(Disclaimer: I’ve been an Affinity customer and have nothing bad to say about that experience, but I should disclose that bit of history). Anyway, welcome to QuadraMed. I appreciate their support. I interviewed CEO Keith Hagen two years ago. I also saw him in the breakfast line at the Peabody Orlando last week, but that’s hardly newsworthy since half the industry’s leadership seemed to be waiting for a Beeline Diner table and a $13 omelet that doesn’t come with toast.

Speaking of HIStech Reports, a couple of folks have asked if we’re still doing them post-HIMSS because those fancy reprints we did were the first collateral to run out as attendees grabbed them up. Yes, we will continue to do them. They’re a lot of work, but fun.

To your right: you can sign up for updates when I write something new here or for the weekly Brev+IT e-mail newsletter. You can also Google all five years’ worth of HIStalk for people or company names. And, send me secure rumors via the Rumor Report button.

AT&T is handling a voice and mobile broadband in-building wireless network for Thomas Jefferson University and Hospital (PA).

Those sly dogs at EnovateIT snapped a pic of our little autographed signs we made for the HIMSS booths of sponsors (earning Tammi from AT&T an Inga hug for delivering them all over the hall). Notice the crafty way they worked their own logo and cool cart in the picture. I can’t figure out how everyone and their brother was blatantly shooting video and flash pictures all week and I got busted for taking one non-flash Fake Inga picture. Seems like HIMSS should just drop that policy. It’s not like there are nuclear secrets in there.

E-mail me.

Inga’s Update

I am in my post-HIMSS frenzy (which is different from my pre-HIMSS/during-HIMSS frenzies). I am in definitely catch-up mode. The swelling in my feet has finally gone away after too much walking in beautiful shoes and too few places to sit down!

Anyway, I have noticed a few comments on some other blogs about HIMSS in general as well as HIStalk and the HISsies. Here are a few of my favorites. Amy Gleason (of Bond Medical, I guess now Medi-Bond) brought a crew to the HIStalk party (wish I had met them because they sound like a fun bunch) and shares some insights on speakers and the convention in general. The handsome Scott Shreeve provided a great summary of Jonathan Bush’s HISsie acceptance speech. He also says the best part of that evening was chatting with Mr. H and me, which is an incredibly nice thing to say given all the interesting folks there.For a very comprehensive overview, check out John Moore’s Chilmark Research site. He touches on booths and vendors and the overall buzz.

In reading the posts the last few days (here and other places) I have determined I must be the only person who kind of liked McKesson’s Vegas-light inspired booth. Yeah, the booth was huge and flashy but, I found it kind of cool. My biggest complaint about it was that it always seemed congested. Either the setup was not conducive to the number of people and demo stations, or, there were too many people like me who walked through it like a short cut to get on the other side of the hall.

The McKesson talk reminds me of a clever nametag I saw the HIStalk party. A lovely lady had on her nametag that she worked for, “Frequently bashed vendor”. She admitted to me she works for McKesson.

There have been some recent posts about one vendor possibly outselling another, with the loser being the one that actually had a better product. Dog of war said he/she thought it was sad situation and that perhaps vendors should invest more in influence peddling. I think the conversation misses the point. My opinion is that most purchases (other than simple commodity items) should include considerations that go beyond determining what product is “best”. Equally if not more important are factors such as company stability, future product plans, integration capabilities, implementation record, management, etc. If functionality were the only consideration, all we would ever need is a demo CD from each company. There are hundreds of examples of companies in this space that have had slick products but have disappeared because of problems in other areas of the company. Organizations need quality salespeople make sure prospects understand the big picture of the company’s offerings. And, that all being said, of course some salespeople are better than others.

From iphone dude: "It was a good show for us. Going through our leads this morning, we had two booths and we didn’t have a lot of repeat visitors between them. The second booth was a last minute strategy placement which worked out – so yes, the second booth definitely was beneficial. [One of our featured products] got a lot of attention. [Competitor] stopped by at least four times, [another competitor] two or three, and I caught [competitor #3] once. The third competitor rep resorted to subterfuge by switching badges, which I figured out the next day when I stopped by their booth and the same person had a different name. Kinda silly. It was really weird, so we started taking pictures of competitors in our booth." One fun aspect of HIMSS is seeing what the competition is doing and comparing their products to yours. Too bad Mr. H and I didn’t have any cool anonymous blogger cocktail parties to crash.

Two cardiologists plead guilty to embezzling about $840K total from the University of Medicine and Dentistry in New Jersey. The pair admitted to taking the money and providing no meaningful services in return except for referring cardiac patients. Both face 10 years in prison and $250K in fines.

From I’m Not Inga: "I was one of the vendors in the Siemens booth STALKER section. You know, back behind the control room, at the end of the aisle, near the private meeting rooms, and in front of the restrooms. We had NUMEROUS Histalk readers that found us for the ‘I’m Not Inga’ buttons. And they really had to work to find us. So thanks for playing along and making this a fun HIMSS deal for us. This was our first time exhibiting and it seemed that when we were discouraged by lack of booth traffic, someone would come up looking for a button." Thanks to the fun Active Data Services folks for making me feel like some sort of superstar. I actually wore the button for awhile until a friend saw it and decided he had to have it.

iMedica announces a new program to equip physicians with a tablet PC loaded with iMedica’s EMR/PM software to test for one week. I think that is a great move. I am sure that other vendors offer try and buys, though perhaps begrudgingly. The fact iMedica is promoting their program is smart. Apparently the sales rep will “train” the doctor how to use the program and then the doctor is on his or her own. If a product is easy to use, then the doctor should be able to figure out how to navigate the application – that is, if the physician actually takes the time and effort to try it out and doesn’t just let it sit around on a back desk. I bet car dealers would say that people who take a car home for a weekend test drive are more likely to buy and I suspect iMedica will find similar results.

E-mail Inga.

Roper Industries To Acquire CBORD

 
CBORD Group, a smart card vendor best known in hospitals for its dietary information systems, announced this morning that it will be acquired by industrial products vender Roper Industries, Inc. for $367 million. The company’s healthcare offerings include solutions for nutrition service, food service, room service, kiosk-based ordering, catering, and cashless point-of-sale.

CIO Unplugged – 3/1/08

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

Chief Ironman Officer Update: Leadership Lessons Learned from Champions
By Ed Marx

At the time of this post, I am 30 days out from my Ironman. I am a mix of nerves, enthusiasm and fear. Am I fit enough? Have I trained enough? What if I get injured before race day? What if I miss the swim cutoff time? (I’m a snail swimmer.) What if I flat more than twice? What if…

…And why am I doing this?

Ah yes, now I remember. It’s not about me. This Ironman race is about something much bigger than myself. See 01/02/2008 post.

To facilitate my training and to familiarize myself with the racecourse, I recently attended a “multisport” camp. The camp was run by former professional athletes who have organized many Ironman events. One of them, Paula Newby-Fraser, had won 26 Ironman titles including eight world championships. To this day, Paula has recorded the fastest finish among women. My first day at camp, I ran a warm-up 5K with her and gleaned all the wisdom possible regarding the course, the Ironman and running in general.

After an initial day of a short run, a short bike, and a long swim, we settled down for a hearty dinner. Camp leaders announced the cycling ride groups for the next day, which were formed based upon predicted finish times. I was selected to be in the fastest group led by the #1 ranked woman Ironman in the world. Fear struck me like a bolt of lightning, and I considered putting myself in a slower group. Michellie Jones, Miss #1 Ironman (my assigned group leader), happened to be sitting across from me at dinner. I promptly confessed, “I can probably hold my own at 20mph for five hours, but that’s my max.”

She no doubt heard the fear in my voice, yet still replied, “You’ll be fine with that.”

I didn’t believe her.

She added, “I like to start off slow and finish fast.”

God save me!

Apprehensive about the ride, I woke up three times that night. I wanted to drop to a slower group, and yet I couldn’t shrink from the challenge. Finally, I decided if I got dropped I’d just slow down and wait for the other ride groups to catch up.

That sounded like a reasonable backup plan until my ride group gathered that morning. Of the 10 riders, five were professionals; of the other five — mortals like myself — I was the only virgin Ironman. Talk about a clay blob among marble statues. Their bikes and aerodynamic outfits were three times as costly as mine was, and I was the only soft body amongst hard bodies. This was going to be a long day.

We set off at a blistering 26mph pace. Despite a fitful sleep, I had fairly fresh legs and was able to stay steady for the first 40 miles. In search of hills, we headed off the Ironman course and found some rollers with lengthy inclines. We had already lost two mortals; I was determined not to be the third. I was sixth in the draft line, and I noticed the cyclist in front of me falling off the pace, which meant I was falling off the peloton as well. At first, it was just a couple yards, but that stretched to ten yards, and I knew we were in trouble. We wouldn’t be able to push back up to the pack.

Lesson number one: Be sure the person you are following has the vision and stamina to keep you on the straight and narrow. “Followership” is a critical talent for survival.

