HIStalk Interviews Joel Diamond, MD, Chief Medical Officer of dbMotion

A reader suggested that we might want to talk to Joel Diamond MD, chief medical officer for dbMotion, practicing family physician, and a former CMIO with UPMC. “You should try to interview Joel – he is smart and funny and really knows his stuff.”

Joel is working on an $84 million initiative to jointly create a healthcare interoperability model that will use dbMotion’s technology to connect clinicians across UPMC’s 19 hospitals and 400 outpatient sites and doctor offices. Thanks to Joel Diamond for sharing his thoughts with the readers of HIStalk.

Inga: OK, you ready to go?

Joel: Yes, though I am really nervous. Is this really Inga? [laughs]

[Laughs] Yes, but don’t be nervous. So, you do read HIStalk?

All the time. I am a huge fan.

So, you came from UPMC where you were CMIO. What led to your decision to move to dbMotion?

I have been following the interoperability plans for UPMC for a very, very long time ever since I was involved in establishing UPMC’s CPOE at one of UPMC’s remote hospitals. After the success of CPOE and other projects, it was clear that interoperability was the solution of the future. I dug in and learned about dbMotion. When I found they were looking for a medical director in the US, I jumped on the opportunity. dbMotion is great and it is a fun job.

Tell me about your position as CMO with dbMotion. What type of activities are you involved with?

The bulk of my work is this massive UPMC project, which has two separate parts to it. First, the core interoperability project itself. There is a lot of work to be done here in terms of customizing the physician views and integrating the multiple disparate platforms. The UPMC project itself is massive because we are trying to interface many, many disparate systems.

Also there is a joint development project between db and UPMC that is just getting off the ground. We are trying to develop a product to enhance patient safety issues. Trying to have the product reflect the needs of individual clinicians is one of our major goals.

In October, dbMotion and UPMC announced an agreement to create a joint development partnership. What is the scope of the project?

It is centered around a product called SmartWatch. SmartWatch is focused on looking at populations of patients and then being able to get lots of disparate data and then turn it into something actionable. For instance, we could define what child abuse might be and what to look for, and then put in certain parameters in order to monitor it. Patients with certain characteristics can be found and then you are able to report it to a particular organization or entity. Or it might involve bio-surveillance on a large scale.

We have a couple of use cases we are developing with UPMC. One of them involves transfer of care. When going from one venue to another, determining what needs to be done to ensure that the handoff is done properly and the patient information is collated properly. One of the other use cases is readiness assessment. If a patient has to schedule a procedure, then determining everything that needs to be done on an administrative level and making sure it is done. Third is chronic disease management and it will likely center around diabetes.

Are you involved with any of the international projects that dbMotion is working on?

No, because we have a CMO of dbmotion in Israel, Dr. Ran Goshen, who oversees all those projects.

What about any non-UPMC activities?

Dr. Diamond: Some with the Bronx RHIO project that is underway and has an expected go live in May of ‘08. I am also involved in the evaluation of new business opportunities in the US market.

Are you also visiting potential clients?

Yes, as well as trying to explore new areas where dbMotion might be needed other than what we have been focused on.

There have been a number of announcements over the last few months of RHIO efforts that have failed, either due to financial issues or lack of support from the community. Does that concern you?

It really doesn’t. It really isn’t a surprise. If you look at the Gartner’s Hype Cycle, we are at the Trough of Disillusionment. There had been some unrealistic expectations. We are now much more realistic about what RHIOs can do.

I am not pessimistic about RHIOs all. I think our focus will change a little bit. A lot of people set out to do RHIOs, but didn’t have the technology to do it. I think that is where dbMotion makes a difference.

Who does dbMotion see as competitors?

A lot of people are in the so-called interoperability space, but we don’t necessarily see them as competitors because they have a very different focus than us. A lot of people are in the portal space and that is more of a forum to view information. There are several companies trying to collect data to see in a single space. dbMotion is different because we have the Unified Medical Schema and we are focused on aggregation and integration of data.

So, explain to me how dbMotion is different than a company like Healthvision?

dbMotion has very, very unique architecture that allows it to handle a lot of the complicated interoperability issues in a very, very short time. It has a broad and deep reach. We are not a product that just has the ability to point you to the information you need or just display data you need.

In a true schematic operability, you can exchange information because they have a common understanding. You may link up a disparate system that has different terminology for the same diagnosis. We have the ability to take the data and present it as a single common knowledge piece and do whatever needs to be done. It can be used by an individual in a format that is meaningful.

The other thing that is different is that if you are just presenting data, it becomes a very huge list for people to scroll through. A large data dump may discourage users from using it. Looking at a list of allergies, you may overlook important data if you don’t present the information in a format that is relevant to the physician. Our technology allows the information to be displayed in a more meaningful format. It also helps with patient safety.

Why are UPMC’s interoperability projects surviving?

There has been a tremendous vision from the start. In addition to that, the people involved in the project, from IT to doctors and nurses, have really kept the focus on the entire project more on a quality. So, focus plus talented people, and then they keep building on their successes. They have also had a very steady and well-constructed ambulatory project for EMRs that has allowed for integration of all the data, along with a goal of improving patient safety.

So the goals are good and people are good.

Yes, and they haven’t been afraid to change their course when appropriate. They realized at some point that having a one-size-fits-all model was not going to be sustainable. At that point, they realized they needed multiple solutions and needed some central ability to control the processes. And that is when the decision was made to partner with dbMotion.

I understand that in addition to your work with dbMotion you are still seeing patients. How do you balance your dbMotion work and your clinical activities?

Yes, I am still seeing patients. I am balancing it very carefully. [laughs] I need to maintain seeing patients on a personal level because I enjoy it so much. And, two, without seeing patients, I am not sure I can maintain credibility and an understanding of physician needs.

Having an EMR for so many years provides me access to my patients’ information in so many ways. I have a patient portal and use e-prescribing. Many of my patients I have known for years have access to me by cell phone 24×7, so my situation doesn’t mean they have any less access to me. I work one full and very long day in the office seeing patients.

You spent some time working with Misys in an advisory role for their EMR and CPR products. Any thoughts on the recent changes, including selling off the hospital pieces and re-selling the iMedica product?

I have mixed emotions on the CPR sale. I think it will help their focus. There were so many great people associated with that product. I think it was one of the best products I had ever seen.

I can’t comment on the business reasons and whether it was a good decision. But the product isn’t going away, so that is good. And, I wouldn’t know enough about the iMedica situation to comment about it at this point. I will say that Misys’ focus on the community is a very, very smart play.

Who do you admire in the industry?

Hmmm… Mr. HIStalk and Inga? It is a very, very long list after Inga and Mr. HIStalk.

News 9/12/07

From The PACS Designer: “Re: ILM. One of the tools that can be used to better manage archives for data parameters is to employ ‘information lifecycle management’ techniques. Through ILM, you can prioritize data and image files by time periods so that you more effectively manage the speed of accessing those wanted recent files. As older files become less relevant, they can be compressed and stored in less expensive storage spaces, either onsite or at a remote storage facility provider. TPD will be highlighting the features of a new software database from Oracle, so watch for more postings on database management solutions.”

From Gwen Fabin-Blunt: “Re: that physician EMR company you keep mentioning. I hear that, in an attempt to reduce financial liabilities, management is trying to negotiate paying certain sales reps a reduced percentage of commissions owed if payments are made today, versus when clients pay. Additionally, management wants to reduce the number of vacation hours that can be rolled each year, again to reduce liabilities.” Doesn’t seem too harsh since employees still have the option. What I really dislike are those vendors that demand long hours or personal sacrifice like it was somehow your obligation to bail them out and keep management in bonuses. If they don’t have profit sharing, why is their lack of planning or resources your problem? If they need more than 40 hours a week of your time without paying for it, then they need to hire more people. Think WWCD (What Would Contractors Do).

From Byron Davies: “Re: codeine overdose. Turns out it was an unusual genetic profile (1% of Caucasions) that caused the mom to metabolize codeine into morphine. She was at home, not in the hospital.” Link. Few hospitals have systems that will catch drug-pregnancy and drug-lactation problems, not that it would have helped here. Maybe this will spur interest.

From Dominique Adikadika: “Re: Acermed. Dead and shut down for good. Got the letter today. The cause was lawsuits against them and the illness of one of their executives.” There’s always that risk when dealing with a non-publicly traded company or conglomerates. Of course, those larger companies could screw you as equally and quickly by sunsetting your product or by choking you slowly through ineptitude or lack of product focus. No matter who certifies, recommends, or guarantees a product, in the end it’s just you and your vendor because only they know what goes on behind their closed doors. Caveat emptor, especially in this consolidating physician systems market.

From Real World User: “Re: AJAX. The simple AJAX Solitaire game posted here seemed impressive for a web page, but was sluggish compared to the real thing. As a regular user of Yahoo Mail and Gmail, my sense is that at its best, AJAX makes web pages great, but it is always slower and more sluggish than a real program. This kind of sluggishness is fine if I am just checking e-mail, but it would drive me crazy if I had to see it all day in an EMR.” The Solitaire game is unusually graphics intensive since it shows large, full motion graphics. I don’t find it any worse than the usual Citrix front-end to healthcare apps and certainly better than the usual “click and wait a couple of beats” browser applications.

From Philip Rivers: “Re: QuadraMed. Here in San Diego. Just beat the Bears, so I stopped in on the QuadraMed User Group at the Harbor Sheraton. Looks like a good turnout and lots of buzz surrounding this new thing they call CPR. Clients are really saying nice things about what they see. As a player, I am impressed with the CPR clients and their presentations. I think we may have something here!!” I, too, am cautiously optimistic. QuadraMed has had its own troubles not unlike those of former CPR parent Misys, but at least not under current leadership. Whether they’re too late to save the aged patient remains to be seen.

From Glenn Welsch: “Re: Allscripts. When Allscripts makes a sale that isn’t an interface to an existing IDX installation, then you can consider them a player. That will show that the overall product is what the market is looking for. How many times do they sell a unified solution to a new client? Not many.”

From Tucker Livingston: “Re: McKesson. News about McKesson and First DataBank inflating drug $ seems to be few and far between. If the accusations are true, wouldn’t it be Medicaid fraud? Where are the feds?” Good question. If the government pays based on AWP, then they’re a customer like those others who could join the class action suit. Are criminal charges possible? I’m not sure, but I bet somebody out there does.

From Dr. Allan Pearl: “Re: physician systems. How well does hospital-small office system integration work? Have there been problems with compatibility when affiliated practices use different EMRs? Are EMRs in office practice really the next best thing since ballpoint pens, or just a way for number-crunching administrivia units to get physicians into the corral of quantified performance measurement? Sometimes the numbers seem to obscure more than they reveal, especially when demographics of patient population are not taken into consideration. Having the same health insurance plan, age and sex does not make for comparability of patient groups, nor does process measurement necessarily correlate with clinical outcome. These may be obvious public health research principles to some, but not to the majority of health administrators, in my experience.” My knowledge pales in comparison to that of some HIStalk readers, so I’ll invite their comments. What motivates hospitals to integrate affiliated docs into their systems and how well does it work?

From PMGuy: “Re: (company). Word on the street is that (company) is close to going away. As a client, this concerns me. I heard the entire consumer group quit after the contract with (company #2) was canceled due to non-payment. Heard it Friday from the support desk when I called to ask for help resetting a password.” I’m uncomfortable naming names, but it’s a struggling vendor who bet big and early on interoperability. I hope this is a false alarm, but I wouldn’t be surprised either way.

From John Wheelwright: “Re: Epic. Ian MacDougall will be the keynote speaker at Epic’s UGM.” Link. Starts September 17, 6,000 attendees expected, 5,500 of them from Kaiser (kidding).

Brev+IT top five stories this week:

#5 – Ingenix Acquires Healthia Consulting
#4 – Former Hospital Employee Sues After Data Loss Firing
#3 – SEC Interested in Germany’s Siemens Investigation Records
#2 – Report Says RHIO Market is Small Unless Philanthropy Kicks In
#1 – Mr. HIStalk Says Subscribe Here Free So You’ll Know Next Time

AmerisourceBergen will pay $21 million to former Bridge Medical shareholders who claimed it paid less than promised when it bought the company,sold in turn to Cerner in 2005.

VeriChip shares take a pounding after reports that federal regulators overlooked data suggesting that the company’s implantable RFID chips caused cancer in animal testing.

Speaking of VeriChip, here’s a picture of a guy with one stuck in his arm, John Halamka, CIO of Beth Israel Deaconness. It’s in the blog of his boss, Paul Levy, BIDMC CEO, and shows him standing on a big rock, supposedly keeping in touch with the office via BlackBerry.

Reminder: the search box to our right will plow happily through 4+ years of diarrhetic HIStalk output. I’ve mentioned just about every company and product here at least once, so give it a click. You can sign up for the e-mail update while you’re over there, too, so you get instant notification when I write something new.

Inga mentions the upcoming HIT investments of David Brailer’s private equity fund. Show how smart you are: e-mail me your choice of growing HIT-related companies in which you’d recommend he invest: software companies, service providers, whatever. Lots of private equity firms are looking for investment, so what companies are worth a look? Tell me why you like them. Maybe we’ll do some profiles of the lesser known.

Microsoft’s healthcare interest is outlined. Says they have 600 people working in healthcare. Maybe it’s been mentioned before, but I hadn’t heard it: Microsoft is working on a standard for personal health records, with announcements coming in the next few weeks. Acquisitions are coming, the article says.

PACSGEAR says it got its 600th customer. The product allows sending documents to PACS. I’m not a fan of all-capitalized company names, especially when the logo on their site has it in lower case, so I’ll attribute that annoying inconsistency to some confused marketing types.

Baylor docs can order images from their BlackBerry.

A Mayo doc says an “intelligent EHR” can populate an EMR using static text records, something he calls “minimally invasive informatics”.

Another RHIO is spawned, this time in Minnesota. They’re making the same mistakes their failing counterparts have made: trying to start out big, relying financially on the big hospitals and insurance companies that started it, and discouraging use by charging subscribers. The universal, ancient PR example is offered to the press: “You’re in the ED unconscious …”

Inga’s Update

Re: the new SCI ads. I noticed the superhero ad before Mr. H pointed it out and I really like it. When I first saw it, I wasn’t sure whose ad it was, so I had to watch it for a few moments until the SCI logo came up. Anyway, I think Bob LaBla is a scrooge for his comments … it is eye-catching and fun.

I just read something about a company called Sermo and became intrigued by their offering. The news bit I read concerned the $25 million in Series C funding they just raised, with Sermo labeled as “aggregators of healthcare information.” Checking out their website, they claim to be the largest online community of physicians and serve as a site where physicians can communicate to one another online to discuss “medical insights” and “improve patient outcomes.” There is a “top postings” section where physicians had made notes of complicated cases and asked for other physicians to provide feedback. Of course, I wondered where the money came from, especially since there were no ads on the site. I liked the wording of this: “Sermo’s business model is one of information arbitrage, the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare.” I didn’t get what that was saying (or not saying) the first few times I read it. Digging deeper, it appears they sell aggregated data to financial institutions, pharmaceutical companies, healthcare organizations, and government agencies – any organization that benefits from early insight into clinical events. Clients can also pay a subscription fee that enables them to post questions to the Sermo community. I thought the concept was pretty slick. I also noticed that the Cambridge, MA company was hiring, in case anyone is looking. The benefits look terrific – you can bring you dog to work, they have free catered lunch every day, and they have an Xbox (which reminds me – I am getting really, really good at Guitar Hero).

David Brailer and his Health Evolution Partners firm are ready to start giving money away. The health care private equity firm has commitments for $500 million to invest in late stage health care companies. Another $200 million will be invested in early stage ventures through partnerships with other investment funds.

Someone suggested that I might want to look at a particular company that offered some slick technology. Though I try pretty hard to fake it, I am not too much of a technology girl, so it didn’t take much to confuse me as to what this company did. I went to the guru, Mr. H, to help me understand it all. To which Mr. H made the wise commentary about many of the slick technology companies in general: “It’s no wonder people don’t get interested in all (this stuff) … they have zero marketing ability and just expect people to plow through the geeky exterior to get to the even geekier interior.” I thought it was a great observation that even the best technology is going to be overlooked unless some attention is given to the marketing side.

A class action lawsuit has been filed in Florida on behalf of purchasers of Health Management Associates Common stock. The suit alleges that certain company insiders sold over 900,000 shares of HMA stock for gross proceeds in excess of $17 million between January 17 and July 30, 2007.

The Doctors Clinic in Bremerton, WA selects Sage Healthcare for their 75-physicians multi-specialty medical group. The clinic will implement the Intergy suite of products for all EHR, practice management, analytical, and radiology management needs.

I really liked this story. Meditech is offering free classes in MAGIC programming in the community of Fall River, MA. Meditech is in the process of building a new site there and plans to move 500+ plus jobs into the area. Meditech needed more skilled programmers, so they worked with UMass Dartmouth to develop a program to provide a 30-hour course for participants. Though completing the course does not guarantee a job, it certainly will provide an opportunity for many. And Meditech has a new pool of trained programmers.

Poke Inga.

HIStalk Interviews Nick Jacobs, CEO of Windber Medical Center

Nick Jacobs isn’t just a popular blogger. He’s also president and CEO of Windber Research Institute and Windber Medical Center of Windber, PA. A couple of readers suggested I talk to Nick about small-hospital technology. If you think that’s an oxymoron, read on about what this tiny rural hospital of a few dozen beds is doing.

Thanks to Nick for the chat.

Tell me about Windber and about yourself.

The hospital is 101 years old, started specially as a hospital to take care of the coal miners for the 40+ coal mines of the Berwind-White Coal Company. When the town of Windber was constructed, it was seen as what would be a model town for the industrial revolution. Every house had a central heating system provided by the coal company, schools, hospitals, and churches. It was like the Celebration community in Orlando. The commitment was made that this hospital would be one of the most outstanding in the US.

For the first 40 years, the starting physicians were innovators, to the point they held numerous patents and successes. They studied with the Mayo brothers, like learning to remove the thyroid without leaving scar. Celebrities came for the surgery, like Betty Grable, Arthur Godfrey, and Jeanne Woolworth.

We’re 30 seconds from where Flight 93 went down. I came in 1997. We have 550 employees now and a $21 million payroll.

The issue for me when I came was that the hospital had been given a death certificate by Ernst and Young. In the coming era of capitated managed care, the hospital had a short life left. That gave me a chance to challenge my board. I told them, “We can let it go, or we can try to go back to innovation and technical advancement and high-touch care.”

We had the first hospice in the US, founded in 1977, for a rural area. I was able to use that as a model for physicians and the board, telling them, “Look how people are treated in the hospice. I want to take this hospital-wide.” We’re a Planetree hospital now, the third in the US of what is now 200. We embraced the concept of spiritual, holistic, mind-body-spirit care, the highest touch concept.

Having interviewed at Boys Town Hospital in Omaha in 1992, I got to a hospital that looked like Windber but was called National Research Hospital. I asked a priest why. He had 38 PhDs and was a genomics center in 1992. I found myself at a dinner party with our local Congressman talking about the Dean Ornish CAD Reversal Program. I explained it to him. He said, “We’re spending $1 billion a year on heart disease in the military.” We launched partnership with Walter Reed the following year.

Then, a board member got breast cancer and came to our hospital. That made me uncomfortable. I wondered why she didn’t go to Sloane-Kettering or MD Anderson. She went through it at our place, then went there for a second opinion. She went to our Congressman and said, “These guys have figured it out.” We have massage therapy, popcorn, clowns, family access, everything. She told the Congressman that the military was spending all that money, but nothing in our district.

We built a research facility with 50 scientists and 40,000 of the most highly annotated breast cancer tissue samples. These are longitudinal studies because they’re in the military. We built a team of biomedical informaticists who have perfected software and methodologies for mining huge quantities of medical-related data.

Because I’d never worked in a research institute, and in fact didn’t get into healthcare until I was 40 because I was a high school band director, one thing I discovered is that I didn’t care about the past and wasn’t tied to it. When I had a chance to create a research center from scratch, I decided I would meet with my first three PhD hires and ask them what the bottlenecks had been. First, all science is called small science. You get an idea for secret sauce, go to NIH for money, build your team, then I might take it away from you. I decided that instead of creating divas, I’d create a ensemble of people who could work with each other.

Also, I decided that all information would be stored together instead of on individual PCs. So, we had terabytes of data to study, but had to build from scratch data mining. I hired a Penn bioinformatics director, hired 10 people, and worked with dozens of companies to come up with trademarked capabilities. Researchers in our institute can query all 40,000 ladies in our database. How many of you drank coffee? How much coffee? Then, you can do an analysis of which ones got breast cancer. This was set up in a manner so that not all donated serum and blood and tumors were cancerous. Interesting. Maybe those who drank the most coffee don’t have breast cancer. It creates a way to query issues that could be pertinent to disease states. It was not disease-specific. It can apply to any disease.

I found that PhDs don’t talk to MDs. I hired some MDs and got teleconferencing to meet weekly with oncologists and pathologists from the Army about problems with individual patients. We took those back to the bench to find solutions. That’s translational medicine. We’re way out ahead of everybody’s headlights, and for those mired in the traditional system, they’re not only afraid but desperate victims because it changes the way they get funding.

To communicate information back and forth to the Army, we have a network of OC-48 capable dark fiber. We can transfer entire hard drives in seconds. In Windber, PA, a town of 4,200 people, we have some interesting opportunities. The space and missile defense command that had the original Star Wars defense program had a civilian who put together a team of $7 billion worth of research to fuse infrared and radar together to detect missiles from outer space. His sister died of breast cancer. He vowed to have those algorithms declassified for us to fuse ultrasound and digital mammography. GE is a partner doing research with us. We have three MRIs with breast-scanning capabilities doing fusion of technologies to find better ways to avoid misdiagnosis. All in a little 50-bed hospital two hours from Pittsburgh. It’s a fascinating evolution that came from the mind of a band director. [laughs]

Describe the hospital’s IT systems and their role in your strategic plan.

Because of the system that we’ve put together, we have interest from all over the world, except in the US. Go to the Netherlands, there are eight academic medical centers cooperating, but they didn’t have tools to mine the data to make it translational. We’ve been back and forth for a year working on software we created here to mine that data.

We get breast cancer tissue donations. We can do a genetic analysis in-house to determine which genes contributed to it. Then, we have the capability of determining which proteins were contributors to spreading the disease. Both of those modalities create huge quantities of data. Then, we do histopathology and molecular research, clinical and diagnostic data. We have mountains of data. One piece of equipment can create six months of data to research. We can see the potential impact of alcohol or obesity. We think it will contribute substantially to future cures as we analyze the data.

On the downside, we’re way out ahead of the headlights. We’ve spent millions trying to get software companies to cooperate with each other and designers. In one meeting, we had six companies involved in the data collection process. We had to put them in a room and lock them in until they agreed. Everybody was afraid to let their secret out. One large company that I’ll leave nameless – they can mine huge quantity of data for retail and banks, but in biology, they walked away and said, “We can’t and won’t do it becuase something that’s brown 1000 times turns green. It just happens.” They had no way to turn their analytical tools into biological analytical tools to meet our needs.. Another company asked for a meeting and in the NDA said, “Anything you say that we can remember, we can use.” [laughs]

How important is IT overall to a hospital’s success and to patient outcomes?

We just put out another $3 million for Meditech.

Concentia Digital of Columbia, Maryland … Duane Shugars is president, a young guy. His company was hired by National Geographic to digitally catalog all their images and films. If you want a picture of a lion with a bird on its nose, you can search for it on the Web and buy it on the Web. Then the NFL contracted with them to catalog and organize plays, so when they said, “Here are Terry Bradshaw’s top plays”, they can find them. Then the CIA and FBI hired them. They came to us through an acquaintance. Everything we do is digitized and put into their repository. With 40,000 samples, a single pathologist has done an analysis. He’s a research pathologist instead of a clinical pathologist, so instead of 20 things, he looks at 120. Theoretically, any scientist anywhere in the world looking for samples can be search and those samples would come to them visually.

They say politicians can have national influence, but they still have to be re-elected by the folks back home. Windber has a lot of national publicity, but you’ve said locals don’t really know much about the hospital. How can you bring the national message back home where it can do some good?

In 1977, we had the second Johnstown Flood. We had the largest out-migration of any urban area in the US except East St. Louis, Missouri. Our demographics look like Dade County, Florida. We have large quantities of octogenarians. The average person has lived in their home for 38 years. The hospital went through a tough decade in 60s and 70s. If they have a bad experience, they don’t easily forget it.

Our publicity has been in Forbes, Fortune, Wall Street Journal, CNN, the Today Show. That’s not where they live. It’s been a 10-year uphill battle to get our locals to realize that this is a unique place. The national infection rate is 9% in a hospital. Ours has been below 1% for almost nine years. So, how do you put billboards up and say, “Come to Windber and you’ll die less”? [laughs] It’s a challenge that doesn’t make for happy competitors.

We’re starting to get local recognition, but it’s happened because of my blogs. The former public relations director of the Pittsburgh Symphony, now 81 years old, said, “Why aren’t you blogging?” I wrote my first blog in May 2005, having no idea that I was the only hospital CEO with a hospital-endorsed blog in the country. The local paper asked me to write op-eds about healthcare. Another little paper asked me to write a comedy column and I became a local folk personality, the baby boomer with the child problems. Then, there were other blogs. The bad news is that none of them pay, but we’re getting the word out. When I was in the Netherlands, they said, “We love your blog.” [laughs]

Tell me about the Planetree system.

Angela Thieriot had to have surgery in the 1970s. She went into a San Francisco hospital and had the typical hospital experience, like being a lab rat. You’re a number and an organ and it’s cold and detached and there are heavy duty rules based on the military system of triage. She came out of it wrecked that American healthcare was so insensitive and cold.

She convinced the hospital to give her a wing to design care that doesn’t require leaving your dignity by the door. A hospital in Oregon tried it and was interviewed on Bill Moyer’s “Healing and the Mind.’ She became a folk hero in a little 50-bed hospital. The movement started to get traction. It did well for eight or so years, then died. A hospital in Connecticut bought the franchise rights and I was the third hospital in the US to become a Planetree hospital.

I’ve been on their board for four years. We’re pushing 160 hospitals worldwide. It’s catching on as Baby Boomers become patients. They’re not happy with instant Sanka in a pack. They will want a decaf latte with skim milk. It’s the best of a hotel, hospital, and spa. Patient empowerment and patient care. Care isn’t centered on physician times and dates or employee’s availability. It’s based on centering care around the patient. Every patient in our hospital is touched multiple times every day by caregivers other than RNs and MDs. We provide beds for loved ones, kitchens, showers, and beds in the OB suite.

The greatest compliment was when surveyors from state were here two years ago and couldn’t fund anything wrong. The surveyor said she wasn’t from around here and it was the 35th hospital she’d been in this year, but told her husband that if anything happened to her anywhere, no matter what, bring her here.

I’m 60 years old and have six heart stents and my mission is to change the way healthcare is delivered. I’m saddened by how science works and how hospitals don’t cross the line of taking care of souls and not bodies

Can the hospital succeed as an independent and can anybody compete with UPMC in western Pennsylvania?

I don’t know. If we had not made the choice made by our board, there would not be a community hospital here. Was either decision a good one for the community? The board chose to take this on and try to compete. We only represent 6% of the healthcare in this region. It’s not like we can put them out of business. On any given day, if you say “Go Penn State” or “Go Pitt”, you’ll make half the people in the room mad. It’s not just an UPMC juggernaut, it’s also a Geisinger juggernaut.

Three, four or five years from now, will Conemaugh survive? UPMC has already made a run on this area and it didn’t go the way they hoped, but they have their joint ventures and insurance here. It remains to be seen if Geisinger comes in. We can survive only if we put all the pieces of the puzzle together. Oprah drops off her dog at a spa 20 minutes from here. If I can get her in here and beat that 30% error rate … I think the answer is yes, we can survive, but that’s an uphill challenge.

You mentioned in discussing Michael Moore’s Sicko that we’ve never had a health policy in this country. Why do we need one and what will it take?

I’m not a policy wonk and I was out front in rejecting Hillary’s last plan. It doesn’t do any of us well to have what England or Canada has. The waiting time is years. People come across the border from Canada for heart surgery. I’m not sure that plan is the best way to go.

Internationally, we’re through the roof, #1 in cost and #42 in quality of health. I’ve seen a lot of diagnostics that relate to typical overhead. With a private insurance company, it’s 20%. With Medicare, 3%. There’s got to be something in between that makes this work. UPMC is positioning themselves to be a global player in single payer. Highmark is doing that. Does that look like Medicare or a modified insurance system?

I can be the least expensive hospital in the US and it doesn’t matter because the insurance company doesn’t have to pass it on to the consumer. We have to find a solution that doesn’t permit this outrageous 47 million people to be uninsured. That’s unconscionable. Some kind of single payer has to evolve or it will become a worse and worse train wreck.

You’re speaking at a blogging conference this month. What’s your message going to be?

So many of my peers are finance guys who stick their heads in the sand and go with business as usual. It’s kept us locked in the industrial revolution. I’m doing a podcast next Friday with someone from Mayo. Transparency will be huge. Communication through the Internet is huge. We’re more connected than we’ve ever been in history. A political leader who could lie to his people is being checked internationally by hundreds of young people. We’re finally totally linked.

I wrote a blog that I thought the demise of Imus was because of that. It wasn’t that he hadn’t said something like that 1000 times before, but everybody grabbed onto it and made something out of it. Get with it and figure it out. It’s the new world order. New tools will reach out to people in a different way that will make or break your business.

If you weren’t CEO at Windber, what job would you want?

If I’d been talented eough, a top level orchestra director. It’s the most rewarding thing I’ve ever done. Touching people’s lives like this is important, though. At this stage of my life, I’d just like to speak and write to change healthcare. I love getting the message out and shaking up the status quo. It’s not my system, it’s an old system that needs re-evaluated. Some day I’m going to write a book at how being a high school band director is like being a hospital administrator. It really is.

Monday Morning Update 9/10/07

From Inside View: “Re: Bronx Lebanon. Eclipsys won. Cerner, who everyone assumed was the winner a couple of months ago, was the surprise loser. But the biggest loser was GE. They should have won, could have won, but didn’t execute and their product is a mess. The rate at which GE is losing LastWord clients is alarming.” Unverified, I should mention. Thanks for the update.

From Abe Froman: “Re: Dubai. In Cerner’s presentation at the conference, they showed how CPOE cuts medication turnaround time from hours to 20 minutes. A hospital director there couldn’t understand how you can put the ordering process in the hands of a physician. What happens if he makes a mistake? In Dubai hospitals, pharmacists are simply glorified salesmen, dispensing whatever the order says. They do not question anything. The nurse provides the review when the order is transcribed, which doesn’t happen with CPOE. The conclusion was that Cerner doesn’t understand that market.”

I mentioned tee shirts that will be worn by former employees of a certain vendor at their “glad I’m out of there” reunion. Folks asked me to run a picture. If you want a look, see here and here.

I got an e-mail from Jason Maude, CEO of Isabel Healthcare, after I mentioned the press its diagnosis product receives. He recommends a book called Super Crunchers: Why Thinking-by-Numbers Is the New Way to Be Smart. It has a healthcare chapter that covers IHI’s 10,000 Lives campaign and devotes five pages to Isabel. A quote: “House makes excellent drama, but it’s no way to run a health care system. I’ve suggested to my friend Lisa Sanders, who recommends script ideas for the series, that House should have an episode in which the protagonist vies against data-based diagnostics ala Kasparov vs. the IBM computer. Isabel’s Dr. Joseph Britto doesn’t think it would work. ‘Each episode would be five or seven minutes instead of an hour,’ he explains. ‘I could see Isabel working much better with Grey’s Anatomy or ER where they have to make a lot of decisions under a lot of time pressure.’ Only in fiction does man beat the machine.”