The turnaround point for our hill excursion was coming up, and I managed to get back in the line. I understood clearly that the key to my survival was drafting closely, if not right behind the leader, in this case Michellie, Miss #1. I stayed slightly to her left with my front wheel overlapping her rear wheel by an inch or two. I drafted well, and during this stretch, at about 28mph, I was smiling, having the ride of my life. I was drafting behind the world’s best! My legs felt fresh again, and my confidence reawakened. About mile 80, we started to hit a gradual incline. As the last surviving mortal, I slipped to third position, then fourth, and was soon passed by the peloton. Heading up the incline, they stayed steady at 25mph, but I was too far off to draft. I ended up facing the wind resistance alone. Despite increased physical effort and motivation, my speed dropped to 18mph. I was alone in the desert. I could do nothing in my own power to reach them.

Lesson number two: Riding in a pack you can gain 40 percent efficiencies over riding alone. Teams can accomplish more. Pushing and pulling together, a team outperforms the loner every time.

A few miles down the road, I was saved by the refueling vehicle that carried extra drinks and food. As we resumed, I took 2nd position behind Michellie and did not let go. I was smiling again. No more inclines, all flat terrain. The closer together we rode in the peloton, the greater the “eddie” we produced, which helped propel Michellie forward. A truly symbiotic endeavor. As we reached the 90th mile, however, I was riding on empty, and Michellie razzed me for the umpteenth time about inadequate hydration. She made me a concoction out of two of her bottles, and we finished in a flourish. By the time we coasted into the finish lot, I was cracking up. I had just ridden over 100 miles with the Michellie Jones. And this woman led no patsy ride!

Lesson number three: Sometimes it takes sheer grit and hunger, but you can push yourself to do amazing things. Test your boundaries, then break through and grow to the next level. Just do it!

Throughout the camp, someone kept saying, “It’s about performance, baby!” One definition of performance: the efficiency with which something fulfills its intended purpose.

Last year’s trophy looks nice on the shelf. I have a few of my own, including work-related awards. But their beauty is fleeting. Their intended purpose has stagnated. Sitting back and bragging about yesteryear’s accomplishments is fruitless, inefficient. At some point, the past no longer matters. It is about what you’re going to do in the next race. Sponsors aren’t seeking out racers because they were yesterday’s champ or because they’d been doing Ironman for 20 years. They’re searching for the continuous quality, or excellence, of a racer — the guy who keeps pushing himself to perform and improve. The same should hold true in our health care careers.

Lesson number 4: You can coast for only so long in the draft of a trophy, but when you cease pedaling, you will fall over.

I’ll wrap this up with bullets of wisdom gleaned from champions:

· Teamwork

· Followership

· Sheer grit

· Breakthrough

· Performance

· Even gifted leaders need a coach

See you at the finish line!

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

Monday Morning Update 3/3/08

From Gatorbait: "Re: McKesson. McKesson is nothing if not a sales machine. I’m in a system selection and I am impressed with the lengths McKesson will go to in order to win a deal. They are relentless and seem to have no bounds. HIMSS seems to be a fertile ground for them. A friend of mine just named them VOC over QuadraMed. The QuadraMed sales manager is baffled.  He was overheard saying, ‘I just don’t understand.’ QD got outsold."

From Al Beauterol: "Re: reception. You really had every single Wall Street HCIT analyst and banker there." If you’re one of them, I’d be interested in your thoughts about the conference, observations from the reception, etc.(I’ll keep you anonymous). I’m glad they came. Someone e-mailed me to observe how conversations at the reception had a lot more energy and creativity than the usual customer-type events. Not that we CIOs, IT people, and clinicians aren’t smart and resourceful, but it’s a different vibe outside of hospitals, and seeing the intermingling was cool. I hope we’ll do it again and maybe stream it to the web or something for the folks who can’t be there (say, that may be the excuse I needed for one of those streaming video camcorders).

From The PACS Designer: "Re: HIMSS. Wow, what a great job Mr. HIStalk and Inga did on informing all of us on the HIMSS activities. It made TPD feel like actually being there."

From Ken Griffey IV: "Re: your question. In my highly unscientific conversations with folks about HIStalk, pretty much everyone had heard of it but, only half of them knew what it was or read it." Darn. Glass-half-empty guys like me hate to hear that.

From Todd Cozzens: "We would like to congratulate two HISsie winners and Picis clients who have gone beyond simply automating with IT to transforming how care is given to benefit their organizations, patients and staff. Both have shown amazing documented results. They are: MD Anderson (Best provider HIT organization) and Judy Middleton of William Osler Health Centre (Most effective CIO in a healthcare provider organization). My only regret is that I had to miss the festivities in Orlando due to a prior event commitment that evening. By the way, I think HIStalk should get first dibs on the Cerner booth space for next year’s HIMSS in Chicago!" Thanks, Todd, for bringing that up since I meant to, but forgot. Among the athenahealth sweep and the unflattering awards, these two are the "real" ones for providers and we should recognize them for winning. I know some MDA people read, but I’m not sure about Judy. Anyway, congrats to both. It would have been cool if Cerner had just said, "We’re pulling out, so our HIMSS space is all yours," although I wouldn’t have had the money to do anything with it except maybe to invite the HISsies winners and Fake Ingas to hold court there.

From Will: "Re: Just an update on your December 19 posting on Tim Thompson leaving Adventist. Well he came back, and now he is leaving again, this time to a site in Texas." Another reader says it’s Methodist he’s going to, but not sure which one. We’ll watch for his bio to be expunged from AHS’s web page.

From Orlando Cepeda: "Re: ICW. I had planned to make the HIStalk reception, but was caught up in the hype at InterComponentWare (ICW). It seems to be well earned. They had Blackford Middleton and Newt Gingrich speaking, along with some other dignitaries from Europe, on their accomplishments globally. They have an open source, interoperability play that connects disparate systems that feed up to an actionable patient as well as professional view. Not only very cool stuff, but this German based company has been doing this for over a decade. They provide the EPR in Germany, Switzerland, Bulgaria, and other places. They are global and building a presence in the good ol’ USA. It is a little confusing in that this German firm uses the acronym ICW — there is another ICW in the USA that makes stands and carts for computer." I will check them out.

From BigTen: "Re: Cerner’s decision to drop out of HIMSS. One of your sponsors, SCI Solutions, also dropped out of the dog-and-pony show a few years ago. I bet they felt their money was better spent elsewhere. Were they there this year?" They were not present this year. Your observation was good, so I asked John Holton, SCI’s CEO, to provide some context. See below. Reading his thoughts reminded me of something I always forget to mention: several of HIStalk’s sponsors do no advertising of any sort other than HIStalk. That makes them special to me, so an extra big thanks to them.

From Peter Venkman: "Eric Schmidt’s address at HIMSS. Perhaps my expectations were too high, but to me, he had nothing much to say beyond a) Google is good at collecting/organizing information, and b) Google should help people collect and organize their health information. The video presentation (which included mostly physicians – what about all of the other people involved in health care?) and the ED physician he trotted out for a demo were uninspiring. If they are trying to help consumers get PHRs, I think their health advisory group should include less ‘experts’ and more patients/consumers/regular folks.and probably not just the young engineers and project managers at the booth who seem unlikely to have any chronic health problems.That said, I certainly hope Google is successful. It seems to me that the Cleveland Clinic should be any easy target, since they already have a PHR." John at Chilmark Research weighs in on Google Health.

From Oohhmm Patience: "Re: HIMSS. The customer dinners seem to get more lavish each year (I wonder what would happen if some of the vendors put as much effort into their products?) but I want to share a commendable event. Sentillion took half of what they would budget for a glitzy event and donated it to Orlando charity Give Kids the World, which brings kids with terminal illnesses and their families to Orlando for a week. Sentillion’s CEO gave a nice (and short) speech about leaving behind footprints wherever we go. I wanted to share the Web site for Give Kids the World." Link.

From HISReader: "Re: Kaiser. I think all hospitals are live on Epic and 10 on everything. The ambulatory rollout was finished this month. It’s easy to talk about big numbers, but HealthConnect is simply a term that all IT budget numbers roll up to. A $4 billion price tag for the last five years needs to be put in perspective because of its size. Truly an impressive accomplishment that deserves at least an honorable mention. Kaiser manages the care for more patients than the populations of entire countries. Would be nice to see a mention about the accomplishment, but maybe that doesn’t create the readership, sponsorship, or lavish parties that your sponsors now afford you and Inga." HealthConnect is a phenomenal accomplishment, no doubt due to that hard work you mention. Nobody questions the ability and effort of Kaiser’s IT people and clinicians – it’s the big brass and their policies (mostly non-IT) that usually raise the criticism. That’s why I wanted to hear what Justen Deal had to say — I was just about the only place talking about how hard the Kaiser IT people were working, how many were leaving, and whether HealthConnect could succeed without giving them more credit.

I’d like to write more about the people in the IT trenches, especially since people sometimes forget that I’m among their number. I’ve tried getting regular people to interview and contribute here, but with few results. Everything in HIT is just about a 50-50 split between vendors and providers, but vendor people tend to get more involved. Provider-siders are often less interested in the broad industry and more focused on their own vendors and projects, but my goal for 2008 is to get more of them reading. Tell me how.