Researchers involved in the development of relational databases now say they’re obsolete and should be considered legacy technology. Reason: row-oriented databases are slower than column-oriented ones, especially for data warehouses. I thought the article might mention Cache’ since it doesn’t have those performance issues (remember they used to call it a “post-relational database”) but the guys quoted have already started their own company, so they’re not likely to bring up competitors.

In the UK, Cerner suspends work on the new Millennium R2 release intended for the London and South trusts.

Check out the new SCI Solutions ad to your left. Kind of a cross between the old Batman and Austin Powers.

Computers stolen from a McKesson office in July contained the personal information of thousands of patients who had signed up for prescription assistance programs from drug companies. The company said it’s “not clear” whether the data was encrypted, which is a nice way of saying it wasn’t (few users encrypt their data).

MPI vendor Initiate Systems signs a deal with Capgemini UK for a children’s services application.

A VIASYS engineer has been charged with hacking the computer system of his employer in 2003. He started by deleting files of his EEG development coworkers, then went after the executives. He was finally caught by an outside firm who located the outdated computer he used along with its hard drive, which he kept locked in a desk drawer.

A UK hospital bans employee access to Facebook after heavy use degrades its network.

The latest issue of The White Stone Group’s newsletter is out (warning: PDF). They run a contest to see which hospital has overturned the largest single denial using their TRACE tracker and workflow software. The winner: a Georgia hospital recovered $452,000 when they showed documentation of precertification notification and response. Even more interesting was the “Taste of Trace” recipe for cheese grits souffle, which of course is the food of the gods for Southerners. If Mrs. HIStalk could cook, I’d dispatch her to the kitchen to whip up a batch, albeit using Velveeta instead of fancy cheddar.

The Northwest Medical Information Symposium will be held on September 13-14 in Spokane, WA. Speakers: Gingrich, Leavitt, and Frisse, among others. Meditech is even on board as an uncommon sponsor since the meeting is put on by its customer, Inland Northwest Health Services.

An investment analyst surveys US users of its Emdeon system and “… believes that concerns about falling demand from medical practices and possible glitches in the software are overdone. However, it said that it had uncovered evidence that the group, whose core business is accounting software for small firms, had made only mediocre efforts to market its medical software.”

Throughput software vendor Premise Corporation announces events from the first half of the year: client based doubled, 100% “would buy again” results from KLAS, 100% employee growth, new financing, and new operational and board leadership.

A mother sues the makers of Tylenol #3 when her newborn baby dies, apparently poisoned by the her codeine-containing breast milk. If your hospital flags breastfeeding moms and successfully issues CPOE or pharmacy lactation precautions for specific drugs, it would be the first I’ve seen. Tylenol #3 probably wouldn’t be on the list anyway since it’s not a common problem. FDA issued a warning last month.

I’m moving on to Brev+IT from here, so if you pounced on this e-mail notification, you might have time to sign up before I send it out.

E-mail me. How hard can it be?

News 9/7/07

From The PACS Designer: “Re: native DICOM. TSS makes a valid point about the use of private attributes. I’m not sure if the HIStalk community knows that the DICOM Workgroups are expanding into modalities that were not previously DICOM-enabled, such as Pathology Workgroup 26. As more modalities join the DICOM community, it becomes vitally important that we all operate from a common DICOM platform. Why shouldn’t it be native DICOM? Wouldn’t it be better for all of us to work as a team in the native DICOM community?”

From Dale Cooper: “Re: Dairyland. Now that Mediware has a new CEO (revolving door?), looks like Mr Burgess is going to help Vista capital try to get DHS in gear. IMHO – wrong guy, wrong time, wrong place … good luck.” Former Mediware CEO (until September 24, actually, but he’s taking the Mediware job now) James Burgess was just named CEO of Dairyland Healthcare Solutions a few minutes ago (6:17 PM Eastern). Actually, Dairyland is owned by Francisco Partners, but the confusion with Vista Equity is understandable since Vista has investments in SIS and the former Sunquest. Francisco also owned LYNX Medical Systems, but sold it to Picis in July.

Guess the Company, brought to you by Ex-(Company) and redacted to keep me out of trouble: “(Executive) is a pompous ass. He is the most arrogant person I have ever worked directly for. He has vision for this industry, but has a leadership style of complete dictatorship and surrounds himself with the politically focused. The ability to execute sucks. (Executive) thinks it’s services, it has always been his half-assed development team who consistently delivers terrible code. I feel sorry for anybody still there.” The funny thing is that when I run stuff like this, several folks always guess it’s their own company, so it’s not always as obvious as you might think.

Guess the Company II: some former employees of (company) are having a reunion and somebody sent over a picture of the tee shirts they’ll be wearing. They say: “Can’t build it? Have old technology? Tired of trying to convince people that you have a great personality?” There’s also a picture of a dead animal that I won’t name. I bet they’ll be carousing and trading war stories.

From Larry: “Re: Greenway. You mentioned that you were impressed by Greenway’s recent press release. I was wondering if you or any of your readers had any comments regarding the huge capital investments Greenway has received since inception ($80-$100 million, it seems). Is their EMR product and sales performance impressive given what they’ve had to work with?” I’ll defer to those who know more about it than I do.

From Leland Palmer: “Re: Bronx Lebanon. Any update on who’s winning the battle of the Bronx between Cerner and Eclipsys?” Readers?

Special thanks to Sentillion, EnovateIT, Pring|Pierce, and SCI Solutions. Inga and I decided to offer small text ads in our Brev+IT weekly newsletter to support some expansion we’ve got in mind for it. We offered four spots to current sponsors for terms up to one year. Within within 24 hours, these Platinum sponsors had signed on for the full year (we even had to turn a couple of others away). You can’t imagine how energizing it is to have that kind of support. We know these folks and they’re doing it for one reason: they like what we do and they respect HIStalk’s readers. We appreciate that very much and will soon have some new stuff to talk about as a result. Sign up and you’ll know the Top 5 stories each week, like last week’s: (5) Cerner in the UK, (4) Indian BPO acquisitions, (3) MedAssets IPO, (2) FDA’s access to DoD patient information, and the biggest story of the week, (1) … well, let’s keep at least one secret between just us 721 subscribers.

Thanks, too, to recently renewing HIStalk annual sponsors R. Gaines Baty Associates, Healthcare Growth Partners, Picis, Hayes Management Consulting, SolCom, and Novo Innovations. I’m a little old to be saying “you rock”, but you know you do.

Shortwave Coates and others were right several weeks ago with their rumor reports that Ingenix would acquire Healthia Consulting. It was announced yesterday. “We want to share with you today some exciting news – Healthia is going to become a part of Ingenix, a leading health information technology company. Since our inception, we’ve aimed solely at staying on the leading-edge of health care consulting, and as a result we have become nationally known and recognized for the services we’ve provided to the industry. With increasing levels of opportunity nationally, we sought capabilities that better serve our customers and provide challenging opportunities for our colleagues. Becoming part of the Ingenix family of companies does just that – retains our exclusive focus on health care while giving us broader and enhanced capabilities.” Ingenix bought Claredi and Lewin Group recently as well and was rumored here to be acquiring LighthouseMD, although I haven’t confirmed that so far. I was going to list their products and services, but it’s so long it’s arranged alphabetically like a telephone book. They are definitely growing. They got a gem with Healthia, so hopefully they won’t change it much.

Athenahealth’s $14-$16 IPO price will raise around $68 million or up to $115 million, depending on which reports you read, valuing the company at up to $550 million.Cerner is sponsoring and participating in a conference in Dubai. They’re also webcasting investor presentations live Friday morning and Tuesday afternoon.

Ray Moss is named VP/CIO of Valley Presbyterian Hospital (CA), leaving Perot’s Cedars-Sinai tech services group.

Keane gets a $1 million contract to install parts of InSight at Capital Health System (NJ).

CompuGroup’s CEO does an interview with eHealth Europe. On the company’s failed iSoft bid: “Everybody knows iSoft does have problems, both financially and with its products, and these kind of problems do not become less over time. Further more in our view it became more unrealistic to receive the voting power to implement our restructuring plans in time. The whole deal became too risky for my taste and doesn’t agree with my understanding of shareholder value.” He says CompuGroup is still looking for healthcare IT software companies to acquire.Good article: 10 signs that you’re not cut out to be an IT manager.

TeraMedica will distribute its “single patient snapshot” Evercore imaging software in the Asia Pacific, integrating with Healthinc‘s RIS.

Interesting: the 2003 law that limited the workweek of medical residents to 80 hours has had no impact (good or bad) on Medicare patient mortality.

Formedic is offering a free Medical History Questionnaire patient interview application to physician offices. There’s a recorded demo there. I’m not sure I’d lead off warning the patient to enter their “chief complaint” and not their “symptoms” (are patients supposed to know the difference?), but once you get past that screen, it gets better. Nothing tells you who the company is, the domain registration has privacy block on, and the only contact is an online form and 800 number, but the press release points to the main Formedic site.

Worldwide corruption investigations into Siemens may be heading here. The SEC has requested files from German authorities who are going after Siemens for up to a reported $1.4 billion in bribery and anti-trust violations. Just announced: China is looking into possible corruption involving the purchase of Siemens medical equipment there. If an investigation opens up here, you can bet their competitors will be subpoenaing everyone within 20 miles of hospitals where Siemens got the contract. I know would.

Hopkins gets its stolen laptop back with the medical records of several thousand cancer patients intact. Odd: a lawyer knew who had it, called the local newspaper to announce that he’d get it back, and turned the occasion into an opportunity to pitch his law office’s expansion into identify theft cases.

No question: the best vendor for getting good press is diagnosis software vendor Isabel. Nice product and it’s just stunning how well they get articles about it into the mainstream press. It’s in USA Today, which not only misquoted the price as $750 instead of $50,000 per year, but also said it was “highly rated” by HIMSS, which despite many ways of cozying up to vendors, doesn’t evaluate them as far as I know. HIStalk reader Gary Kantor, MD of Case Western was kind enough to review Isabel for HIStalk last year.

The Providence Health System IT employee whose car was burglarized in his driveway in late 2005, resulting in loss of patient data tapes, is suing the health system for $1 million. He says he was fired because he called the police, not for breaking policy.

RemedyMD has integrated medication dosing algorithms from Dimensional Dosing Systems into its electronic medical records software.

Mediware announces Q4 numbers: revenue up 14%, EPS $0.06 vs. $0.07. The company was crowing about its medication reconciliation product just a couple of weeks ago, but the earnings announcement says medication management product sales were slower than anticipated (that includes the eMar and WORx products, though).

A UK health department consolidates its application databases using InterSystems Ensemble.

E-mail me. But only if you want to.

Inga’s Update

Cerner has announced the keynotes for their upcoming health conference. The “star-studded line-up” includes John Kerry and Richard Teerlink (former Harley-Davidson chairman). Will you Cerner users rush to send in your registration now that you have the chance to hear these guys? – or are vendors better off not spending all that money for speakers that know next to nothing about the products you are using?

Last month I had noted that Allscripts had been announcing a number of big wins and wondered if sales were up suddenly up or if their PR machine was working overtime. A reader suggested it was the latter. However, yesterday they announced their largest EHR contract ever with the Columbia University Medical Center. Columbia will be implementing the system in their outpatient physician group and their future community-based IPA. Fortune magazine seems to agree with me, as well as they just named Allscripts #23 on their list of the 100 Fastest-Growing Companies for posting growth numbers as follows: EPS up 138%, revenue up 38%, and total return 48% (bummer that I don’t own any of their stock). In looking over the Fortune list, I didn’t notice any other HIT companies, by the way.

Check in with the fetching Inga.

News 9/5/07

From Pluvial Bitter: “Re: AJAX. AJAX stands for Asynchronous Javascript And XML. If you use Google’s GMail, you have seen AJAX in action. The way GMail is able to check for new messages without you having to refresh or reload your page is due to AJAX. Basically, AJAX applications can be set up to make calls to a server for updated information at either timed intervals or based on a user’s interaction with an AJAX web page. These calls to the server occur behind the scenes. My company uses AJAX for a Web-based smart calendar for physician practices. Let’s say you have a practice rule that states you cannot perform a surgical procedure after you have been on-call the previous day. If a user started to enter a surgical procedure, the AJAX coding would elimate all physicians who were on call the previous day as available options.” Interesting. It’s worked great everywhere I’ve used it except Yahoo Mail, which seems to be flaky (it lost my e-mails more than once, so I went back the old interface).

From John: “Re: Brev+IT. Just subscribed to Brev+IT and received my first issue last week – what a great read. Brev+IT is an excellent complement to HIStalk as it focus on just a few key stories, going into greater depth with some good pithy analysis on each story. Thanks Mr. HIStalk for this expansion of your already excellent service to the industry.” My pleasure. The subscriber list is like a Who’s Who of the industry, with 600 folks receiving it so far. The sign-up box is to your right. And for those getting it, you can help me out by forwarding it to others (we’re a low-rent operation here, so that’s what passes for an ad campaign in these parts).

From Millie Quivalent: “Re: FDA’s access to DoD patient data you mentioned in Brev+IT. Congress is pressuring DoD to merge its software with the VA’s, which they don’t want to do. By linking up with FDA, they have another arrow in their quiver.”

I’m getting interested in the announcement coming next Monday from Sentillion. If you’ve watched their ads to your left, they keep teasing a little more each time. I don’t know the secret, but I’m waiting with you. Cool ads.

Kelly Mann is named CEO of Mediware, coming over from 3M. I missed the announcement that Jonathan Churchill had resigned from the board, replaced by former Assistant Secretary of the Navy Richard Greco. Greco sounds interesting: 38 years old, former CFO of the Navy, big private equity guy, and degrees from Hopkins and Chicago. Anybody want to bet that Mediware will go private soon by selling out to private investors? MEDW’s market cap is low for being publicly traded and the company is struggling in an up market.

Cerner co-founder Cliff Illig gets interviewed by the KC paper about his and Neal’s pro soccer team. “Entrepreneurs, I think, do organization stuff different than companies that have been around for a long time. At Cerner we think of our organization as a bunch of teams. It’s much more of a peer-to-peer kind of a model as opposed to a rigid hierarchy where everybody has a boss. We have a lot of young people working for us. You bring those young people in and you make them part of the team and you give them a mission and it’s pretty impressive what they’ll go produce.” CERN Employees: what do you think?

The Delhi, India government has spent $3 million developing and testing a hospital software package that they didn’t know was available as a free download. “Talking to Newsline on condition of anonymity, the engineer said: ‘I’m surprised that people working on the project did not know about the website. It is easily available and quite popular. The huge waste of time and money could have been avoided.’ HIMS project in-charge Dr Vijay Rai, however, said he is not aware about the website. ‘The HIMS software is the best that we have.'” The screenshots look pretty good.

Bob Fabbio, the Austin, TX entrepreneur who started Tivoli Systems, is in the doctor house-call business, along with a doc who was involved in Revolution Health. His new company offers scheduled doctor visits 12 hours a day, seven days a week. Families pay $88 a month plus $75 per visit, not including labs and meds, but some are handled by nurse practitioners. Doesn’t seem like a good deal, especially compared to concierge medicine, but that’s just me.

A Maryland dialysis center operator will test implanting VeriChip RFID chips in patients to bring up their medical records when they visit.

Speaking of RFID, a patient safety expert says barcodes are better than RFID for medication safety. The article briefly mentions 2D barcodes, which I’ve worked with recently. They’re the tiny, dense squares that you sometimes see on post office envelopes. They can encode a ton of information (several hundred characters), are readable even if damaged and from any angle, and take up a fraction of the room needed for Code 39 or even Code 128 formats. Plus, super-fast scanners that can read those plus the old linear codes cost less than $200 (I’m partial to those from Hand Held Products). I’m sold on them, even though HIT vendors will probably take forever to implement them if their readers are serially connected instead of as a keyboard wedge.

Brazil’s government will offer a medical exam portal powered by TrakHealth, now owned by InterSystems. I’m beginning to think InterSystems was smart to buy that company a few months back.

E-mail me. I need your rumors and ideas. Inga is far more enchanting, so you can always ping her alternatively.

Inga’s Update

I saw Mr. H mentioned that Modern Healthcare came out with its list of the 100 most powerful people in healthcare and he expressed disappointment at being overlooked. I wonder if he and I were the only ones who voted for him?

Phillip Rivers sent me a note about the Quadramed acquisition of the Misys CPR product. Phil comes from the Quadramed camp and offers some great insights.

“My thoughts of CPR acquisition are the following: smart, smart, smart. It is the real deal. It really does what others say they do. I have so many prospects tell me they want “integration”. Well, here it is. This is robust, flexible and proven. What more would you want?

As for the business deal, when all the numbers are made public, I think we will see this was a no-brainer for QuadraMed. I had really questioned Misys and their decision to sell the acute market products. I didn’t understand why a company would sell off a profitable part of the business. Well, I spoke with some senior Misys executives in Raleigh and they put some perspective on this sale for me. They really believe that Misys, which is known for the ambulatory products, was not able to partner with other HIS companies to fully market and sell the ambulatory into the client base of Meditech, for example. This was due to Misys perceived “competition” with CPR and the Lab products.  Shedding these will allow Misys to develop the “Channel Partnerships”. Makes more sense to me in that light.

QuadraMed will be able to take the integrated Cache database that CPR and integrate their other top notch revenue cycle products running on Cache, which is a truly underrated,extremely reliable, fast, and stable database.”

If you missed Mr. H’s posting yesterday on the HIStalk Forum (Works Sucks, Then You Die: Finding Your “One Thing”) it is worth a read. From one who has gone from the “front lines” in this industry to a comfortable seat in the bleachers, it hit home. Here is my favorite nugget of wisdom: “Every person has one thing they do extraordinarily well. You will never be happy in your job unless the majority of your time involves doing that one thing. And if you do that one thing, money and success will find you, probably when you least expect it.” I am still figuring out that “one thing” and definitely looking forward to having that money find me. Meanwhile, I agree that life is too short to not to love what you are doing. (For the curious, I am definitely having fun at HIStalk).

The Healthcare IT Transition Group has released its annual survey (warning: PDF) that focuses on RHIO financing. I didn’t see the full report, but the summary has a few data points of interest.

• The estimate for RHIO technology expenditures for 2007 is (only) $128.6 million, which represents 0.7% of the total US HIT market. If that is a real number, then that is bad news for vendors targeting this market.
• Not surprisingly, 53% of the respondents reported that cash flow was a significant challenge (see first bullet point).
• 52% of the respondents indicated they were in the startup stage, 24% in the transition stage, and 24% in production.

IPC The Hospitalist Company Inc., a North Hollywood, Calif.-based network of hospitalist physicians, has filed for a $105 million IPO. Several venture capital firms have the biggest ownership shares today, including Bank of America, Morgenthaler Ventures, Bessemer Venture Partners, and CB Health Ventures. IPC has over 600 hospitalist physicians and over 900 employees in 16 states.

I attended the first HIMSS virtual conference earlier this year and probably won’t attend the next one. That being said, it was interesting to interact with the other attendees. Since there were so many folks online at one time, there was quite a bit of posting about a variety of different topics and people were able to make quick connections. There were a number of attendees who were hunting for jobs and a fair bit of posting around employment issues. I sat in on a couple of webinars, but I guess I really am not a webinar kind of girl. I find it difficult to stay focused on the speaker when I have e-mail popping up, etc. But I am sure it works great for some folks. For people who don’t have an opportunity to go to meetings in person, it’s not a bad way to get a taste of it. If you took the time, you could learn about some new technology, etc. In terms of the vendors, I didn’t see much provided that couldn’t be found from the web. Oh, and I didn’t win any door prizes. Big disappointment.

Say hi to Inga.

Monday Morning Update 9/3/07

From Timber Roller: “Re: AJAX. See this Solitaire application, which looks like a Windows program, but which has been implemented using only JavaScript, cascading style sheets, and DHTML … so-called AJAX. That’s why AJAX rocks: not because it’s solitaire, but because thick client-like applications can be implemented without having to load and configure software on the desktop. This site uses widgets from Yahoo’s UI library for the drag-and-drop stuff.” Link. A good time-waster if your employer removes Windows games by default. It works really well – impressive.

From Chuck Lumley: “Re: open source EHR initiative. openEHR is a fascinating (and apparently already internationally successful) open source EHR initiative started by an historical EHR thought leader — Dr. Clem MacDonald at the Regenstrief Institute in Indianapolis.” Link. The website makes it hard for non-geek, non-academics to know what the heck they’re talking about, but it looks like some sort of standard rather than an actual product. My only takeaway was that Ethidium Health Systems is using the specs in its Evolution EMR product. Actually, this presentation (warning: PDF) is a better intro, although still way deep in the programmer stuff.

From Rogue: “Re: Epic’s new learning center. It is clearly shaped like a treble clef sign (as in sheet music). Hitting a high note? High-pitched screams? Anyway, I do like the dollar sign analogy the best. What, no helipad?”

From The Shelton Shadow: “Re: private attributes. TSS has been investigating the use of private attributes in DICOM Conformance Statements. Private attributes can cause problems when trying to view the image files stored in archives. Everyone making new purchases should compare the private attributes section to other DICOM Conformance Statements. Siemens and Philips look to be in good shape since their current products have no private attributes. GE is another story – their products have 20-30. Non-GE viewers will miss the private attribute data stored in an archive. The only way to see them is to store them in the DICOM Header, which will create an archive with mixed image files. GE sales reps might promote their product as better, but you are increasing the likelihood of a forklift upgrade if you decide to move to a native DICOM format supplier.”

From Edward Koogle: “Re: Misys. The former Misys office in Johnstown, originally a Sid Goldblatt Sunquest office, closed today. Remaining employees will work from home until new owners QuadraMed and Vista decide what to do. It’s sad considering over 100 people worked there at one time.”

From SG: “Re: BPO outsourcing. On the same lines as MedAssist acquisition, Indian healthcare outsourcing company Apollo Health Street acquired a leading US-based medical billing outsourcing company – Zavata.” Link. Interesting quote: “Technopak’s Singh noted that Indian hospitals and those in the US were at different phases in their investment strategy. The Indian players seek health-care consultancy for business strategy, facility design, planning and, only then, turn to health-care information technology. Most US hospitals, meanwhile, are now spending on redesigning information technology systems.”

From Darla Mackadoo: “Re: Rabbit Healthcare Systems. Consultant recommends an oncology software EMR package to a couple of clients, including Lone Star Oncology (good size group). Oncology EMR goes belly up shortly after. Consultant makes a smart move and gathers folks together to create a new EMR for resale. Lone Star Oncology becomes a big stakeholder in Rabbit. Consultant/new President goes back to all those folks that had the old belly up product and sells them the new stuff. That’s what I heard, anyway.”

No consensus yet on “healthcare” vs. “health care”. Dictionaries differ. It’s probably not a good word to describe most hospitals and doctors anyway since few are worried about “health” as they are “episodic treatment of abnormalities”. That’s another argument.

Sean McDonald, the Pittsburgh entrepreneur who started hospital robotic drug packaging vendor Automated Healthcare and sold it to McKesson for $65 million, will take his new company public. Precision Therapeutics sells a test that helps choose the most effective cancer chemotherapy. UPMC people are involved, which got UPMC in trouble previously: one of its lab directors was medical director at Precision Therapeutics and was named in a lawsuit that claimed he sent them specimens unnecessarily for his own benefit. He quit the company, although I don’t know how the lawsuit turned out.

Nova Scotia’s health department is seeking bids for a RHIO-type project.

Jobs:

CIO, Phelps County Regional Medical Center (MO)
Executive Director, Wisconsin Health Information Exchange (WI)
CIO, Olean General Hospital (NY)
Technical Project Manager (DC)
Cerner Analyst (NC)
Implementation Consultants (MN)
VP of Clinical Transformation, BayCare (FL)
CIO, Delnor-Community Health System (IL)
CIO, Sacred Heart Health System (FL)
Meditech PCS, ED (National)
Centricity Healthcare Consultant (MA)

It was the perfect feel-good hospital story: San Diego Chargers running back LaDainian Tomlinson would serve as the celebrity spokesperson for publicly owned Palomar Pomerado Health. Everybody figured it was a nice charity gesture until a reporter probed, the hospital balked at giving details (apparently not quite getting the “publicly owned” part of their governance), and a public records request revealed that the $60 million athlete is being paid $2 million over five years for his celebrity services. When nonprofits start throwing big money at their “brand”, they’ve forgotten the mission (unless it was self-aggrandizement).

HIMSS will offer another Virtual Conference on November 6-7. The first was met with underwhelming response based on pre-conference estimates, but 2,200 people is still pretty good (will they come again?) It’s kind of like Second Life for HIT, I suppose. For vendors, HIMSS is offering the usual cornucopia of opportunities to send them money, including a $5,000 deal to put your logo on each e-mail confirmation (I’m positive that will kick-start record sales). HIStalk sponsorship is quite a deal in comparison. Somewhere in all that commercial feeding frenzy is some education, although of a modest nature. And timeshare-like bribes … err, door prizes. One session is blocked out for the “can’t avoid it if HIMSS is involved” RHIO topics, although with a slightly more cautionary tone than the rah-rah of years past (a curt nod to the expanding RHIO graveyard). Seems like an overly heavy reliance on vendor speakers for a not-free program if you ask me (two of the ten sessions have a McKesson presenter alone). Pass.

Brev+IT is coming with the Top 5 HIT stories this week. Sign up here.

E-mail me.

News 8/31/07

From Captain Grammar: “Re: spelling. I find it disturbing that an industry as small as ours can’t agree on how to spell our name. Is it ‘healthcare’ or ‘health care’?” I use the former, but as a staunchly traditionalist grammarian, I really should insist on separate words. Opinions?

Practice Fusion, the “free if you’ll look at Google ads” EMR, announces that it will put Healthline’s medical search toolbar on its application. It’s probably a good match – Healthline is a “free if you’ll look at Google ads” medical search engine. I’m really not getting the business model. Will doctors really click on ads for stuff related to the condition of the patients they’re treating? Would you want to see a doctor that has to Google your condition?

Speaking of which, my idea of giving away a free EMR by jamming drug company ads in the faces of doctors is too late. Amplus HealthNet has what it calls an EHR (not likely) that offers on-screen drug company logos. “Every time a physician clicks on brand content, payment to that pharmaceutical brand occurs. For a brand manager, physician-initiated contact indicates a strong possibility that s/he is preparing to prescribe a product. ROI thus becomes needs-driven, highly- focused and target-specific. Better yet, this occurs at a much lower fraction of cost than traditional journal ads.” Damned annoying Flash and stock music site, I’ll say. I’m guessing its “EHR” solution is a lightweight. And I still refuse to call products EHRs unless the vendor can prove that it’s not just an EMR renamed to seem cooler (none have so far).

And speaking of free EMRs, RemedyMD is making its EZ Office suite free. I interviewed CEO Gary Kennedy in April, getting some good business lessons in running a healthcare IT company in the process.

A RICO lawsuit against McKesson for its alleged involvement in inflating published benchmark drug costs via First DataBank is certified as class action.

The local paper runs a story on Canada’s new Brampton Civic Hospital and its technology, including a picture of William Osler CIO Judy Middleton.

A ValueAct Capital partner ups his stake in Misys PLC to nearly 14%.

Modern Healthcare names its 100 most powerful people in healthcare. Sure, it’s just way to get the attention of readers too distracted to read anything substantial and instead lure them with pictures and cute graphics (I’m thinking about doing an HIStalk “100 Biggest Idiots in Healthcare IT”). Privacy fanatic Deborah Peel is #4, Newt Gingrich is #25, McKesson CEO John Hammergren is #38, Kaiser’s George Halvorson is #60, Suzanne Delbanco is myteriously #69 (parting gift?), CCHIT’s Mark Leavitt is #79, and HIMSS’ Steve Lieber is #100. I’ll move my hopes to next year.

I’ve never heard of oncology practice systems vendor Rabbit Healthcare Systems (TX), but if they’re being honest about increasing last year’s $165K revenue to $750K this year, somebody must have. Rabbit’s revenues are multiplying! (sorry).

August will set another record for HIStalk visits and the millionth one will drop by in October or so. Thank you for reading and thanks to the sponsors who make it possible. If you’re a Brev+IT newsletter reader and like it, drop me a line with a comment or two that I can use for pitching it to those who don’t read (what?) Several folks are surprised that it isn’t just an HIStalk rehash – it’s got more background and opinion that I’ve got space for here. The five biggest stories in the most recent issue involve Epic, Siemens, iSoft, Cisco, and at #1 … well, you should really sign up.

The Johnstown paper writes an article about now-independent hospital Windber Medical Center (still working on that interview with CEO Nick). An early challenge: a $3.5 million computer system replacement for what Conemaugh was providing. One of these days I need to get back up that way, if for no other reason to eat at my old favorite Oakhurst Tea Room just down the road.

CompuGroup has pulled out, so iSoft goes to IBA. For now. I mentioned a fact no one else has observed: private equity firm General Atlantic has a stake in both CompuGroup and iSoft.

Speaking of private equity companies, the 20 highest-paid private equity fund managers in the US average $658 million in compensation (and that was in 2006). I’m guessing some exceeded $1 billion a year in compensation, making outrageous CEO salaries seem paltry by comparison. I suppose they’re worth it if they provide big returns to investors, but that means investors lost that huge skim. They’re like Milliken’s junk bond kings – livin’ large now, but subject to investor fear of unregulated markets.

An Indian outsourcing firm buys medical billing company MedAssist Holding (KY) for $330 million. They like that BPO business overseas.

Bart Ponze, director of computer services for LSU Health Sciences Center, has died of cancer. Condolences.

If you’re an Epic Systems customer, here’s what those high prices provide: a $100 million learning center seating 5,300. Some say it looks like a horseshoe, but to me, it’s either a question mark or dollar sign (both appropriate). Note the Godcam-view company logo on the roof. Maybe Judy should have made the “most powerful” list. (Thanks to Romeo for the link. Photo from builder J.P. Cullen & Sons, Inc.)

I’m here.

Inga’s Update

I was thrilled to get an e-mail yesterday from Ralph Nader!! I knew that HIStalk had wide readership, but never imagined that folks I have actually seen on TV would be reading. Anyway, his email was not that nice (he called my postings “average”) but he did have an interesting comment about the Misys/iMedica partnership:

“My dear … If you had bothered to research anything about iMedica and its offerings, you would have the answers to yours (and others) questions about “Why iMedica”. The Mysis sales guys (and gals) should be dancing in the streets!”

(See what I mean about it not being that nice, especially since I did say some good things about iMedica? Now that I think about it, I wonder if this guy really is Ralph Nader. I mean, he had a grammatical error and even spelled Misys wrong. What does “dear” Ralph know – he has lost the presidential election, like five times hasn’t he?)

A consultant who was not claiming some phony name also sent me a note about iMedica/Misys. He indicated that iMedica had been losing money and needed to raise capital, thus, from a cash infusion standpoint, the arrangement is beneficial to iMedica. However, beyond that, he did not see much advantage of the partnership for either vendor since they sell similar products. “I think it makes them both look desperate, especially Misys. You have to give credit to Nissenbaum (iMedica’s CEO) for making one of his competitors resell his software for agreeing to refer his clients to only a segment of what Misys offer, such as their EDI services. How would you react to a Misys sales rep that has been touting their wares, now coming at you with one of their competitor’s applications? What about all the small practices who just purchased Misys? Why would they go through a reseller when they can go direct to iMedica? I also suspect that the Misys field reps will be disenchanted with having something else to promote. I suspect they will devote a sales force that will only focus on the small practices, similar to how GE uses their VARs.”

Yet another e-mail this week came from Obiwan Kenobe (by the way, keep all that sweet e-mail coming … I get so excited to hear from you all!) Obiwan thought I was “absolutely correct” in my comments about what really matters when it comes to enjoying your job. “You took the words right out of my mouth. Having been a sales person in this business a long time, you are absolutely correct in your statement. I have worked at a number of well-known and not so well-known companies. I am having an incredible time and success and much, if not all of it, directly relates to the things you mentioned that really matters.” Obiwan also mentioned he worked for HIStalk sponsor SCI (and I really don’t think he was trying to give them an extra plug, or even suck up to his bosses – I think he just really likes his job.) “I have never worked for such a fine company as SCI. I have a simple philosophy – it starts at the top! I believe many organizations and the people who work there reflect the attitude of their CEO and senior level management. It all starts with John Holton, our CEO, and filters down.”