I had to smile a little at the comment about the lavish parties I’m involved with. Here’s how the big evening played out for me. I came down at 6:15, waited in line for a beer, and drank it alone outside the reception room. I shook hands on the sly with three or four people who know me. I stood alone outside the room until around 7:15 and realized I hadn’t eaten for many hours, so I slipped in for food, then came back out to eat it alone. I stood in the back alone through the cartoon and presentation. I left when it was over, waving to Inga, trudging back to my car way out behind the convention center, and went back to my hotel and wrote HIStalk for five hours despite being dead tired. Total people spoken to: five or so. After five hours of sleep, it was back to the conference for a very long day. I’m not a party person and I was keeping an even lower-than-usual profile, so that was for readers, not for me. I almost decided to not even attend, but I wanted to quietly observe. Not exactly a rock star existence, is it? Inga’s quite the social butterfly, so she was in her element.

Jobs: Siemens Consultant, Clinical Analyst, Soarian Consultant. Sign up for a short weekly e-mail job summary from the wonderful Gwen, who some of you met at the reception. With all the layoffs going on, it never hurts to watch who’s hiring.

My editorial in this week’s Inside Healthcare Computing, which I wrote from a food court table at HIMSS: Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist.

Now open for business: Google Sites, the latest of the Google Apps (formerly JotSpot). Easy, cool way to create a department intranet or project page. It wasn’t free when it was JotSpot, but I don’t see anything about pricing now, so it must be now (thanks, Google!) I’m going to find some excuse to use it, being a geek and all.

Now that HIMSS is over, it’s time for the HIStalk Reader Survey. Fifteen questions, doesn’t take long, and helps me figure out what to change or to leave alone. Thanks.

Hankering to hear the HIMSS08 Theme Song, "Now Is Our Time," a few dozen more times? Here’s the video, apparently shot live at the opening session. I take no responsibility for the possibility that the tune could get stuck in your head like a malignancy.

Listening: The Sounds, Swedish dance punk, icy blond singer, ABBA meets Blondie.

Final HIMSS attendance: something over 28,400 attendees and 900 exhibitors, beating previous record San Diego 2006 by nearly 15%. I noticed something unusual about HIMSS09, other than it’s in the unusual Chicago and even more unusual April: the full conference will start Sunday and end Wednesday, moving up a day. I can’t decide if that’s a good thing.

Another record: Bowe Bell & Howell  set the Guinness World Record for the world’s longest continuous scan at the conference Monday with a 3,875 foot long fetal monitoring strip. A Guinness judge traveled from London to certify their place in history. Somewhere in my closet, a Bell & Howell slide projector is smiling. Great PR, right up their with Urinalgate.

I got a note from Heather at eClinicalWorks, who says the company is "working with" the analyst who mentioned implementation backlogs. She says the company’s Q1 growth was up 60% and implementations are not delayed, starting within 24 hours of contract signing. I mentioned how good Girish’s intervew was in 2006 and asked for another one, which I’ll be doing in a few days, so I’ll ask him then.

MedAvant appoints Peter Fleming as interim CEO and Lonnie Hardin as president and COO following the resignation of CEO John Lettko.

A Siemens Medical Solutions lawyer involved in the fake joint venture bidding scam at Stroger Hospital gets a year of house arrest, three years of probation, a $12,500 fine, and 200 hours of community service for lying to FBI agents about the $49 milllion deal. Another Siemens exec gets the same punishment plus a $10,000 fine for perjury. Siemens already pleaded guilty to obstruction of justice and paid $2.5 million, plus they lost the contract because GE Healthcare sued the pants off them for their scumbaggery, one of many cases of bribery worldwide that Siemens hopes everyone forgets.

E-mail me.

John Holton, President and CEO of SCI Solutions, On Not Exhibiting at the HIMSS Annual Conference

I was able to attend your party and it was by far the best event at HIMSS in a long time. I would like to thank you and Inga for everything you have done for the industry. You are a real catalyst for progress and you give us all a little humor in the process.

I agonized over the decision not to exhibit at HIMSS for several years before withdrawing three years ago.  We were spending $250,000+ on our 20×20 booth when all direct costs of attending HIMSS were included (The $100 waste basket rentals and $5 bottles of water add up). We closely monitor our traffic at HIMSS and the ultimate outcome as to whether a sale occurs.

To be honest, in the last year of exhibiting, only three legitimate prospects could be traced back to HIMSS and I was convinced that we would have found them (or they us) even if we didn’t exhibit. So it came down to — was it worth $88,000/lead? I felt we could spend the money in better ways that would benefit us and the access management industry (sponsoring HIStalk, providing educational webinars on access management topics, better web site, and other such venues more directly related to access management). 

I think the decision to not exhibit was positive for our organization. It has freed up a lot of time that went into planning HIMSS and allowed us to focus on providing thought leadership to the access management industry, which I think ultimately is making hospitals more service-oriented towards physicians and patients and improving their financial strength. And while I’m not aware of efforts of competitors to portray our non-presence as a negative, I think in the long run it would be a foolish strategy, because by investing the money saved from HIMSS into the other efforts to improve access management, the people that count in the industry know we are a good solid company with exciting services.

HIMSS is a real challenge for all but the largest vendors.  It is just very hard to compete with the big guys at essentially their own time-tested game; grabbing the attention of prospects with flash and dazzle. I think HIMSS is aware of the issue for small companies, as I saw they had a reception for new vendors and several areas where new vendors could present, but I think it is still an exclusive show for a few large vendors.  

I am not sure I am in a position to give Cerner any advice, but I applaud their statement that HIMSS is a very expensive investment and that maybe there are better ways to help the industry than spending on booths and parties. I don’t think it’s a bad idea to question the value of your marketing efforts from time to time.

News 2/29/08

From Jay Mason: "Re: HIMSS. Thanks for the great event at HIMSS. I really enjoyed it. I have a question for you. Do you know who the largest ASP ambulatory practice management company is?" You’re welcome – thanks for coming. And, perhaps this is a trick question: the largest company, or the largest number of installed ASP clients? I know eCW has lots of ASP customers. athena’s are all ASP. I really don’t know, but I bet someone does and will tell me.

From HIMSS Road Warrior: "Re: HIMSS. You should probably have some form of HIMSS awards – best booth, worst booth, etc. I thought the McKesson booth was ridiculous. I have to imagine McKesson customers are wondering why they spend millions on a booth but struggle delivering a nice product. I found myself attracted to the smaller, more approachable booths. Picis was nice, knowledgeable people and had some good customer presentations. Epic was non-impressive as well as Oracle. PS – I saw many people with HIStalk stuff." Now that I’ve had a day to think about it, I’ll go with MCK for the worst booth; Cerner for the best big booth but, since they were on a different tangent, an honorable mention to Siemens; and Medicity for best overall for being innovative and well designed without being gaudy, although it’s tough to compare, especially when you know you didn’t see them all (I missed Picis, somehow). Wonder what they do with the retired ones? Sell them cheap to third world HIT vendors? Cannibalize them for parts?  Set them up in a special HIMSS Boat Show Simulation Room to have the glad-handers practice their smiles and small talk and Olympic badge-swiping?

I was happy to see all the HIStalk stuff, though I really couldn’t comprehend it all. As I was watching people at the Mr. HIStalk Shoe Shine in the Red Hat booth, I wanted to have a dialog with the shinees: Do you know what HIStalk is about? Are you disappointed by the real me because I’m not what you expected? Does it seem strange that my name’s on a shoe shine?

From Neal’s Pizza Guy: "Re: UK. Don Trigg to be named Cerner’s General Manager for UK and Ireland." I e-mailed congrats (with a question mark) to Don and he didn’t reply, so either he was heading out of town or your rumor is true and he can’t confirm it yet.

Happy leap year. It’s good to be home, although I’m always kind of depressed after HIMSS for some reason. I always feel like such a loser when seeing other people out there doing cool stuff (especially the young ones).

I put a new poll to your right about Cerner’s decision to drop out of the HIMSS09 exhibits. Good idea or bad? You know where I stand.

Matt, the founder of CME Networks, e-mailed after reading one of our HIMSS posts, so here’s a little plug.

An ASHP survey whose results were released at HIMSS shows that only 11% of pharmacy systems are not integrated or interfaced to other systems. Bedside barcoding was reported in use by 23%, which sounds high based on what other surveys have found.

Smart marketing: Eclipsys announces that two of its Sunrise users have achieved HIMSS Analytics EMR Stage 6, joining fewer than a dozen hospitals: full physician documentation in at least one unit and radiology PACS (and including the lower stages: EMAR/barcoding, CPOE, clinical decision support, etc.)

The Methodist Hospital of Houston picks Picis for periop.

Big-time investment guru Carl Witonsky (who also happens to be a pretty good guy from my limited experience) is named to Dairyland’s board. I hadn’t kept up: last time I checked, he was running CliniComp, but now he’s on Sentillion’s board, too. I envy those big-picture money people, especially when I’m mired in day job minutiae after my "Cinderella at the ball" moment at HIMSS.

Students in India and China can take an online HL7 certification prep course for $100. And probably will.

Philips realigns its entire informatics business, although lost in the numbing flurry of buzzwords is an explanation of what they actually did.

QuadraMed has ported QCPR to Cache’. Like with RelayHealth, we scooped that a little in their HIStech Report.

Lacy Thomas, the former CEO of University Medical Center (NV) is accused of awarding uncontested hospital contracts to unqualified friends, among them former Cook County Hospital CIO Greg Boone. Boone got $50,400 for an 25-minute PowerPoint IT evaluation that caused employees to "chuckle and laugh" because it was recycled information he got from three employee interviews over two days (well, he’s not the only consultant to do that). A UMC IT director complained that Boone was unqualified, but boss CIO Doug Northcutt, sharing a fear of unemployment like many of his peers, told him to pipe down. Prosecutors say taxpayers lost $10 million because of Thomas’s  shenanigans.

Kaiser says 10 hospitals are live on HealthConnect, with 23 to go. They finally admit a cost of $4 billion, although that could well be a low estimate.

Let’s give some more free PR to the urinal marketing people, just to annoy their competitors! Seal Shield announces a $40 dishwasher-safe mouse.I think they should run a HIMSS special and send a free banned urinal screen with every order, maybe framed like a gold record.

Elsevier begins marketing its clinical decision support applications that now include the former CPMRC of Eclipsys.

Medsphere announces an open source partnership with Tolven.

Former Medstat CEO Tim Murnane is named CEO of EVP/COO of NightHawk Radiology.

New York City claims its eClinicalWorks health records network will be the largest in the country, involving 200 doctors and 200,000 patients so far.

Inova Health signs an $8.3 million deal for Centricity EMR.

The analyst who upgraded athenahealth’s stock earlier this week says he’s hearing that eClinicalWorks may have hit the wall on its ability to scale up support and implementation. I looked back on my 2006 interview with Girish Kumar to see if he mentioned it, reminding me of what a good interview he did (check out his predictions and competitor evaluations). I know someone told me that in an interview about their company, so I’ll have to dig further.

E-mail me.

Sponsor Updates and Housekeeping

I’m thinking about shutting down the old HIStalk site at blog-city.com. Anybody have a reason I shouldn’t? I know some folks still read there, but I could send some reminders. It would make maintenance easier. I wouldn’t kill it since it’s got all the older articles, just not post to it.

I checked the HIStalk stats and February will set the record for most visits. Thanks for reading.

RelayHealth announces its Results Distribution Service, which we covered quite well, I think, in an HIStech Report interview. I should have asked Fake Inga to explain how it works.

AT&T will provide RFID asset tracking to Health First (FL).

Sage Software announces Intergy PM/EHR version 4.0.

Premise announces a partnership with Stryker Medical, contributing workflow and communications solutions to Stryker’s iBed project.

SXC Health Solutions will acquire National Medical Health Card Systems. Healthcare Growth Partners was strategic advisor to SXC.

NextGen’s EMR wins an MS-HUG innovation award in disease surveillance for its work with the Medical College of Wisconsin.

Art Vandelay on HealthVault

I took the plunge and played with HealthVault (HV). HV is not a PHR – it is a set of related health web services, schemas, and a storage service. Microsoft stated it is opening the toolkit and service. This follows its recent strategy for many of its other servers and portions of .NET. Codeplex will be the tool for sharing the open code.

The good: initial set of services, growing third party support for connected devices (BP cuffs, HgA1c monitors), cost of the service, and use of HL7’s CCD.

The acceptable: documentation, support forum, granularity of the security model, and basic service and XML schema testing.

The bad: no interactive debugging, error details, terminology services, overlaps in the data schema, and a confusing user interface. A number of issues exist with the Terminology services. This includes the lack of use of HITSP formats, the lack of terminology maps, and a lack of a consumer terminology engine. The confusing UI is less of an issue as Microsoft wants the partners’ developers to shield consumers from this layer of the tool.

The open questions: support responsibilities of Microsoft vs. partners, the number of hack attacks, and the intrusiveness of HV Search. HV Search is Microsoft’s sole revenue model.

Inga’s Update

It’s Wednesday afternoon and I am at the airport sitting at the gate. Don’t know how things will be Thursday but it took forever (more than an hour) to get my bag checked and go through security. It was ugly. Also ugly was my suitcase, which I could barely zip closed because of all the treasures I collected.

As I reflect on the last few days, it all has seemed a bit surreal. For example, walking by the booth for various sponsors and seeing the HIStalk signs prominently displayed – with my signature. And seeing various name tags and knowing that I have e-mailed or chatted with them. It hasn’t been that easy for me to keep my low profile, especially because my true nature is to go hug everyone!

If you are a sponsor, trust me, I stopped by. Michael, Dewey, Tina, Lauren, Don, Lynn and Bill – sorry I didn’t give you a hug. I did hug Tammi with AT&T because she helped me deliver the HIStalk signs to our sponsors.

Readers may not be aware of this, but it was also the first time Mr. H and I had met in person. He is just as funny and smart and warm-hearted as his posts suggest. Better really. He is not as gregarious as me, but I don’t think that surprised either one of us. We had fun sharing really gossip that was so juicy that it isn’t printable. I think he was amused and not surprised that I found attend several great after parties while he went to the hotel and made sure HIStalk got posted so that readers would get their fix.

Anyway, despite (or because) of all the fun and Internet access issues, I feel out of touch with real HIS news, so I look forward to catching up. Let us know your impressions of the meeting and make sure you have checked out the HISsies cartoon. The HIT Transition guys have asked what people have thought, so let us know.

E-mail Inga.

From HIMSS 2/27/08

I’ll be heading out later today and I was ready for a sitting break, so I thought I’d be one of those ultra-trendy guys and blog right from the event (that fad kind of died out, didn’t it?)

From John: "Re: HIMSS. Great event last night and congrats to Healthia for making it happen. Quite sure they got a lot of good will out of that one. Hats off for stepping up to the plate and Mr. HIStalk, I bet you’ll have more than a couple of your sponsors approach you to do something next year. Google has a surprisingly small 10’x20′ booth where they are doing VERY limited demos (capabilities of solution) to hordes of people. Whenever I went by, crowds were 4-5 people deep. Not surprised by Cerner bowing out in 2009. Seen similar actions taken by other anchor vendors in other industries, but they don’t stay away for long, at least not until this industry consolidates a lot more and penetration in the market is deeper. Still a lot of opportunities in the market. BTW, got a wonderful Polaroid picture with a Miss Inga (she called herself Leah) over at the RelayHealth booth. It will go up on the wall back at the office. Thanks RelayHealth and Inga." That particular Fake Inga’s name really is Leah, actually, so maybe she wanted you!

From PTSD: "Re: HIMSS. Great reception with two free drinks! Tote bags are a nice touch and at least have two handles and could be put over your shoulder (more manly color next year? 85% of vendors use blue in their logo/marketing). Hotter babes at the reception than in the booths! Great finger foods, although anything with conch in it scares me. We did need some extra tables to put empties on and the back of the room could have used a bag check person. Most frequent comment; ‘One man, shooting straight, made all of this happen.’ Then of course Jonathan broke out with his digital balls comment… Urinal Marketing, absolute genius as I had something to talk about to fellow urinal users (not that I normally do that). People (guys) were talking about it in the show room. Google is here, but states they are consumer oriented… trying to get buy in from HIS? Most booths are here for current clients and to get name recognition so that when people bring a vendor to their IS departments attention, hopefully they have at least seen the logo and know that the vendor was at HIMSS. Cool toys, T-Shirt that says ‘Why does my nose run,’ bouncy balls that light up (my two year old will love that) and a tool with Phillips and flat head screw drivers. Also, where do you get the light up lanyards? I’m glad you liked the totes – I may need to print your comments to present to Mrs. HIStalk when she comes after me with the Visa bill wondering why some company she never heard of charged us $1,000 (that gets you 400 of the tote bags, in case you were wondering). I liked the conch fritters, although the crab cakes were amazing (lots of spice and heat, surprisingly, which I like). I saw the light-up lanyard people, but I forget who it was. Urinal marketing: genius, but not so much that I’d strike up a conversation in there (plus, how will they market to the ladies?)

From FOSSer: "Re: FOSS. As I am not attending HIMSS, could you comment on any FOSS type of exhibits at HIMSS and the reception of FOSS solutions within healthcare?" I don’t follow that area much, but it seemed to me it definitely is picking up. Red Hat had good crowds (the Mr. HIStalk shoeshine chick was cute today, by the way) the two commercialized flavors of VistA were there, and Misys had the open source EMR and integration engine in their booth. I’m sure there were more examples in the sessions. If anyone wants to report, feel free.