I played “Heart Full of Black” (by Burning Brides) on Guitar Hero for the first time today (Xbox360, for those of you not into such toys.) Gosh I was good. I am thinking if this gig with Mr. H doesn’t work out, I may look into some of those Guitar Hero contests and start a new career.

Microsoft’s Azyxxi announces a new contract with Novant Health, a North Carolina-based healthcare system that includes eight hospitals, two nursing homes, and an 800-physician medical group.

Inga’s waiting.

News 8/29/07

From The PACS Designer: “Re: middleware. TPD has commented on service-oriented architecture in the past and wanted to expand on it since it’s the ‘middleware’ software concept that employs SOA. Middleware is a term for software applications that allow various software programs to communicate with each other. Many HIStalk interviewees have discussed middleware. Since it is a fairly new concept, not much has been published about it, even though it’s growing rapidly according to Oracle, which recently stated that it is now a billion-dollar business for them. With the diverse environment within healthcare practices, it sounds like SOA middleware is the concept to bring healthcare new efficiencies for daily  activities that wasn’t available in the past. Oracle Magazine had an article about middleware in their July-August 2007 edition titled ‘Hands-free Management’.”

From XSQ: “Re: Windber. A few weeks ago, Mr. HIStalk posted a blurb about the Windber Medical Center breaking away from the Conemaugh Health System (CHS). Intresting note on CHS that it’s Sidney Goldblatt’s (of Sunquest) home turf and he’s on the board. I agree Nick Jacobs from WMC would be a great interview.” You’ll be pleased to know that CEO Nick Jacobs has agreed to do an HIStalk interview, which I sought at your suggestion. We just have to work around our full-time jobs to find a time.

From Stan Saber: “Re: GE. Are you hearing anything from the GE user group meeting in Boston? Any promises of what’s coming from IHC?” I haven’t heard anything, so I’d appreciate an update from someone who went.

From Neeve deMick: “Re: wireless. Wireless comes up in every market survey as a key obstacle to EMR adoption. Hospitals spend millions on EMR/IT, then get limited or no return because of poor networks. Many EMR benefits are tied to point-of-care and network performance and reliability. COWs sit in the hallways and trench nurses deal with poor solutions while their ‘most wired’ CIOs do national IT speeches. No wonder there is a huge disconnect between dollars spent and user adoption and satisfaction.”

From Jeese: “Re: iMedica. You have mentioned several times that iMedica was started by former Millbrook execs. This is not the case. The former Millbrook execs came to iMedica after Millbrook was sold to GE around 2002-2003. The company was already up and running with a product. Most of the current senior management at iMedica is made up of former Millbrook execs.”

From Bumblebeast: “Re: QuadraMed. The Keith Hagen interview makes interesting reading in light of two happenings since then: (a) Quantim has lost its VP of product management and three product managers, and (b) with the Misys CPR acquisition, you have to believe that Affinity will be relegated to the dust bin, especially since Affinity and Quantim couldn’t be integrated as easily as Quantim and other clinical systems.”

From Portia Control: “Re: IBA. I hear that a juicy scandal will be coming out related to IBA and a deal in Thailand.”

Sorry if you got multiple copies of the e-mail update message about Misys today. The good news is that I had found (and hopefully fixed) a hopelessly obscure server problem that may have explained why some folks haven’t been getting the updates. If you’re a Unix geek, it involves changing the batch submission to a cron job to avoid auto-killing and restarting the Apache HTTP services that run the bulk mail script after memory consumption redlines.

Motorola is suing wireless network vendor Aruba Networks for patent infringement.

I mentioned in Brev+IT what sounds like to me a big waste of taxpayer dollars paid to SAIC for building and maintaining the DoD’s AHLTA system. Someone who should know e-mailed me that the original bid spec specifically said that the public domain VistA could not be used because the DoD was jealous. DoD reneged later, allowing SAIC to use the free VistA for its $1 billion bid, tweaking it enough to ensure highly lucrative annual maintenance. If you’ve got first-hand info, let me know. I hate $900 hammer guys.

Wake Forest Baptist University Hospital (NC) will roll out (no pun intended) a ton of products from EnovateIT: infection control keyboards and mice, barcode scanners, wall mounted articulating arms, CPU holders, and med carts. I’ve been to that hospital (872 beds!) and it’s as highly regarded as Wake Forest University, which has the med school there.

Bruce Friedman was especially pithy in his open letter to Siemens and Intel about their decision to get into the blood banking software business in Malaysia. “Developing a blood bank computer system for even a single small hospital is a project that will reduce grown men to tears … Simple computer errors in blood banking software can easily kill patients. Blood bank software is the only healthcare software that the FDA has chosen to regulate. This regulatory environment plus the complexity of the software has caused many of the U.S. vendors, previously active in this area, to defer to a small number of domain experts.” Soarian blood banking, anyone? Better re-check those bids.Picis hires two new SVPs for professional services and R&D.

The fired CFO of Mee Memorial Hospital (CA) is accused of setting up an automatic electronic payment on the hospital’s account to pay off his personal credit card each month. He’s charged with stealing $96,000, which included donations to his church.

This article definitely sounds like an Intel informercial disguised as news. It’s supposedly about nurses and IT, but it has a lot of background on bit player Intel, including talk about their nursing research and the Motion computing device.

Design Clinicals will integrate FDB’s medical knowledge base into its MedsTracker medication reconciliation software.

A psych patient in physical restraints breaks loose from an orderly and gouges out his own eyes before the orderly can restrain him again. The patient’s guardian is suing for over $10 million. The hospital then billed him for the $2.2 million in care it delivered, which the plaintiff’s attorney calls “mean-spirited”. Only in hospitals is trying to collect what’s owed you considered to be a heinous insult, although granted the ridiculous prices charged to private pay patients almost put me on the patient’s side.

Congratulations to HIStalk reader Ed Marx, formerly CIO of Cleveland’s University Hospitals, just named today as SVP/CIO of Texas Health Resources. That’s where David Muntz was until a year ago when he left for Baylor. I like to think that Ed’s HIStalk-gained knowledge got him the new gig, but that’s a bit presumptious.

I’m here.

Inga’s Update

I loved the posting from Insider Outsider about loving his/her job. Made me wonder what readers believe are the best and worst jobs in this industry. My best job was probably a few years back when I got paid ridiculous sums of money to work trade shows and “demonstrate” software. I got to stay in great hotels, wear fabulous outfits, and always got offers for free dinners. There were some downsides, such as static cling and four-inch heels, but all in all, it was fun.

So, what makes a job “good?” I personally think company culture has a lot to do with it. As Insider Outsider said, more money could be made elsewhere, but it isn’t always about money. I think what really matters is working with people you like and respect, promoting a product or service that has value, and receiving a fair wage is worth more than being the best compensated programmer or salesperson or nurse in the industry.

The Professional Association of Health Care Office Management (PAHCOM) has negotiated a “discount” for members for athenahealth’s PM and EMR services. That part is not so interesting in and of itself, but I sure liked this quote from PAHCOM”s founder Richard Blanchette, a retired Lieutenant Commander in the US Navy’s Medical Department. “I would equate the operational capability of athenahealth to one that is so well coordinated that the U.S. Navy would be dutifully impressed.” (In layman’s terms, I think he was saying things were “ship shape” over at Jonathan Bush’s place).

Acer is buying Gateway Computers for $710 million. Does that mean all those cows will be put out to pasture?

MedAssets, Inc. has filed a $230 million IPO. MedAssets is an Alpharetta, GA-based provider of software to improve operating margin and cashflow for hospitals and health systems.

After all the weeks of rumors about Misys and who they may or may not purchase or partner with, it was interesting to hear that iMedica was the selected company. I have heard their product has a lot of functionality and offers all the bells and whistles that the Misys EMR product lacks (SQL, .net, and a single PM/EMR database.) It also sounds like an ASP offering is in the works as well. The announced plan is to offer the solution at the low end, where Misys EMR has had a hard time competing (due to price and dated technology). The biggest question I have is why would Misys announce this agreement today, while also stating in their press release that the “initial products, including ASP service offerings, will be announced this November?” It would seem to me that Misys is going to have a hard time selling too many systems – at least at the low end – until buyers see what the new offerings are all about. If I were a Misys salesperson I think I would be frustrated and wondering if the light at the end of the tunnel will ever come.

First Consulting Group wins a contract with NYC-based RHIO NYCLIX to build their RHIO infrastructure. FCG’s FristGateways technology will be used for the secure data exchange between provider organizations and the largest hospitals in Manhattan and the other boroughs. FCG will host the data.

A Moscow woman set fire to her ex-husband’s privates as he sat naked watching TV and drinking vodka last week (there’s a picture). While I don’t think it was a very nice thing to do (he claims it was “monstrously painful”) I don’t buy his story that he doesn’t know “what I did to deserve this.” Come on ladies, he “knows,” doesn’t he?

Inga’s waiting.

Misys Licenses Small Practice PM/EMR from iMedica

Misys Healthcare announced this morning that it will license practice management and electronic medical records products from iMedica. Misys will pay $8 million for minority ownership in iMedica plus $5 million in licensing fees. Misys will also get a seat on iMedica’s board of directors.

iMedica was founder by former Millbrook executives in 1998. Michael Nissenbaum is president and CEO.

New Misys-labeled product offerings, including an ASP product, will be announced in November. Misys CEO Mike Lawrie said the deal will allow the company to quickly market a small practice product, an area identified earlier as a weakness.

Monday Morning Update 8/27/07

From Lacey Underall: “Re: VA. I wish I could have been in the room when the House Appropriations Committee scolded the VA for buying vendor EMR systems that weren’t interoperable. I would have laughed out loud. Next time I am looking at systems, I am going to be requiring (particularly if they state HL7 compliant) that the vendor be able to receive and post every single transaction type that they send out. Currently, I am working with an Atlanta vendor that won’t accept any flowsheet data from other systems. They are trying to keep their clinical documentation close to home. We have several systems that allow the input of clinical data elements, however we have to send them into our clinical record as text blobs. The clinicians cannot trend that data in our clinical record. How about stepping up for patient care?” Well said. I like that idea of requiring vendors to receive and manage the same transactions they send. Vendors won’t integrate unless customers demand it, especially the broad-line ones that refuse to acknowledge that customers might cherry-pick.

From Inside Outsider: “Re: liking your job. I’ve been in the industry for 15 years or so. I worked for Sunquest back in the day when it was just growing beyond the Mom & Pop business of Sid’s to the bureaucratic mess it became prior to the Misys purchase. I got out and was happier for it. I moved to the business side of healthcare for a few years before moving to a small consulting company. I love my job. Been here for about 7.5 years so far. We are small, but we all work hard. The company does not push us to bill 80 hours a week, they pay us decent wages, and we can earn bonuses. There is not really much deadwood in the company, unlike everywhere else I’ve worked. We are out there to make other people’s jobs easier, despite many of the negative comments I’ve heard about consultants on your blog. Our customers like us, and I think we do a  good job. So yes, I do like my job. I could make more money out there in the ‘real world’, but I’d probably have to put on clothes every day and go to an office. I don’t want that, and I don’t need that. The owners of the company are awesome. I hope they never sell our company to a big company, because that will probably be the day I go.”

McKesson is hiring 120 people to call people to remind them to refill their high-profit prescription medications … uhh, I mean “to improve patient outcomes by increasing adherence to prescribed drug regimens.” The shocking thing about this practice is that it took manufacturers a long time to figure it out. I was arguing that it was a great business tactic 20 years ago. Why chase new patients when it’s cheaper to just keep current ones taking more of the same drugs under the banner of compliance?

West Penn goes live on Eclipsys and claims nearly 100% CPOE in just a few weeks.

This letter to the editor sounds like something I would have written: “One area that he and Michael Moore missed in the conversation on costs is hospital waste, inefficiency, lethargy and plain stupidity. In my 15 years in the industry, I have witnessed unbelievable waste and ridiculous decision-making on the part of hospital administrators and health care technocrats. For instance, my employer makes imaging software that easily outperforms the GEs and Siemenses of the world at one-tenth the cost. But key hospital decisions are not fully researched; the best solutions are shelved in favor of ‘this is how we have always done it.’ We live in an age of marketing, not of patient care, intelligent decision-making and financial discipline. Our hospitals could function as true health care institutions if they were not consistently in a battle to build Taj Mahals.” I agree, with a caveat: the really dumb and financially irresponsible decisions are made almost entirely by big hospitals and IDNs, whose large egos and bankrolls allow it to happen without disastrous consequences. Little hospitals don’t have that luxury or that motivation. I’ve seen greed, corruption, and stupidity first-hand in hospitals, but never in one under 200 beds.

Here’s a local story on an Ohio hospital’s smart IV pumps (which the article calls SmartPumps). It claims the hospital’s “chemical coordinator” had to “write software”.

Cardinal Health is recalling the Pyxis Anesthesia System 3500 because it can lock up while being rebooted. Only 17 hospitals use it.

This must have been interesting: the 20-year-old doctor asking a 14-year-old girl in a chat room for nude pictures was actually a 72-year-old doctor hitting on an undercover agent. One of the deceitful parties faces a minimum 15-year sentence.

FDA will get access to Department of Defense electronic medical records to monitor prescription drug usage. It isn’t mentioned whether patients have to consent.

iSoft is tired of the one-upping between prospective acquirers IBA and CompuGroup, so it says it will auction itself off if another bid is made.

A UK paper says the Cerner Millennium implementation at its first London trust is “besieged by problems”. Bigwigs called them “expected teething problems”. Worker bees weren’t so nice: “It is an American system and is so long-winded. It has not been adapted properly for British use. Every day someone bursts into tears in my office. One woman is thinking of retiring early because of it. These are not teething problems – the system is rubbish.” They must have some terse software over there.

Say, I wonder who this internal e-mail is referring to? “Blogs” are casually mentioned as part of a list, sort of like that scene in American Graffiti where underage Terry tries to buy liquor: “A Three Musketeers, and a ball point pen, one of those combs there, a pint of Old Harper, a couple of flashlight batteries and some beef jerky.” Anyway, the e-mail concludes, “I trust all of you to exercise good judgment”, which must not be exactly true since an e-mail warning was necessary. I don’t blame the company, though. They should be encouraged that I didn’t get a copy of it for nearly four hours … I often get stuff like this in minutes, so maybe the loose lips are tightening up.

Email me.

News 8/24/07

From Enid Keese: “Re: Initiate. Check out a link between Initiate and Provident Health Plan – Oregon & Northwest. That may be who acquired Initiate.” Hmm. Anyone?

From The PACS Designer: “Re: latency. TPD has dealt with network latencies in the past. Latencies are caused by too much traffic on a network and/or poor planning for daily usage. Some are quick to blame a vendor for not informing them of the network bandwidth required for an new application, but the real issue is the institution has not planned network expansion needs adequately in this new bandwidth-hogging era. Typically, network bandwidth usage peeks in the middle of the day between 9 A.M. and 4 P.M. for most institutions. One alternative is to install a second fiber optic link that isolates imaging file transmissions (which are large) from daily e-mail and system network usages. Whatever is decided, it should be adequate to satisfy network bandwidth needs for at least the next five years to insure adequate planning has been attempted.” Thanks as always, TPD. I like relevant learning squeezed into small bites. Maybe he should do his own “word of the day” type calendar for HIT noobs.