From Bobby Orr: "Re: Cerner. I’m disappointed in your ability to be swayed by the Cerner marketing machine. I expected better. You let them post this nice HR message when they canned experienced people for more college students. And now the bravo to them for cutting costs by not spending money at HIMSS. As mentioned the other day on your site, I agreed the Cerner Health Conference (CHC) is a great educational event for their clients each year but understand this move is very simple. Stock not doing well equals cut costs and not spend on HIMSS because it’s not winning us extra business. Simple business decisions." I posted their HR response to their layoffs for one reason: it lets you judge for yourself what position you take. It was spin, sure, but at least you could decide for yourself. I would be surprised that their decision to not exhibit was based on money – a 3.5 billion market cap company can afford a nice HIMSS booth. My understanding (reading between the lines a bit) was that they were still prepared to participate in HIMSS in a very financially significant way, but in a different format that was more focused on education. I think they’ve come to the conclusion that the exhibit is formatted for hard selling, but the market is ready to move away from that (and if they save money, that makes it even more attractive.) Some companies exhibit only because they know how quickly the competition will spread rumors if they don’t (like when SMS pulled out years ago). Fear is the wrong reason to spend all that money that could be better used for R&D.

From Watcher: "Re: Cerner. Recall that SMS dropped out the year before they ended up selling. Charlie McCall told me at the time that he envied their ability to do that as he never saw the value of the show. McKesson, otoh, had so much neon I wonder if they’re contemplating spinning out provider technologies." That blue was painful. Everybody else has moved to light woods, soothing shades of green, and rounded edges like Danish furniture and suddenly here’s this monstrosity shouting, "I’M A MASSIVE WALL OF BLUE, DAMMIT, SO GET IN HERE AND BUY STUFF." I might rank it as the worst booth of the conference, especially given its footprint, although Epic’s was sure looking long in the tooth.

From Faith Popov: "Re: HIMSS. The Healthia shindig was great. The cartoon was cool. I went to the RelayHealth booth before the show for an ‘I’m not Inga’ button, but they were all out. I guess they were a hit!I had to laugh about the automatic soap … I noticed that too, and thought it was weird! Tip: There was a vendor in the 7000 area that was giving out free tiny smoothies." I noticed the smoothies this morning. I also sat through the OnBase magician again – that guy’s a riot in a smarmy, smug Mr. HIStalk kind of way. Which makes me think just now how few live performers were in booths: no fake fisherman statue, no Richard Simmons, not many magicians. I think Inga and I should pimp ourselves out as marketing consultants because I bet we could pack ’em in with some fresh booth ideas.

Reception pictures:

The dedicated Healthia folks working the reg desk, surrounded by HealthcareITJobs.com syringe pens and HIStalk tote bags. See how happy their people are?

Gwen and Eric. Eric works for Vitalize Consulting Solutions, which recently merged with Lucida. Mary Pat Fralick is still there, so if you’re still at the conference and want to say hi, they’re in Booth #1509.

Jonathan Bush accepting his HISsies awards. I like to think that a speaker’s gravitas and sincerity is enhanced by setting his beer right down on the podium as he speaks as if he will be quickly returning to it, don’t you agree? He was outstanding. He was on the networks this morning to talk athenahealth’s just-announced deal with Community Health Systems. HIMSS Watcher sent over a link to CNBC’s interview with him this morning and it’s a fun watch.

I saw some companies handing out their HIStech Report interviews. Cruise over and take a look. As a reminder, these are our usual interviews, but with questions written to help companies describe their product and its position in the market. They’re on a separate site because their purpose isn’t to be hard-hitting like the interviews here sometimes are, but rather to put a personal face on a product like you’d get talking to a company executive one on one.

Cool technology I saw #1: Design Clinicals.(Disclaimer: they’re a sponsor, but I cut them no slack for that and this is an area in which I have considerable expertise.) Now I’ll be honest: Dewey and Dasi are lovely and highly educated people, but I figured that, as a fairly new company, I’d have to paste on a phony smile while looking at some amateurish application (doctors sometimes think they’re technical as well as medical gods and do their own terrible design and programming). Their medication reconciliation tool, though, is elegant and system-independent. The design is very clean and easy to understand and their integration with the newest First DataBank tools is spot on. I interrupted them five minutes in and said, "You’re telling the wrong story on your site – you’ve got to get some Flash session demos up there because it’s a thousand times better than it sounds." They were already planning that. From a patient safety, physician, and patient point of view, this is the killer app for med rec as far as I’m concerned. I know how the under-the-covers stuff should work (like using NDC number vs. FDB RMID) and it passes the test. CPOE systems should have a user interface that’s as easy to follow and us as theirs. It ties into RelayHealth, I believe, to create a patient prescription profile from billing data in addition to other interface and manual entry. They just signed their fourth hospital yesterday. Most definitely worth a look if you’re struggling with med rec (which pretty much everyone is).

Cool technology I saw #2: Sonitor Technologies. (Disclaimer: they sponsor too, but I don’t care, although I only went through a quick demo). Their deal: ultrasound locators. Remember the story of how Post-Its came about because 3M had some crappy glue that wouldn’t stick well? Sonitor’s stuff works because it has a seeming shortcoming over RFID for locating objects: its signal can’t penetrate walls. What that means: it can locate objects down to the sub-room level. In the demo, they have a fake patient fall that triggers an alarm because the sensor detects movement away from the bed. You can watch in real time on a monitor as the booth people walk around while wearing their wristbands. They’re suggesting many uses: documenting that caregivers really did check on the patient every so often (and to bill for that) was an example. They’ve also got it set up for proximity-based PC security using the PC’s microphone to read the ultrasound from your tagged badge: when you walk up, it logs you on,and when you walk away, it logs you off. Pretty darned cool.

Cool technology I saw #3: Covisint. I stopped by because they announced a health information exchange deal with AT&T that will cover all of Tennessee. It’s a portal application that can be distributed by IPAs, hospitals, or larger groups. I can’t really describe it well, but it can tap into lots of systems (like EMRs and payor systems), has context to synch up separate apps, can plug in all kinds of widgets and let the doctor personalize his or her own screen, offers secure communication and file sharing, and can handle fax-outs and barcoded fax-backs with indexing. I was kind of overwhelmed so I didn’t get it all, but it was a very slick, lightweight application that anybody could use without training. There’s a lot of technology under the covers for authentication and personalization. I asked the guy why a hospital couldn’t use it to tie its affiliated docs into their data, solving the never-ending problem of unshared allergy, eligibility, and demographic information. He said it could be used for that with no problem (I didn’t ask what it cost).

The ever-loyal Inga filed her report below from a HIMSS "Surf the Net" station (does anyone still say "The Net?") because her connectivity hasn’t been working. I’m sure she’ll have more to say later.

E-mail me.

Inga’s Update

I spent a good part of Tuesday walking the exhibits. I talked to vendors at many of the smaller booths (including some HIStalk sponsors such as The White Stone Group, Stratus, Sonitor) and found booth traffic heavy all over the place. I chatted with the eCinicalWorks folks and they told me that their agreement with Wal-Mart precludes them from talking much about the whole thing and they preferred their clients to make those sort of announcements. A comment that made a bit more sense was that they do no outbound marketing (no email, direct mail, advertising, etc.) because they have all the business they can handle via word of mouth. Based on the traffic I saw there, that could very well be true. They also mention they rarely lose customers – maybe only 5% ever leave.

I played with a couple of the small tablet PCs, including Fujitsus, Dells, and Motions. Fujitsu had the smallest device that weighed about 1-1/2 pounds or something unbelievable like that. Dell’s included touch screen capability that was very slick. And Motion’s was a sealed device for infection control and had a built in scanner and biometrics.  So all different enough from another to prevent them from being "just another tablet."

Mr. H and I walked into the Sage Booth. We agreed they had the prettiest color booth. The sales guy was impressed that I knew of Medical Manager and Intergy and Peachtree. I was pleased I didn’t choke and forget the names…

I stopped by the dbMotion booth. Dr. Diamond was one of my first interviews for HIStalk and he was very funny. So I checked him and his crew out. They seemed quite busy showing the product to several big groups of people and Dr. Diamond was much cuter than the picture we had used.

I talked to the Relay Health Miss HIStalk and asked her if people had a clue was. She said many did (which was good). I told her who I was and that she was doing a good job being me, which I think she thought was funny (I don’t know if she believed me.)

E-mail Inga.

From HIMSS 2/26/08

I’m on convention center wireless, writing from the lobby since my hotel’s connection is dysfunctional. So, I can be verbose again (lucky you, huh?)

From Joe Mayo: "Re: Sunquest. Does the new Sunquest have a booth and what are you hearing about their Radiology Product?" They do have a booth, which I would characterize as small but tasteful. They had a little theater with a good speaker line-up and seemed to be getting a few folks in to hear the talks. I chatted briefly and they seemed to be nice folks. I like their logo. I haven’t heard anything about rad since they announced they’d resurrect it (wisely).

From Lori Loveless: "Re: booths. I thought you were absolutely on target with your comments on the booths. As you said, the Cerner booth was right on with them giving homage to their clients and partners. I too thought Siemens was well done and very open, they even asked me to sit and watch one of their presentations … which I have to say was also nicely done. What about Google?" You know, I didn’t even notice Google’s booth. I think I saw it yesterday and they were along a wall. I heard nothing about it, so the buzz factor might be less than you’d expect. I did finally get into Microsoft’s and wasn’t impressed … the little snot who finally deigned to show me Azyxxi wasn’t very good – it just looked like Excel from what I saw.

From Sal A. Selleck: "Re: your sponsors. Just thought you may want to share with your sponsors that their sponsorship money is well spent. I have been looking for implementation assistance and hadn’t come up with anyone through the usual sources. I Googled for consultants and hit a large dead end. I turned to your web site and have submitted requests to Healthia, MedMatica, and ICG. Don’t know if it will work out, but they have a chance to get in the door at my firm through their sponsorship on your site. I enjoy reading BrevIT and your site when I have the time. BrevIT is excellent." I appreciate that, although now I’m feeling guilty that I couldn’t get a BrevIt done Sunday because of my connectivity problems. Mike’s a big-system CIO, by the way.

From Tony Llama: "Re: urinals. Glad you ran the info about Seal Shield. No good deed goes unpunished, though. Turns out a competitor read about the urinal screens in HIStalk and complained to show management, who made them remove them. I guess no more chuckling in the men’s room . . ." So here’s a shout out to the loser competitor who doesn’t appreciate guerilla marketing: check out Seal Shield’s site, which has videos on their products. They have keyboards, infection control kits, antibacterial mouse pads, and Meditech keyboard overlays. And urinal screens, if you’re in need.

From Michael K. Fox: "Re: party. Party was great. Jonathan Bush was amazing. I stayed till today just to come last night." Jonathan had a great time, too, and lest I be repetitive, it was an honor to have him there (along with all of you, of course). Interesting news today: one of the big-name investment analysts who was at the party last night upgraded ATHN stock this morning, causing it to jump 10% today (I’m not taking credit, just saying). Also, athena just now announced a big deal with 125-hospital Community Health Systems, who will replace its PM systems with athenaCollector.

Scott Shreeve, who I’m sitting here talking to in the lobby as I write this, did a first-person recap of the reception and has some details. I’m hoping we can do something next April in Chicago. I told Shawna from Healthia that the coolest part was how well attendees meshed – it’s not like most vendor events where all you have in common is that you all bought the same stuff, so you end up talking shop all night.

One more time: I have to thank Healthia for putting on the event last night. I’m sure they had lots of other things to do, but they spent a great deal of energy working on the reception. Thanks to the very nice folks from there who worked the registration desk. I came undercover and they made a good impression. I know Healthia might be hiring consultants and I’ve written before how well they seem to treat them, so if you’re looking for a gig, I’d seriously listen to what they have to say and not just because they sponsor.

Just a quick recap of who’s got what HIStalk stuff in the booths. Healthia #4560 may have tote bags left. Ribbons are at DB Technology #4442, IntraNexus, Inc. #1851, Novo Innovations #4128, RSM McGladrey, Inc. #4038, and Stratus Technologies #569. RelayHealth may have some, but I’m not sure there (Miss HIStalk as doing great there today, having Polaroids made with admiring men – those RelayHealth people are fun). You can’t imagine the thrill that the fam will get when you proudly walk through the door and stick a badge ribbon on them, so take 1 or 200. Red Hat has a cool shoe shine stand labeled "Let Mr. HIStalk Shine Your Shoes" or something like that. 

Fred Trotter sent some comments about the open source movement of Misys. He’s actually at least mildly impressed, I think. They’ve got Tolven and OpenMRS in their interoperability demo and are giving exposure to the Mirth project (it’s an open source integration engine). If Fred approves, I do too. I had serious doubts about their intentions, but they may be serious.

I didn’t comment on Monday’s opening events. HIMSS did a really cool movie that wove songs from previous decades into HIT-related events. They had a live band that was pretty good, kind of a white bread "we’re moonlighting from our Disney day jobs" feel. Somebody had written a song called "It’s Our Time" or something like that, which was pretty good for the first couple of verses, uninteresting for the next several, and annoying for the next 50 or whatever it was (if the singer hadn’t been a good-looking female, it would have been as skull-pounding as "It’s a Small World.") Plus, they played again as everyone left, which they did rather quickly given the alternative. I never have a clue what value flag people add, so when all the painted-on gray suited people ran in with nondescript flags and waved them around, I was more puzzled than anything else. Bill Frist was the keynote and did a pretty good job, at least as well as possible given that you’re pitching cutting healthcare costs and helping the poor when your multi-million dollar mother lode came from running for-profit hospitals. I’d give him a B, boosting his score a little because he obviously personalized his talk (some speakers don’t) and did is own sometimes amateurish PowerPoints, which I found endearing. So, overall, is it really our time? That might be a stretch.

The HIT Transition Group guys wrote about the HISsies cartoon and included some back story for the noobs. They had already tripled their server capacity, but the incoming hits choked it, so they had to add a mirror. It was a big hit.

Confirmed: Cerner will not exhibit at HIMSS09. They believe that the future is all about customer experience and outcomes, not the "boat show" atmosphere that Jonathan Bush observed. They expressed interest in changing their participation to provide more education and customer involvement (I’ve been a little bit involved in their planning, for which I’d say kudos to them for asking my opinion as a proxy for all of you). For reasons I was asked not to mention, that won’t happen despite their best efforts. Bravo to them. The industry has matured past the Neon Gulch point of picturing yourself behind the wheel of the latest software wizardry, giving away Hummers, and even my much-beloved booth babes. Here’s a prediction: other vendors will follow Cerner’s lead, either because they support the concept or because they don’t see the value of spending big exhibit bucks and now have a way to save face in following the market leader in opting out. I have fun with Cerner and call them out with they screw up, but they get it. They’ve broken new ground the last few years in how they handled their exhibit and now they’ll make the biggest leap of all by abandoning the concept. Did I already say bravo to them?

Speaking of which, I’ve got some broad conclusions about the industry from what I saw and heard at HIMSS. I’ll write that up when I get time, but the teaser is that I think existing provider backlog, capital constraints, and declining revenues will hurt sales for the foreseeable future (and I’ve got some facts to back that up). I’ve theorized who will win and who will lose in that scenario, which I’ve validated with a few CEOs while I was here, and how the industry change as the rising slope levels off. There’s no killer app coming that I can see, so it’s time to digest what’s been bought. More to come.

Recommended exhibit to visit: the Department of Military Health. If you need a reality check from all the glitz, have a soldier in uniform demo the AHLTA-Mobile and AHLTA-Theater systems for wounded troops, calmly explaining that bullet wounds also usually involve thermal injuries from the friction-induced heat as the bullet pierces your skin.

Booth trend: Wii games as simulators. And: some fruit and water as snacks instead of the usually unhealthy stuff handed out at a health-related convention.

Odd bathroom factoid other than Seal Shield’s strainers: the convention center soap dispense is motion-activated, but the faucet requires pressing. Strange.

Best session of the conference so far: Deborah Peel on privacy. She is just amazingly rational, persuasive, and downright charming and self-effacing. I started out months ago calling her a flake, but I’m now a big fan. She mentioned that her group is starting a privacy certification process, with Microsoft’s HealthVault and eMDs being the first. She’s also lobbying to set privacy standards for e-prescribing. The industry probably doesn’t agree with her on all counts, but I figure it’s like politics: even if they meet in the middle, she’ll have done great work.

A few more booth observations: McKesson was really ugly blue with a disruptive traffic pattern, but it was big. Medsphere was dead. Misys had a cool booth. Abreon had a tiny one set up like a pet adoption center, with stuff animals (dogs) in cages. My favorite geek booth was SupCam or something like that, way over on one end, with a tiny DVD-quality camcorder that can stream over the web for $298. The guy said he was doing big business.

E-mail me.

Inga’s Update

Tuesday a.m. – I got up early and headed to the convention center in hopes of finding an Internet connection that worked. How nice to have free and fast Internet! It is pretty peaceful here at 7:30 a.m. I am enjoying overhearing a vendor at the next table make a pitch to a couple folks. Commerce at work!

I spent Monday afternoon walking the floor. Perhaps I should have taken the advice from my new friend Suzanne with Active Data Services (booth 3787) who advised me to wear my walking shoes rather than the more fashionable high heels.

Here are a few fun booths and people I encountered yesterday.

McKesson used their Enterprise Visibility system to display the diagram of their 110×110 foot booth. Cool way to show off their technology. Also walking through the McKesson booth, I saw someone wearing a “I’m Miss HIStalk” ribbon, which made me smile.

Every time I walked by the Motion Computing booth, people were three deep checking out their tablet presentations. Microsoft was the same way – I didn’t even try to get into the booth because it was so crazy busy.

VasTech (booth 1543) offered me a margarita early in the afternoon (I declined) but maybe I will go back today. Drank some good Starbucks at Allscripts (5145) instead followed by a fresh warm cookie from Wayport.

Perot had a fun set-up where people could pick up a paintbrush and brush a few strokes on a painting. Don’t know if there was sort of correlation with their marketing theme, but I liked it.