From Stella Hansen: “Re: employers. I think I worked at the same company as ‘Private Joker’. I agree with everything he said. He did forget to mention that this company starts employees at $22,800 per year for getting treated badly. You wanted to hear some good things about employers. Well, I’ve worked at two major software companies and a few consulting companies. After 18 years in the medical software industry, I finally found a company that I absolutely love! It’s called Lucida Healthcare IT. I’m not trying to advertise them in any way (I have no stake in it). I work there as a Senior Consultant and want people to know how great the people are who I work with. First of all, even though I work for the CIO, I feel like I work with him and not for him. Same goes with the Chairman, President and CEO. I love working with the people who get me the jobs as well. They all have a great sense of humor and we have fun working together. They just started this division in Sept. 2006. So far they’ve gotten me some great jobs. I was psyched to find out that I’d be working with different systems (Siemens, Partners, etc.) and not just Meditech and Picis. It gives me a different perspective of how other systems operate. Best of all … they pay well!” I’ll disclaim, since someone will criticize me otherwise: I don’t know Stella, she doesn’t know that Lucida is an HIStalk sponsor, and she’s not a shill (she used her real e-mail address). I’m also pretty sure she didn’t work at Private Joker’s company (for reasons I can’t divulge), but it sounds like she’s equally glad to be out.

From Nick Rails: “Re: RHIOs. Thought you would find this article interesting. I know you have commented on the demise of several high profile RHIOs across the country. I agree that. for the most part. these community health organizations were set up to fail (no defined business model to support itself once goverment funding ran out), but it is good to see different models actually work.” Link. The article says the Cerner project at Winona Health (MN) is a success. I hadn’t heard much about it lately. I know I was impressed when it was first announced.

I haven’t made music recommendations for awhile because a few readers complained (they must be really busy to begrudge me a couple of sentences out of a bunch). Listening to now: new Operator. Strong, hard-rocking album – could be the next Chili Peppers. Now back to your regularly scheduled programming.

I’ve been fussing about non-informative press releases, so here’s a good one for a change: privately held physician EMR vendor Greenway Medical Technologies announces a 41% revenue increase over FY06, 600 practices as customers, and its community EHR initiative. It has a good quote from the CEO, some comments about its growth, and product certification information. Good information, no flab, well done.

Here’s a reader’s idea I’ll run by you. Would you be interested in an ongoing HIStalk salary survey that would cover IT management, vendors, consultants, informatics, etc.? I can do it if folks would participate and find value (I’m not looking for busy work). Thoughts?

Misys announces another 22 layoffs in Raleigh (already reported here, but now official). They say (again) that no more are planned. Headcount is still higher than a year ago.

Odd UK news: hospital employees can’t leave work without changing back into street clothes. People complained after seeing them in bars. Personally, I like seeing uniformed lasses on liver rounds, but that’s just me.

Mercury Computer Systems announces a medical imaging subsidiary.

IBA Health said it would concede iSoft to CompuGroup. It lied. IBA raises its bid and says it will beat CompuGroup, which would make IBA the largest healthcare software company outside the US (Australia).

Industry longtimer George Giorgianni leaves DocuSys for Unibased Systems Architecture.

Congress is prepared to throw a lot of money at the VA and hope it uses it to improve veteran care: $109 billion in 2008 spending, of which $65 billion is discretionary. $1.9 billion of that would be for EMR and integration with DoD’s AHLTA. “In its measure, the House Appropriations Committee scolded VA for developing EMRs with programming language that is not compatible with Defense health systems. The committee report calls for blocking any expenditures on EMRs that won’t work with Defense systems. It also urges VA ‘to involve leading software companies’ so that veterans’ ‘will be interoperable with existing systems used by the private sector, and the report advocates ‘a portable EMR so that veterans may have a personal electronic record of their care.'” Those politicians need to get out more. Where in the world did they get the idea that vendor systems are interoperable or that programming languages are the culprit? They should be talking to an integrator. We’ve already amply established that software vendors have every incentive to keep their stuff proprietary and non-interoperable.

Siemens continues its undisputed world dominance when it comes to being investigated for bid-rigging. Add Indonesia to the list of countries going after the company. Several vendors bidding for a hospital project there were suddenly dropped, leaving Siemens free to overcharge as the lone bidder, the charges claim. Their KLAS PACS scores may offer an explanation: they’re dead last among 11 vendors and so far beneath #10 that they might as well not even be in the race. You’re gonna have a tough time moving that iron without cheating.

The Feds bust a South Florida infusion therapy billing company and charge it with $105 million in false Medicare claims. Medicare says anti-fraud software stopped $1.8 billion in false claims in two years. Scammers bribed homeless, HIV-positive people to let them bill Medicare for drugs. As a result, South Florida AIDS infusions cost $16,000 per patient compared to $2,000 in New York.

Mike Leavitt has already overcome a common blogger malady: not posting regularly. He’s toiling away at it, which is more than you can for many healthcare IT blogs, which just hang there un-updated in cyberspace with no goodbye or maybe an overly optimistic “be back soon” post.

I always read your e-mails.

Inga’s Update

The Wall Street had an interesting article about the trend for doctors to recommend bariatric surgery as a “cure” for diabetes. The surgery alleviates diabetes in almost 77% of the time. With 20 million Americans affected by diabetes, there is potential for a huge population to look towards surgery. Last year 177,600 people went under the knife. Just think how the face of healthcare would change if we had even a 25% decline in the diabetic population.

eClinicalworks makes Inc Magazine’s 26th annual 500 list of the fastest-growing private companies in the US. ECW was 34th and also the fourth fastest-growing company in the software industry. I just looked at the list quickly but also saw Hospital Partners of America at #3.

HIStalk Interviews Huy Nguyen MD, President and CEO of Cogon Systems, Inc.

Readers asked me during the HIMSS conference to check out Pensacola, FL-based Cogon Systems, Inc. I was vaguely aware that the company was doing some Florida RHIO work, but that was all I knew about them. HIStalk readers are talented at sniffing out up-and-comers that have the potential to be disruptive, so naturally I was up for learning more, even though I never did arrange a HIMSS rendezvous.

President and CEO Huy Nguyen was agreeable for a chat when I e-mailed recently. I appreciate his taking the time to give me some background on the company and to peek inside the mind of a Navy doctor turned entrepreneur, which I found fascinating.

First, help me pronounce your name and that of the company. Is it Hyoo NWEE-un?

Yes, and the company is pronounced COE-gun.

Tell me about yourself and Cogon Systems.

I’m a physician by training and I still practice part-time in the emergency environment. I like it because, at the end of the day, what we do in healthcare as well as in business has to translate to better patient care. It’s nice to continue to focus at a very trench level on what the end game is about.

I was a Navy physician. I became immersed in HIT because growing up as a military doctor meant cutting my teeth on an EHR. I always assumed that the market had systems as robust as the military’s systems.

Being an attending physician in the Navy, I was taught that, if you want lab results, you don’t go to the chart. You go to the computer and look it up. You certainly don’t query someone else to look up your data. Sometimes a doctor’s idea of an information system is to ask a nurse or clerk to bring up the information. In a naval career, you couldn’t ask that nurse because she might be a commander and you might be a lowly lieutenant. You knew better than to use her as an interface to your information system.

The Navy, early on, was an early adopter of new technology. One of the things it adopted early on was PDAs. In the early Palm and Handspring days, we bought into it hook, line, and sinker. At Naval Hospital Pensacola, the commander bought all the doctors PDAs. With your taxpayer dollars, I became enamored with the idea of mobile healthcare.

Those were glorified toys at that time. You stored everybody’s beeper and your calendar. That planted the seed in my mind – wait a minute, should this be an interface to the clinical data, just like the desktop was to the military’s CHCS clinical system?

I broached the idea of a mobile interface to clinical data with a friend of mine named David Hsu. We built a prototype and took it to the military. In typical bureaucratic fashion, they asked, “Aren’t you a doctor? Why are you building prototypes in your off hours?” They didn’t allow us to take it to the next step.

David and the engineers took it to Sacred Heart Hospital in Pensacola. This was in the pre-HIPAA era. Today, they’d laugh you out the door for asking for access to live data to build a system. They thought it was great that young engineers and I were interested.

The engineers took a prototype and brought it to production level. Once they had a working product, it was up to me to decide about my involvement with the venture. The guys approached me about running the thing, even though I didn’t come from a business background.

My wife and I thought about it. The military sent me off to Iraq in 2003 in ground support for the Iraq war. There’s nothing like war to make you a risk-taking entrepreneur. After seeing the fighting, I told my wife, “Heck, let’s go for it.”

I left the Navy in 2003 and took Cogon to the marketplace. At that time, we were mostly focused on mobile technology. We had to learn to integrate back-end healthcare systems, focusing on clinical systems. We became adept on variants and flavors of HL7. To stage the data to our mobile platform, we created a CDR.

We had a bunch of guys so focused on the mobile interface that they didn’t realize they were creating a robust back-end world. As we grew, we realized that the value isn’t moving clinical lab results or exposing them to front-end PDAs. The potential value is all the back-end stuff we did and the ability to integrate it into a comprehensive CDR.

I started to realize the true value of what we did. What about the possibility of integrating data from multiple providers? We became early thought leaders in Florida on health information exchanges. We grew our technology and moved way from an enterprise level platform to a Web-based platform.

We have a contract in South Florida and have integrated eight clinics, Mercy Hospital, and soon Jackson Memorial. We take data in HL7 or CCR formats and store those data in separate accounts. Once they’re in those repositories, we have a record adapter service.

We have a service-oriented architecture. We’re able to take data and adapt it to CCR and then move data within our own platform. Our Web portal is almost treated like a third party application. We don’t care which application we’re working with.

In the past four years, we’ve taken a mobile enterprise play and migrated to back-end clinical data integration and now have gone completely Web-based with it. We’re keen on SOA and standards like CCR. Hopefully, we can create a Web-based milieu and can launch potential other partners off that platform.

We’re not a RHIO company. We don’t send sales guys out to find RHIOs. Interoperability, especially with ONCHIT, is too much about RHIOs. A community is defined in different ways.

How is the Moment of Care product different than the usual physician portal?

It’s unique because it has the ability to give the end user control. In Miami, we have funding to establish information sharing between military and civilian providers. The portal can pull disparate records into a cumulative view. It also allows a provider to titrate how much data he wants to view.

Let’s say we have robust RHIO and a Nationwide Health Information Network. Let’s say the user can turn on the fire hose and we can bring in that patient’s clinical data, local and from all around the country. You’ll have to comb through that to make an assessment and plan. We drive our end users to an encounter-level screen to show what they’re interested in – a visit or a lab visit. We bring in the in-depth clinical data from only those encounters. So, what’s unique is the ability to leverage the Internet and control what the user wants to see.

Some would say that physician portals are obsolete in an era of interoperability, where information should be placed directly into EMR systems instead of just being read-only for those who go out looking for it. Do you agree?

I agree. It’s our plan as part of our continuing development. HIS is moving so fast that you always have to stay ahead of the curve.

I’m in complete agreement. I’d love to get to the point when the only people who look at our portal are those without EHRs. We serve as a true data hub. We take data from our trading partners and parse out data based on defined rules to entities that are authorized to take the data from us, consume it, and transiently display it in their own system – electronic health records, disease management, pay for performance, whatever. We would then supply data to those applications.

Once you create a good interoperable platform, it’s not just the Cogon portal. They key is to create a milieu that can grow a wide variety of value-added applications.

As a small company, how can you market and sell your product?

We think of ourselves as a healthcare interoperability solutions partner. One of the things we do that allows us to compete in our regional markets of focus is that we look at ourselves as a partnership. We have a cost-effective application platform that allows people to integrate into the exchange and from there. We are keen in almost liberating the data in a secure manner.

We’re pretty flexible, being privately held, on the best business model that fits a particular community. Is our platform a shrink-wrapped package? Yes, but what are we going to do with it and what’s the endgame? We spend time helping client figure that out. We don’t go into a relationship and say “This is what our package does.”

In South Florida, that community and the folks involved in that RHIO were very forward-thinking. Think of your major metro areas. I don’t think there’s a consensus yet or even close on sharing health information. Miami is quickly coalescing around this. We were fortunate to be early thought leaders. From the get-go, the RHIO has always gotten a sense that we were more than a technology vendor, we were a partner in the deal. As long as I’m running the company, that sense of customer relations will be part of our way of doing business.

A lot of companies are committed to the RHIO vision. Some of their commitment is not straightforward. Others are committed, but don’t have the wherewithal to get the job done.

Earlier versions of the company’s web page list a co-founder and several other executives. Has the management team changed?

Companies, certainly entrepreneur efforts, go though phases of development. The first phase is all about the vision, the conceptual idea and the visionary leader’s hopes and dreams. It was mobile technology in healthcare.

Then, you go to the prototype phase, where you get something to work. Then, the initial market phase, where you have no clue what the market wants, but you think you can teach it what it wants. That’s completely ineffective.

At some point, you go through a process phase, where you realize your prototype isn’t scalable to production level, and the market is telling us our true value is elsewhere. In our case, the market was telling us our mobile technology was gee-whizzy, but it was our integration they wanted.

Then, you reach production. You’re not prototyping any more. You’re delivering the product plan.

Then, you reach nirvana – churning it out, being good partners, delivering on a tight timeframe. Execution is incredibly important.

We have undergone personnel changes as we entered the different phases. As a physician, I realized that it’s great to have clinical knowledge and insights, but at the end of the day, if I wanted to keep running the company, I had to evolve. Vision is great, but execution is better. Was I a manager or a doctor who happened to run a software company? My job is to be a great manager. I have evolved and changed personnel to evolve. The processes for prototyping to delivering widgets is a totally different mindset and sense of purpose.

From the perspective of both headcount and the bottom line, we’ve grown nicely. My #1 growth need is good people who want to work in a culture of quantifiable accountability. This is a company where we are very metric-driven. It’s transparent and achievers are rewarded. I’m looking for developers and sales and business development people.

When I Google Cogon Systems, I get an ad for Patientkeeper. Is that surprising?

That does surprise me, but I think people still think of us as a mobile technology play. A lot of us have realized that mobile technology itself is not a sustainable model. We started to make the move away from being a pure mobile technology play in about a year and a half.

Managers don’t bury their heads in the sand. If you’re a good manager, you read what the market is saying, not what you hope the market is saying. For a lot of us purely focused on mobile technology, too many people hung in there thinking it was going to be rampant when that’s not what the market was seeing.

We haven’t given up on mobile technology. We have a project with the Army on mobile technology on our common Web-based platform, so we’ll continue to drive the possibility of mobile technology of healthcare. You just can’t base your whole business model on it.

The iPhone is just the beginning. This is the second or third inning in mobile technology. In healthcare, we’re in the first inning. It has a very promising future in healthcare and we’re interested in driving value-added solutions from our health interoperability platform.

You were a Navy physician before starting the company. What do you like and dislike about being an entrepreneur?

I dislike, as is typical as someone from a physician background, that things never happen as fast as I’d like to see them happen. The great thing about medicine is that there’s always a conclusion at the end of the day. In business, I learn every day to be patient.

Like South Florida. The people who audit the project would say it’s impressive what we did, indexing live data in six months and in production use. For a lot of people, that would be a fairly rapid implementation. Six months for a doctor is still a long time. Sometimes I find that frustrating.

I’m frustrated both as a doctor and as someone on the technology business side that we’re not as sophisticated as other sectors, like retail and banking. I see much greater interoperability and the power of the Internet. I’m involved in healthcare as a provider and as a technology provider, and at times it hurts me that we’re dealing with people’s health, more important than banking accounts, and we’re not as sophisticated.

What’s exhilarating is that drive for greater performance. If you’re a good company, it takes on a new life of its own and it’s greater than any individual component. If I’m not the best manager, Cogon will replace me. The challenge is on me to keep up with the growth of the company.

That drive always to be bigger, better, more profitable … it’s never enough. You can go talk to the CEO of GE and he’s in the same boat. You can make 10,000 times Cogon Systems, but he and I still share the same fundamental drive – how can I be better and bigger tomorrow?

Executing as a team. Medicine is an individualistic endeavor. If you come into my ER unresponsive, I’m not going to survey my team and ask if should start CPR or intubate you. I’m going to tell people what needs to be done and we’re going to get to it. It’s exhilarating motivating people toward a common goal and delivering it. That’s the most rewarding aspect of business. We’re at the stage of execution and we have an advanced platform, but at the end of the day, what are we going to do with it for a particular client, on time, as promised, and as defined by cost.

What’s the five-year plan for the company?

I’d like for us to be the leader in healthcare interoperability solutions at either a hospital level or even a community level. I’d like for us to be extremely competitive in using the best of the Internet age and the best of creating an interoperable world.

Just as importantly, we’re looking at creative business models to facilitate people getting into this interoperable world, with minimal cost to get on board to trade data as a community. Creating an environment where we have a lot of partners that can drive solutions off that platform, with a whole host of companies that use our platform to create disease management modules or take our data and present it inside their EHRs and facilitate better patient care.

Finally, as a physician, my hope is in five years that our technology has very direct implication on patient care and a more sophisticated, empowered consumer.

What healthcare IT people and companies do you admire?

I particularly admire GE across the board. I think GE always has that drive to be bigger and better. If you’re in this business, your goal is how to serve the market better. They have a diverse portfolio and their ability to manage that diversity is incredibly impressive to me.

What could we do better as an industry?

I would like to see a greater level of consensus and collaboration of emerging standards or a drive toward an interoperable world. We still have a tendency to think about “our solutions, our clients, our turf”. I’d like to see us make greater inroads to lead the charge to facilitating patient care with an interoperable stance. I’m glad the government is leading the charge, but we have to decide if we’re a market or a government endeavor. I’m a proponent of healthcare as a market and I’d like to see the market take the lead in driving the issue of interoperability.

As a doctor and someone in business, what are your thoughts about the role of HIS in healthcare as a whole?

We ought to be clear to the healthcare market and the country and political leaders. There’s a lot of inefficiency and we know it. But, information technology is not the panacea to the underlying healthcare issues.

As a doctor, one thing that always concerns me practicing in the emergency environment is, “Does the patient have access to care and can they afford care? Can they afford a $100 antibiotic, do they have insurance?” No matter how good our common dream of an interoperable world, it doesn’t solve the basic problem of whether that patient can afford the antibiotic.

When I see during the selection cycle using health information technology as a possible panacea, I think it diverts people from some basic underlying issues. Is it a right or a privilege? If it’s a right, how do we pay for it? If it’s a privilege, how do we help people who can’t pay for it? If we’re thinking about HIS as a means to improve cost containment, that’s one thing, but if you’re focused on that as a way to solve the overall problem, you’re being completely disingenuous or naïve.

News 8/22/07

From Madrigal: “Re: Meditech. Meditech is teaching MAGIC programming at UMASS.” Link. The CONNECT people could use some help with HTML layout for non-IE browsers, obviously. Anyway, classes will be given in Fall River and Meditech may hire some of the grads for the new office there. Five weeks and 30 hours gets you MAGIC training plus an overview of healthcare informatics and maybe an entry level job. Not bad, depending on what you were doing before.

Art Vandelay, one of my favorite posters because he’s thoughtful and analytical, did a great writeup about Wal-Mart in healthcare in HIStalk Discussion. Good predictions: one-stop shopping, reselling its franchise model to employers, targeting small business, steering its own employees to in-house services, using technology to brand their operation as high throughput, rapid diagnostics, and several more. Art gets five stars for this one. It will make you think (maybe even enough to post a reply with your own predictions).

Private Joker e-mailed me from an old HIStalk post he ran across in which employees of a certain (name expunged) HIT company were ripping it. I extracted a few of the less inflammatory comments about his time there as an employee: “Worst time of my life … ones who stay have probably lost the edge to get out into the competitive market or are happy to be treated like dogs … totally unplanned and unrealistic deadlines … the software is full of bugs and the database and application architecture is so badly designed that a very robust RDMBS like Oracle 10g comes to a grinding halt … I’m glad I’m out of there and have regained some of my dignity and life back.” Makes me feel better about my job – how about you? In fact, if you really like your job and employer, how about giving me some details since I rarely get those?

A sartorial update from Paul Burmaster, who chides CIOs for casual dress at conferences: “I’m at a great CIO conference, not just for healthcare, and a few are walking around in shorts while everyone else is appropriate business/resort casual. I bet no one wears shorts during the sessions at CEO conferences. The black tie ceremony will be interesting.” A lot of them are former programmers, so shorter inseams alone aren’t as bad as it could be. Nothing’s more depressing than a balding, graying, paunching ex-flower child who still wears wire-rim glasses, hiking shoes, and a backpack. Can anyone look at a ponytail-wearing or do-ragged grandpa without suppressing a giggle?

Scott Shreeve points out that HHS Secretary Mike Leavitt has a blog. It actually sounds like maybe he writes it himself instead of having some overzealous staffer cranking out babbling politician-speak. He mentions AHIC 2.0, as he calls it. He allows approved comments, including one from some other blogger who incessantly pitches his own stuff under the pretext of commenting (I zap that stuff right out when I get it).

From Sales Reporter: “Re: HBOC. Even guys who weren’t the big fish had days of the month exceeding 31 for contracts in their sales regions. Ask any of the reps. Maybe following orders, but not innocently.”

From EMR-Dude: “Re: Allscripts. Seems you have missed the VP of Marketing for Allscripts depature. This link shows Guy Mansueto is now working local in Tampa. Maybe this is better for the family life.” Link.

Also from EMR-Dude: “Re: Allscripts. Misys/A4/Allscripts longtimer David Bond is leaving the Allscripts Healthmatics division at the end of the year. David has been the president of that division since John P. McConnell’s depature. Maybe Ray and David will resurface at some spinoff of Med3000, which is where Steve Ura (the old Chief Technology officer for A4) went this past summer.”

From Breakers: “Re: PHRs. I’m just not that excited about PHRs. I’m a physician, and it’s even a challenge for me to manage my mother’s health records, and I understand what all the terms mean. All but the most curious and persistent don’t have a clue what happened to them in any detail beyond ‘I had a virus’ or ‘the Xray was normal’.  I just can’t see people actively managing this kind of information. When it comes down to it, someone who is caring for them will manage the information for them, and we already have a chart for that.” I’m with you. Any plan for a useful PHR better include feeding it data, since most Americans don’t have the time, interest, or literacy to sit down and document anything you’d want to use for making treatment decisions. If it’s the electronic equivalent of stuffing your old tax receipts into a file folder, then it might work. Asking someone to describe how they PREPARED their taxes? No.

From Holy Crap: “Re: This is the first time I’ve seen a grammatical misprint on HIStalk. Are you not perfect? LOL. Also, have you thought about updating HIStalk2 a few days before Histalk so you migrate folks to the new look and feel?” Guilty as charged on the misprint – my fatigue was showing through. Here’s a recap on how the sites work: I consider the primary site to be the new one (you go there if you just type www.histalk.com in your browser, but the actual URL is www.histalk2.com). I still keep the old Blog-City one updated as a backup, but I can tell you I rarely look over there otherwise. For e-mail updates, I suggest signing up for the new one (the “Subscribe to Updates” option to your upper right) and if you’re still getting updates from Blog City, unsubscribe from that one via the link at the bottom of the e-mail. A little complicated, I know, but you’d be amazed at the number of new readers who’ve come over since I put the new site up (not uncommon with a migration to WordPress and a sexier design, I’m told).

And speaking of signing up, here’s one last sneak preview of the Brev+IT weekly newsletter. I’ve gotten quite a few positive comments, most noticing how it doesn’t really overlap with HIStalk at all (it’s a summary with more analysis of the five biggest stories of the week). Help me make it popular: sign up using the Brev+IT subscription box to your right (with the logo) and forward the e-mail to others who might be interested. It has 390 subscribers so far, but I’d feel better about spending the time if it had a few more.

And speaking of Wal-Mart, an HIStalk reader has started a blog called Healthcare IT: Analyst’s Views and he’s tackling the Wal-Mart topic, too. Blogging is hard work (even when it doesn’t look like it), so give him a click and some feedback. It’s lonely when you’re just getting started and no one (and I mean NO ONE, in the early 2003 days of HIStalk) is reading.

Terry Wilk is named VP/CIO at Henry Medical Center (GA). He comes from Southern Regional Medical Center (GA).

Three Scottish health boards sign up for Carestream Health (formerly Kodak) PACS.

Another non-news press release: Mediware announces that its medication reconcilation product “is exceeding expectations” (right at this minute?) but doesn’t bother to tell the reader what either the expectations or the sales were. I’m inferring that both were modest. As a PR professional who reads HIStalk pointed out, that’s usually the mark of a company that lets just anybody write up press releases with no oversight or professionalism since the pros know it should at least sound like imperative news even when it isn’t.

An Oregon heart surgeon who created one of the first surgery outcomes databases has died. Urlin Scott Page started what is now Axis Clinical Software in 1980 but had developed outcomes tracking software years before.

Partners Healthcare chooses AgilePath for service-oriented architecture consulting services.

Lean Six Sigma, like all quality fads, has been one-upped. Now there’s the new and improved Supply Six Sigma. It’s trademarked, of course, and proprietary consultants will tell you all about it once the meter starts running.

Siemens is named yet again as being the benificiary of a questionable hospital bidding process, this time in the Czech Republic. Three hospitals chose the low bidder, then expanded their bids and invited only Siemens to participate. The lame excuse of one hospital: nobody complained by the due date. Siemens won in one hospital despite a bid higher than that of Philips and Toshiba. At my old employer, they bribed damn near everybody involved with the PACS decision with phony fact-finding trips to Germany. Despite being ranked dead last by the selection team, they nearly won the bid anyway because the thankful junketeers were prepared to override the decision until cooler heads prevailed (the complex, “no capital required” contract was going to end up costing something like $50 million over a few years, our non-junketeer finance people nicely pointed out).

A couple of readers enjoyed the partial list of interviews I’ve done. Thus encouraged, here are the rest. I have my favorites and I enjoy re-reading them.

Peter van der Grinten, dbMotion
Robert Connely, Novo Innovations
David Blauer, Click4Care
Don Schoen, MediNotes
Andy Ury, Practice Partner
Glen Tullman, Allscripts
Girish Kumar, eClinicalWorks
Gerard Dab, VisualMED Solutions
Keith Hagen, QuadraMed
Denni McColm, Citizens Memorial Healthcare
Jon Phillips, Healthcare Growth Partners
BB Babowsky, Sales Guy Who’s Been Around
David Wortman, Mezzia
Kevin Fickenscher MD, Perot Systems
Editor of WhereTheMoneyGoes.com
Scott Shreeve, Medsphere
Erik Johnson, The Advisory Board Company
John Holton, SCI Solutions
Paul Egerman, eScription
Kipp Lassetter, Medicity
Mark Groper, DINMAR
Todd Cozzens, Picis
Howard Messing, Meditech

I read and appreciate every e-mail sent to me. If you have news, rumors, or opinion, why keep it to yourself? E-mail me, or use the anonymous Rumor Report to your right.

Inga’s Update

Sprint and GE Healthcare announce a collaboration to provide in-building wireless communications services to hospitals. The communication networks will leverage GE’s CARESCAPE Enterprise access and include Sprint handsets. Hospitals will require only one installation for voice and data communications over secure cellular, Wi-Fi and telemetry. You have to hand it to GE for their efforts to penetrate every area of healthcare.

I have been thinking about Mr. H’s question about what impact Wal-Mart’s in-store medical clinics will have. While Art_Vandelay definitely covered the topic extremely well, I thought I would throw out my less articulate and less well-thought out ponderings. Actually, I was thinking back on the days I use to travel quite a bit. When I was in a new town, I would often find myself looking for Starbucks for coffee and Fed-EX Kinkos for copies. Why? Because I knew exactly what those establishments had to offer. Over the years I had been sick on the road a couple of times and had to schedule a doctor’s visit. Rather than hunting to find a clinic, then wonder if they would take my insurance, and question what kind of care I would get, I think I would have preferred going to a Wal-Mart. Presumably there would be some consistency between clinics, including the quality of care and insurance options. Also, I would assume that if I had been to a Wal-Mart clinic in Topeka this week and Miami the next, my medical records would be available on line. I think consumers will embrace the concept, and, I am sure that at least the primary care world will feel the effects. Clinic hours convenient for working parents with sick kids or the “working sick”? Great! Free parking? Awesome! Socks on aisle two and paper towels on aisle 12? Works for me!

MediNotes releases the results of an internal study of their 4,300 clients’ top concerns for selecting an EMR. Top was the need for successful implementation and support, followed by total cost of ownership over a three- to five-year period, functionality and interoperability, IT expertise, and time necessary to make the paper-to-EMR transition. MediNotes also claims that they have achieved a 94% implementation success rate since January 2006, compared to 40-60% for all EMR’s. I am not sure how scientific their study was, but the purchasing concerns sound about right to me. In regard to the implementation success…I suppose the first question to ask for a definition of “implementation success.”

Yuma Regional Medical Center in Yuma, AZ contracts with MEDSEEK to develop an enterprise eHealth strategy called eMap.

Appalachian Regional Healthcare (ARH) announces it will deploy McKesson’s Horizon Ambulatory Care EHR system to more than 190 employed and affiliated physicians in rural communities across eastern Kentucky and West Virginia. ARH will offer the purchase of the EHR at substantially reduced rates to affiliated physicians in its service areas and will provide maintenance and technical support. ARH already had several McKesson products including pharmacy automation and a physician portal.

Inga’s listening.

Monday Morning Update 8/20/07

From The PACS Designer: “Re: ASM. The abbreviation ASM might not be familiar to most HIStalk readers, but it will be seen more as we migrate toward more enterprise-driven software platforms. ASM stands for Automatic Storage Management and is the software that controls how data and image files communicate with an archive. ASM is going be more commonly used with Ethernet and TCP/IP usage. Techworld Online Magazine had an article last year that explains ASM along with some technical format ideas for techies on how to set one up for enterprise usage.” Link.

From John: “Re: Wal-Mart. From the Wall Street Journal: ‘In health care, Wal-Mart sees itself providing an array of services and home-health equipment along with prescription eyeglasses and pharmaceuticals that it already sells according to a person familiar with the effort. ‘In five years, Wal-Mart wants to be on its way to becoming the No. 1 health-care company in America,’ that person said.’ The company said it will open up to 400 in-store clinics in the next three years, bringing them up to 2,000 within 5-7 years.” Now that’s interesting. They’ve got a lot of buying power, both as a healthcare provider and consumer. Will doctors and nurses end up having mostly retail chain employers, just like the majority of optometrists and pharmacists? Everybody’s speculating endlessly that Google might roll out a PHR, while plain old bricks-and-mortar Wal-Mart is quietly cornering care delivery itself. Hospitals, medical practices, and labs that are indifferent to providing value and paying attention to the customer experience should be concerned. You can argue smugly about how low-rent and plain they are, but you’ll have to take a spot in line behind all the nay-saying grocery stores, pet stores, clothing stores, and pharmacies that are being crushed under their wheels ahead of you. They’ll spend money on IT, too. Post your thoughts in HIStalk Discussion. What impact will the company have?

Michael e-mailed me about Medicity, wondering why the company is under the radar for many hospitals that have poor inpatient/ambulatory systems integration. I asked CEO Kipp Lassetter, who said Medicity is working hard to get the word out about clinical interoperability. Their numbers: over 300 hospital customers, 135 interfaces inbound to hospital systems, and 1,750 interfaces feeding data to PM/EMR systems. They’re managing 100 million clinical messages a year for hospitals, IDNs, LabCorp, and statewide information networks in Delaware and California. Maybe it’s too easy for CIOs to just call up their HIS vendor, although I don’t know that those companies will always have the right experience and motivation to get the job done.

Vince Ciotti mentions that H.I.S. Professionals will be offering another two-day “mini-HIMSS” in Chicago on October 3-4, with several HIS vendors doing presentations and demos. He says a lot of old friends contacted him after his interview here.

Welcome to new HIStalk Platinum Sponsor Sentillion, the folks who created healthcare single sign-on (ever notice how hard that is to type?) They’re in the Healthcare Informatics Top 100, have over 250,000 live users, and offer five-nines availability. I notice their Q2 was big for single sign-on, user provisioning, and virtualized remote access. They’ve got some big secret announcement coming soon, which I know only because they warned me cryptically, “We will need to change our ad often and on specific days – can you do that?” I guess we can all watch the ad together to see what’s coming (it mentions “expreSSO”, so take your best guess). Anyway, thanks to Sentillion for supporting HIStalk.