Red Hat is offering free shoe shines from “Mr. HISTalk.” Maybe I’ll stop by there today. And of course I saw the imposter Inga at Relay Health (who was looking lovely).

I asked both the folks in the Misys booth and Allscripts about the buyout rumor. Either it isn’t true or nobody at that level has a clue.

My favorite trinkets so far were my pig and frog from the White Stone Group, the Magic 8 ball from Modern Healthcare, and the wide variety of thumb drives. I hear that Microsoft has the biggest drives by the way – the 1GB variety.

Also worth a visit is the Compuware booth, where there is a real race car Corvette. If you like, you can take your picture with a beautiful young thing, or, a studly race car driver like I did.

I also managed to figure out what vendors had the softest and most convenient couches (Microsoft and Healthia were at least a couple I tried out).

So, on to the reception. Gosh I had a fun time! Thank you Healthia for throwing a great party!

I enjoyed overhearing various conversations, especially the ones involving speculation on who Mr. H and Inga might be. I was amused how many people thought Inga might be a man! Do they think my shoe fetish isn’t for real? Real men don’t pay too much attention to shoes, do they?

The best dressed guy was Scott Shreeve, who was adorable! He had the coolest shirt (kind of retro) and some very happening shoes (hmm … maybe HE is Inga.) Plus, he is as cute as can be.

Gwen Darling was one of the lovely blondes in the black dresses last night. Definitely on the best dressed list. There was also a younger lady in a white dress with red shoes. I didn’t see her name, but she had it working! She was with a lovely lady in a short black dress with a bow in the back and black shoes – quite a nice ensemble, too.

Of course there was Jonathan Bush, who simply stole my heart. Mr. H had said he was pretty funny and engaging, but I wasn’t prepared for this boyishly handsome ADD-type! He complimented Mr. H on the intelligence and honesty he has brought to the industry and recognized his leadership. Meanwhile he had us laughing with his “boat show” analogy and “digital balls” comments. If athenahealth has a speed boat in their booth next year, note that you read the prediction here first.

So possibly the funniest part of the evening for me was realizing that the gorgeous blond wearing the “Kiss Me I’m Inga” sash was pregnant! I surveyed a few folks and the consensus was that, in spite of her beauty and perfect looking backside, she was a member of the Angelina Jolie baby bump club. Mr. H swears he didn’t notice (men!) but I think he had the whole thing planned and was really trying to play some very funny joke. For the record, this Inga is not in the family way.

I am heading to the other end of the exhibit hall today – those poor guys in the 7000 booths.

E-mail Inga.

From HIMSS 2/25/08

From Larry Tate: “Re: the reception. Tim, Inga, Shawna, and the whole Healthia team: Thank you so much for a lovely evening! It was nice to rub elbows with the movers and the shakers. The food and drink choices were outstanding; the conversation was scintillating!” Thanks for coming. It was really cool seeing everybody enjoying each other’s company. I never know who reads, but looking around the room, I sure felt good about it (unless it was just a free drinks crowd, which is still OK).

From Quad Studer: “Re: marketing. Seal Shield in the 4000 aisle had submersible mice and keyboards, around $30. Simple idea given nosocomial infections and MRSA. They had an actual dishwasher in their booth which I thought was a pretty neat gimmick, but just saw something else even better. In the men’s room urinals they have placed blue plastic strainers (or whatever you call those things) that say ‘Your keyboard has 400 times more bacteria than this urinal – Seal Shield.’ Now THAT’s marketing. This came from someone I know, by the way, and not a shill. Ingenious and clever. We like. I think I saw that guy with a keyboard slung over his shoulder like a bandolero’s ammo belt.

From Andy: “Re: Cerner. Wondering if anyone has additional information on the rumor that Cerner is not going to attend the HIMSS conference next year? Looking at the booth strategy for next year, they are not included. That is going to leave a lot of C level executives looking around and wondering why thier vendor is not is attendance. Surely, it cannot simply be money?” I’ll probably get confirmation one way or another, but I doubt seriously it’s about money if they’re really not coming. Someone told me several vendors are considering opting out, and Cerner probably has the best reason in that they run an outstanding conference on their own, now right in KC. I’ll let you know what I hear, but I would like to encourage folks not to assume the worst if a vendor opts out of HIMSS since it may just not be a wise investment of their dollars, so they shouldn’t feel guilty for passing. Nobody signs contracts at HIMSS, nobody hears of a big vendor for the first time there, and not that many decision-makers leave with their minds made up. I’ve always said that exhibiting is more for the current customers than bagging new ones.

From XLT: “Re: offshoring. I was at Epic recently for training and sat next to a woman employed by Accenture who was from India. She was in-country for six months attending classes along with numerous other Indian Accenture employees. It seems that Accenture is creating an offshore capability for clinical system build.”

From Neal’s Pizza Guy: “Re: Cerner. Neal was in London last week and gave another bizarre town hall speech which none of the Cernerites could understand. At one point someone observed he’s started five different sentences and finished none of them.” I know he’s hard to listen to, but at least he’s the guy who started and runs the company. Polished hired guns with a holster full of Ivy League degrees and no soul would be much worse.

Some interesting comments were posted about the University Hospital downtime article in the newspaper. Someone who sounds like they know what happened said it was a connectivity issue outside the hospital’s control.

What a reception! If you came, thank you. If not, sorry you missed it because it was a blast. The room was packed and overflowing into the hall and the adjoining area. Two high-ranking folks who know me took me aside and said, “Do you know that this is the must-see event of the conference?” Another pointed out the line of big-name investment bankers rolling in. The food was outstanding (I’ve been living on Subway the last couple of days, so it was especially great to me, especially the crab cakes and carved turkey) and the beer was cold. But what was just completely gratifying to me was seeing all the conversation, the cards being exchanged, and the relaxation after a long day at HIMSS. My favorite moment: I had written a little recognition to the military members who had RSVPed, but everything beyond the first handful of words was drowned out in a roar of cheering and clapping and whistling for those serving. Thanks for that recognition – I wish more of them were there to hear it.

So, let’s talk HISsies. Those amazing guys at the Healthcare IT Transition Group made it into a cartoon, which is online on their Hitch-TV. They’re geniuses, for two reasons: they’re darned smart, but especially because they’ve figured out how to make a living having a blast working together. Their movie got a lot of laughs and applause in all the right places.

Spoiler: athenahealth and Jonathan Bush won 8 of the 18 awards. Jonathan was out guest speaker and what a guy he is! He showed up early stayed late, worked the room, and had a great time. I only wish I’d remembered to record his speech. My favorite quotes: “Digital Balls” (you had to be there) and “HIStalk is a network — that (the conference) is a boat show.” He hit some great topics in patient safety, the need to re-architect existing HIT platforms, and ribbed the Wall Streeters a little. What an utterly fun guy. The big TV network guys are always hounding him to death to go on national TV and here he spends his evening hanging out at some blogger’s reception. Thanks to him and to John Hallock, who just may be the best PR and strategy guy in the business. They brought some of the athenistas along and they were having fun and the CFO came over to chat, having no clue who I was. I’m proud that they could attend.

More thanks: Healthia for sponsoring the reception, handling tons of details, and staffing the event with Healthia team members (thanks especially to Shawna Schueller for overseeing the whole thing and Mike Tressler for handling the emcee duties). Thanks to Gwen Darling, who not only helped me personally with the event but who even outshone the models in good looks and grace. And, thanks to Miss HIStalk and Kiss Me, I’m Inga. Miss HIStalk will be in RelayHealth’s booth tomorrow, by the way.

AT&T announces that it will create a statewide information exchange in Tennessee.

Misys: nothing further heard on any Allscripts acquisition, so that sounds like a false alarm. Someone did confirm their offshoring of Level 1 support, although it’s going to an existing Misys operation in the Philippines instead of to India.

Link correction: the interview with SCI’s John Holton is here.

Gripe I heard today: the exhibitor badges aren’t blue any more, so salespeople were pitching to other exhibitors for a second until they realized.

Cool giveaway: MRV has a tiny key ring flashlight that’s powered by a hand crank. That will be Mrs. HIStalk’s very special gift when I get back home (that and a flash drive that someone was giving away since she asked me to track one of those down).

Acquisition announcement: Noteworthy Medical Systems will acquire MARS Medical.

Acquisition announcement: Eclipsys acquires budgeting software vendor EPSI.

Acquisition announcement: Medinotes acquires Bond Technologies. News only if you don’t read here since Dumbfounded told us two days ago.

Microsoft announces $3 million in available grants for add-ons to HealthVault.

There were a ton of other announcements, of course, most of them trivial. If one caught your eye as important, let me know since I haven’t had time to scour them carefully.

On with the booth reviews! Random notes about my first impressions follow. Let me know if you want me to look at specific ones.

eClinicalWorks: C. Not so great location, but they really don’t care since they’re selling like wildfire, including to Wal-Mart.

NextGen: didn’t get to see the game show, so since I was there for the girls, I’ll withhold judgment. Seemed pleasant.

Medicity – A. Very cool, chrome, two-story and modern. Had our HIStalk sign out, as did several vendors (we made them little color signs and Inga and I signed them).

Siemens – A. A monster light rack overhead, white and orange, huge, and an amazing theater.

Healthia – A. Few companies uses orange this year, so theirs stood out (most companies were into greens with light birch wood). Nice chairs. The folks were working the crowd well.

HMS – A. Last year’s diner theme with the sassy waitresses, my choice for Best Booth That Wasn’t County-Sized. It’s personal, the waitresses are fun, and it’s just cool.

Epic – C. Same old fireplace and stone.

Allscripts – B. a cool beaded curtain overhead and a coffee bar.

Medseek – B. Set up like a kitchen, kind of cool.

Cerner – A+. Best Booth That Was County Sized. It just said “All Together”, made up on close inspection of client hospital logos. No Cerner. No crowding. Huge expanse, some of it dedicated to simply providing seating for attendees well away from the salespeople. Absolute genius. The bigger and better the company, the less it has to shove its name and branding in your face. All those companies who thought they’d catch up this year by copying Cerner’s “customers doing the presentation” idea just got left sucking wind again.

EnovateIT: Know how I always say I can’t resist pawing their carts when I go buy? I watched passers-by doing it today. That Humanscale cart ought to be in an industrial design museum and their new med cart is an amazing shade of green. They chair they had out was a work of art. If you believe in value of esthestics and ergonomics, this is your Ferrari right here.

Sentillion – A. Had an upstairs, a coffee bar, the birch thing, and that green fish that I like.

TheraDoc: A. Popcorn. I didn’t make any other notes, but I must have liked something else about it since I’m not a big fan of popcorn.

Harris – A. Cool color-changing lights.

IntraNexus: A. Modern furniture, very open (giving them a nice double since I liked their bus wrapper best, too).

Eclipsys: A, but I had to think about it. Huge, pushed the salespeople to the perimeter. Great use of the KLAS CPOE adoption quadrant, although they should have put that on the main aisle and not the side.

3M – B.

Meditech – B. Nice design, good use of green, a little cramped.

Greenway – A. LED lights, excellent use of green (duh).

OnBase – A. Still one of my top two or three. The sports bar motif. Damned funny magician (and I usually hate those guys like clowns and mimes).

GE – B. Massive, all white, stark, cold.

QuadraMed – A. Open, sleek.

Microsoft – I have no idea because of the mob assembled in front of it. Right up there with Cisco in terms of having throngs.

RelayHealth – A, but their Miss HIStalk person scared the bejesus out of me. I was strolling by paying no attention whatsoever when I heard a loud “Are you Mr. HIStalk?” I froze and stammered, but that was just her stock question to get attendees to let her put a badge ribbon on. She was working the crowd very well. Nice booth, although security made me put my camera away when I took her picture.

Sunquest – B. Kind of cool, birch.

Beacon Partners – B+. Tropical, with shutters, plants, and comfy chairs.

Agfa – A, but boy did they and anybody in Aisle 7500 and up get screwed. Lots of non-glitzy displays (IHE, etc.) and clear around a wall full of restrooms. Traffic dropped hugely once you hit that barrier. Hope they got a lower rate because most everyone seemed to be turning back before those last aisles.

Cisco – A. Big crowd at the Unified Communications presentation and a cool InTouch robot around back.

AT&T – A. Cool telehealth camera and cart setup.

E-mail me.

HIMSS Sunday video

From HIMSS 2/24/08

It was a long day at HIMSS, but good. I got to the convention center very early and hung around outside some of the workshops (I’m sure I looked like a psycho lurker, but I wasn’t registered for anything, so I had to peek in). Those I saw had great attendance. The combined session of physicians, nurses, and pharmacists was huge, the venture fair was loaded with people, and I heard the project management workshop was good.

Say what you want about HIMSS, nobody runs a conference any better than those folks, at least that I’ve seen. I can’t imagine the logistics involved, but I can appreciate the result: I felt comfortable, welcome, and relaxed. Signage was excellent, the buses ran well (although it took forever to get to the hotel after the opening reception), and registration and tote bag pickup was lightning-fast.

Orlando’s far from being my favorite convention town, but the Orange County Convention Center is definitely my favorite. Lots of room, extremely well maintained, and helpful folks on hand. If it just had San Diego’s view …

The only negative is that it was darned humid in the convention center until mid-morning, so I’m thinking the AC is programmed to kick on later on Sundays. On the other hand, HIMSS had snacks and drinks out everywhere, even the fancy stuff like chocolate shavings and rock candy sticks for the coffee (I don’t drink coffee, so if I did, I’d want all that after-market stuff dumped in). It wasn’t many years ago that the folks in the Sunday workshops would starve because not only didn’t HIMSS provide food, there wasn’t any to be had because all the kiosks were closed. The situation is much improved. I still feel like a king when I can get a free soda on HIMSS Sunday.

Why healthcare costs keep increasing: a crummy convention center double cheeseburger and fries, which looked like it would taste the same as the paper boat it reposed it, was $10.75. Coffee was $3.52. Ball game food is better and cheaper.

I strolled by the venture capital fair to see what was going on. From the hall, all I could see was two groups: intense, fully suited young guys (at 7:30 a.m.) and casual older fellows who seemed to be having a blast. Guess which group was the guys with money? Hint: when you’re loaded, you can dress however you damn well please. I admire that.

The buses were wrapped in huge ads, of course (pic above). Microsoft had the most with Amalga, but the IntraNexus Sapphire ones were far cooler. While I was looking at the buses, I noticed some of the company reps loading in the usual cases of stuff. The ladies wore clothing ranging from casual to double-take revealing, so there’s a plus (well, in a few cases, anyway).

They were already handing out Monday’s Healthcare IT News, making me feel temporarily psychic again (no stock market or sports page, unfortunately, or I could have retired early). It had the usual lame, pun-filled headlines. I overheard one publications reporter, who looked about 20, explaining her background: “I don’t know anything about healthcare, but I did take biology in college.” Great.

I saw a fair number of people I know and another few that I know only through HIStalk. The only sponsor I saw was a guy in a Novo Innovations shirt.

I swung by the CIO meeting area and they’ve pretty much got the luxury track over there. They got their own tote bags, better lunch, and more goodies (not to mention their own lounge). That room looked packed, too. They get a free iPod if they sit through three focus group sessions. Rank has privileges.

Galvanon had their kiosks set out with maps and session guides. Great marketing idea. I fiddled around with one and they were pretty cool.

I’m still trying to figure out the tote bags. They were designed to be used as a day pack kind if deal, which I refuse to use since it just looks weird on anyone over 25, so I tried to carry it like the usual tote bag. It’s got one handle that’s on one side, which means it always feel like it’s off balance. You also can’t carry it open since the non-handle side just gaps open. I’m not a fan.

I saw a guy with a vendor CEO badge (I won’t mention which company, but it’s one whose commentary here isn’t consistently positive) peering intently at his laptop on a wireless connection. I sidled around behind him to see what was drawing his rapt attention and it was HIStalk.

I’m on a terrible Internet connection, which is driving me nuts. I should have stayed at the convention center to get this written since they had good Wi-Fi from what people were saying. They also have recharge stations for all of one’s gadgets.

Lots of people at my hotel and at the convention center were riding around on Segways, which were apparently a dismal flop everywhere but Orlando. The strangest was a guy cruising around outside by the buses and smoking like a chimney. It always strikes me as both funny and sad to see someone pedaling a bike and smoking, so this was similar.

Outside the speaker ready room: I saw two folks with a Cochise-like string of ribbonry, none of the the unauthorized HIStalk kind. I could decide if they were trying to be funny or really were that full of themselves.

The opening reception was pretty good. I took a little video, which I’ll post if I ever get on a non-hamster powered connection. I really like it when the reception is held outside, like in San Diego, and this one was in a dark ballroom, which felt like somebody’s very large basement rumpus room. The band was OK and celebrity imposters were on hand. RelayHealth’s Fake Inga (pic above) wasn’t getting a lot of attention that I noticed, but I couldn’t keep track of her. The memorable moment was when Real Inga and I approached her, got an “I Might Be Inga” ribbon, and asked her what the Inga thing was all about. Real Inga was tickled because Fake Inga gave some kind of evasive answer, like “It might be a person and it might be electronic, but you’ll have to visit the RelayHealth booth to find out.” She was pretty cute, but Real Inga’s got her beat.

Update: video is here. Not the best quality, but I was on the sly.

And yes, it seemed strange to hear the occasional HIStalk mention. That hasn’t really happened before. Real Inga and I were babbling like children at how strange it is to see Fake Inga and other evidence that we’re not just a figment of each other’s imagination, sitting in front of a keyboard for way too long each day.

Rumor heard: Allscripts will announce its acquisition of the remaining part of the healthcare business of Misys. Unverified and certainly questionable, but the sources were fair to good and there were more than one. Kind of makes sense.

Just one completely unnecessary reminder for those who RSVPed: Monday, 6 to 8 at the Peabody (it’s that giant, sun-blocking building that looms large from every window in the convention center lobby). No hints on the 7:30 guest speaker, but I believe an entourage is involved.

E-mail me.