A reader suggested I run links to previous HIStalk interviews to make them easier to locate. The full list is here (25 CEOs so far, plus several other high-ranking and interesting folks), but here are the most recent ones:

Ken Creager, Meru Networks
Vince Ciotti, H.I.S. Professionals
Cindy Dullea, SCI Solutions and the United States Navy
Michael McNeal, Emergin
Kim Pederson, Allina Hospitals & Clinics
Toni Rienzi, NYU Medical Center
Stanley Crane, Allscripts
Adam Gale, KLAS
Ed Daihl, SIS
Jim Morrow MD, North Fulton Family Medicine
Gary Kennedy, RemedyMD
Dewey Howell, Design Clinicals
Glenn Galloway, Healthia Consulting
Mike Cottle, Sumter Regional Hospital
Scott Decker, Healthvision
Bruce Cerullo, Lucida
Jon Phillips, Healthcare Growth Partners
Justen Deal, Kaiser Permanente
Tom Skelton, Misys Healthcare
Jonathan Bush, athenahealth

Mike Smeraski, now at Eclipsys, pays $50,000 to settle the SEC’s stock fraud investigation against him from his HBOC days. I read over the charges awhile back and got the impression that his bosses were doing all the fraudulating, not him, and I’m guessing the relatively paltry $50K fine reflects that. The Big Fish is still swimming (or sailing) freely, of course.

QuadraMed releases Version 9.0 of the scheduling system formerly known as TempusOne.

Brookhaven is live on Soarian. If anyone from there has a first-hand report for me, I’m listening.

A reader asked about lobbyist spending by HIMSS, leading Adam (“long time fan, first time caller – er, e-mailer”) to send over its federal 990 form (disclaimer: I’m not an accountant, but I’m reading it as best I can, and HIMSS will be due to file a new 990 shortly). It shows $1 million in lobbying expense. Other high points: HIMSS had $31 million in revenue, with $17 million from the annual conference and $4.5 million from publishing. Membership dues are listed as bringing in $4.2 million. Expenses were $32 million. It paid about $10 million in salaries and bonuses, of which CEO Steve Lieber got $485K. The form says HIMSS owns $16.6 million in investments, mostly stocks (it doesn’t say which companies’ shares) and sold $42 million worth during the year (I don’t understand that huge number for sure). HIMSS Analytics took in $5.1 million. HIMSS paid $331,000 in credit card fees (!) and $3.2 million in consulting fees. The form says HIMSS made $317K from professional services and $752K from industry affairs, each line footnoted to say that’s from “representation of the society” in government affairs/health industry events, so I’m not sure who’s paying that. HIMSS owns a chunk of Medtech Publishing that it values at $544K, which brought in $89K of income. If you’re an accountant and want to give a more professional interpretation, I can send the PDF over.

LA’s Antelope Valley Hospital will migrate from 70 Dell servers to four virtualized IBM 3850s.

Epic’s $100 million learning center will open next month in Verona. The horseshoe-shaped building is painted red to resemble a barn. The auditorium seats 5,300 and will be nearly full for the company’s September user group meeting. Campus 2 is already underway and will cost the same as the recently opened Campus 1: $150 million. The treehouse will be open this fall (I’m still waiting on Judy’s offer to sit up there as the company scribe). The article says Epic’s revenue last year was $422 million, about a third of Cerner’s and a little more than Meditech’s.

Need evidence that most press releases are rarely newsworthy and sometimes don’t even involve news? Oracle fires off an urgent release that describes TheraDoc’s choice of Oracle for its database … seven years ago. I shall alert the media.

Cisco says hospitals its strongest sales growth is coming from hospitals, bringing in about $1 billion a year.

A software developer in a UK hospital goes to jail for downloading kiddie porn at work. He claims a virus did it.

InterSystems subsdiary TrakHealth gets a 10-year contract to provide an EHR in the UK. You may recall that InterSystems acquired the Australian company, a former development partner, this past May.

E-mail me. Or, use the Rumor Report to your right. I’m fastidiously confidential with sources, so you need not fear being outed. A reminder, too: I’ve been writing HIStalk for over four years and all of it can be searched using the Search box to your right. Thank you for reading.

News 8/17/07

From John Winger: “Re: Ingenix. Ingenix acquired LighthouseMD. Not sure when it will hit the wire, but I hear it’s public within Ingenix.” Thanks for that info. Does it seem like just about every semi-cool, little-known physician EMR vendor is getting bought or buying someone else? I admit I’m mostly a hospital guy, but I’ve never heard of most of these companies.

From Reggie Hammond: “Re: Misys. I hear that Misys is looking to do some sort of partnership with e-MDs. Misys wants to resell e-MD’s new ASP software. I think it makes sense because Misys has been wanting a lower-end ASP integrated PM/EMR option and the Amicore effort failed. Look for Kelley Schudy (former head of Physician System sales) to oversee the transition and then leave. Also, speaking of leaving Misys, three HR VPs have announced their resignation, though it is unclear if any/all will leave now or over the next few months.” Reselling a much hotter company’s software? How far the mighty have fallen.

From Billy Bear: “Re: Misys. After having been pared down to the bone to make the books look good for the Vista Equity buyout, Tucson support staff have been told the deal is contingent on their reducing the (large) volume of outstanding support calls. That may be true, but it’s more likely current management trying to shift the blame.” I doubt the deal hinges on it, although incentives may be in place. There’s nothing that keeps already antsy customers happier than demanding that terrified support reps prematurely close their support tickets.

From Cheryl: “Re: Google Health. Here are screen shots.” Link. Not much to look at. I bet it’s got a good personality.

I read an interesting editorial about Citrix’s purchase of virtualization software company XenSource for $500 million. Aimed at private equity guys, it argues that the VC model is less successful than incubating a company to begin with and (surprisingly and arguably) less risky. That’s an interesting thought since most companies jump in big only in later rounds. They also mention that Citrix probably wishes it had latched on before competitor VMWare did its own blockbuster IPO this week ($1.1. billion raised – priced at $29, now nearly double that).

I noticed that Lucida Healthcare IT has a new web page design. I know it’s geeky to watch for that kind of stuff, but it fascinates me. I think their current consultant openings page is new – lots of Meditech, Epic, clinicals, imaging, etc. They also offer a Personal Career Advisor and a Star Service Concierge Specialist to help consultants keep everything running smoothly, locating engagements, and structuring compensation. The site lists the engagement options that Bruce Cerullo talked about when I interviewed him.

And speaking of cool new sites, eScription has one, too. Will companies have to update yearly to keep up with new design styles, kind of like buying a new car every year? It’s looking that way, but the Web 2.0 stuff was the first big change in awhile.

SureScripts joins NACDS, NCPA, AAFP, MGMA, BCBS, and Intel to form The Center for Improving Medication Management. It will perform research on using electronic linking technologies (like that of SureScripts, let’s say) to improve prescribing, dispensing, and using medications as well as measuring outcomes. They’re talking about bringing in RAND for a study. If they can keep it non-proprietary, they could do some good work. E-prescribing and electronically managed refills will bring patient compliance issues (of which there are many) out of the closet.

Gerard Dab, CEO of VisualMED, is interviewed by the Wall Street Reporter. I liked their product when I saw it many years ago and I still think they’re kind of a cool company. I interviewed Gerard last year.

Barnet and Chase Farm Hospitals become the first London NHS facilities to go live on Cerner Millennium.

New executives at anesthesia software vendor DocuSys: Robert Watson, formerly of Concuity and Cerner, is named CEO. Joseph Heins is the new EVP/COO after previous stints at Eclipsys, Cerner, and Infoway. If you’re an up-and-comer suit, it’s obviously good to have worked at either Cerner or GE Healthcare since those folks are popping up everywhere. Does that mean we’ll end up with a boatload of companies just like those two?

Another former Eclipsyser, Noel Strong, is Mediware’s new CTO.

Google bundles Sun’s StarOffice in its Google Pack, meaning its price just went down from $70 to $0. I’ve used it (a little) and it’s a nice option when you otherwise have to pay for Office (like for your kid’s computer).

Transaction processor MedAvant announces Q2 numbers: revenue down slightly, EPS -$0.31 vs. -$0.14. That’s if I did the math right, since EPS wasn’t reported (I can see why).

The VA and DOD are issuing millions in healthcare IT contracts. The recipients aren’t surprising: Northrop Grumman and Booze Allen (oops, that’s Booz). Somehow noble-sounding government initiatives always end up meaning millions for SAIC, Accenture, BearingPoint, or all the other high-price, insider IT mercenaries out there. Not surprisingly, once their people are on the ground, the government never seems to find a way to dismiss them and do the work with its own employees.

Rodney Schutt, formerly of GE Healthcare, is named COO of Luminetx.

Siemens and Intel will co-develop an electronic blood banking system for Malaysia’s 334 hospitals.

Verus, the healthcare billing company that made itself a household name by allowing all kinds of data breaches involving its hospital clients, has shut down. Investors pulled their money and MedSeek has taken over some of its business. A spokersperson said it was really just one IT error that caused all the problems. The fifth hospital, Sky Lakes Medical Center (OR), announced a Verus-caused vulnerability today. You just know there’s some nerdy network engineer who screwed up and brought the whole company down in the process.

LA County supervisors vote unanimously to shut down Martin Luther King Jr.-Harbor Hospital (a.k.a. King-Drew, a.k.a medical cesspool). One supervisor said it best: “I don’t know how you’d be able to tell how stupid some of these people are. I mean when I read this, I can’t see how a nurse couldn’t mix medicine. I can’t see how she says, ‘I don’t know where to find this instrument.’ That is incomprehensible.” On the other hand, someone had to have hired that person and supervise them, so I’d blame the bosses. The closure plan is here (warning: PDF). Here’s the CMS report (warning: PDF).

Another flavor of medical tourism: US seniors are heading across the border to live in nursing homes in Mexico. And why not, for $1,300 a month? “Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.” I’m ready to head there now. If they have broadband, I can write HIStalk from there while sipping Dos Equis and eating carnitas and flan. The ladies are pretty there, too, although Mrs. HIStalk wouldn’t find that a plus.

Windber Medical Center (PA) cuts its ties with Conemaugh Health System and goes independent. CEO and blogger Nick Jacobs goes public with a plea to get the word out about Windber, although they’ll need local exposure instead of national to survive. A reader suggested I interview him. I’m game. I’ll evaluate and brag on its IT function if it’s any good.

IBA Health finally surrenders to CompuGroup on its attempted takeover of iSoft.

Philips buys RIS vendor XIMIS, whose site doesn’t say who runs the company. I hate that crap. Is it embarrassing or something? I’m going to start critiquing HIT-related web sites. Would that be entertaining or would you glaze over?

CMS is offering Web-based education for doctors interested in implementing EMRs for their practices.

Internet trade association USIIA opines on healthcare IT. Recommendations: more broadband, physician incentives for EMR adoption, and anti-Net neutrality. I was going to see who its members are, but in a delicious irony, its site was down. Maybe some of us healthcare geeks should return the favor and criticize how they run their industry.

News, rumors, HIStalk government contracts: e-mail me.

Inga’s Update

Ethidium is a company I hadn’t heard of until earlier this year when Take Care Health Systems (a Walgreen’s subsidiary) implemented their clinical software in 16 of their clinics, all of which are located in retail pharmacies. Ethidium has a line of products that include an ASP-based EMR, a personal health record (PHR) option with patient portal, and medical decision making tools. Now Ethidium announces it has acquired exclusive ownership of VLink health information exchange from Vaceris, which will enable Ethidium to offer connectivity needed by RHIOs, IPAs, etc. VLink is currently implemented by the 1700+ doctor Genesis Physician Group IPA in Dallas (oh by the way in HealthVision’s backyard.) No word as to whether Genesis is looking to offer their doctors an option for the Ethidium EMR solutions, but you have to believe they would love to. About three years ago Genesis had secured preferred pricing A4 health Systems/ Allscripts, GE Medical Systems (Centricity) and NextGen but the rumors are that not too many physicians took advantage of the offerings. I think Ethidium will be an interesting company to watch over the next few months.

WiFiMed Holdings Co. of Atlanta has completed its acquisition of JMJ Technologies Inc. JMJ is the developer of the EMR product EncounterPro.

Blue Shield of California announces it will award $31 million in pay-for-performance bonuses to medical groups and IPAs that showed performance improvements.

Talk to Inga.

HIStalk Interviews Ken Creager, Sr. Dir. Strategic Markets, Meru Networks

A long-time reader whose background is clinical suggested I talk to the folks at Meru Networks. I figured it takes a lot to get a clinician excited about IT nuts-and-bolts stuff, so I was happy that Ken Creager, senior director of strategic markets for Meru, agreed to chat. I hear gripes regularly about wireless networks, even with the relatively modest demands placed on them. I was interested to learn more about what’s changed in the time since many hospitals put up their first 802.11b network. Thanks to Ken for the conversation.

Tell me about Meru Networks.

Meru has been in business since 2002. We produce a family of access points and controllers for mission-critical and life-critical environments. The company is headquartered in Sunnyvale, California, with operations in all of North America, Europe, Asia, and R&D in Bangalore, India. We’re not public so we don’t provide financial numbers, but we’re about 280 people, growing at a very rapid pace due to a lot of industry demand. We’re having a great time trying to respond to the needs and requirements of the field.

The lion’s share of our business is in the healthcare and education markets. In healthcare, we solve unique problems as a result of doing a lot of observation in the marketplace, getting assistance from people, and from our participation in HIMSS. We don’t always go in and talk to the technical people.

We look at the nurse as the integrator. If the technology is going to work, it has to be easy to use and functional to a nurse. If a nurse is using a PDA at the bedside, that person doesn’t really care if it’s the applicaton, the unit, or the wireless network if it fails. We work closely with our clients and our partners to make sure we’re very functional for the clinical staff in hospitals.

What’s the penetration of wireless networks in hospitals and how are they being used?

The actual penetration is close to 80%, but let’s clarify. Many of those deployments are first- or second-generation, with fat access points that are difficult to configure and lots of cost. They also tended to have been installed for a single application or department, like something radiology or oncology wanted to put in. It wasn’t pervasive until recently. Most hospitals report that they have some use of wireless, but it’s not pervasive.

What we see happening is an absolute explosion of applications. Go to HIMSS or trade shows and you’ll see applications and devices using wireless as a transport. There was a time when wireless was nice to have, like in the conference room. Today, it’s an integral part of the architecture and an enabler for taking care delivery to the bedside.

We spent a lot of time looking in hospitals and saw this snowball of applications coming at clinicians, but found that networks aren’t pervasive or are limited in their capacity and are failing. Those first implementations may have worked well for an application or two, but with 15 or 20, they are failing. Adoption of devices is not being as well-received as it could have been with a more robust network.

That has given us a window of opportunity to come in and show how our technology is differentiated in the marketplace. We have better coverage and performance and can prioritize traffic to assure application delivery. Let’s say we have a Wi-Fi based phone and we want to make sure that calls get through ahead of someone in the back room who’s Web surfing. We can inspect that traffic, prioritize it, and makes sure it gets through. We have quality of service built into both the upstream and downstream.

A great application of pervasive wireless that we have witnessed first-hand are nurse-type devices like Wi-Fi based phones or Vocera-type badges. You see clinicians walking the hall with those devices. We noticed they stopped walking. They told us it was because they had a good signal and stopped so they wouldn’t lose it. We’re in the mobility business and we asked whether that makes sense. We’ve seen areas where good coverage was marked on the floor with tape. That’s the pervasive element. Is if through the entire facility? Not yet today. We’re getting there.

Common problems in hospitals include dead zones, slowness, and overloaded access points. How does your technology address those problems?

Wireless runs on a series of channels, usually 1, 6, and 11. Access points have different channels and you roam between them, much like when you’re on the cell phone in your car. That inherently causes problems in your end device because it has to continually look to figure out which one of these guys it wants to talk to. At some point, it’s talking to two of them and has to decide how to hand off.

RF planning is required to determine how access points in a general area interfere with each other. Also, as devices move, they have to decide which way to go. If I’m trying to talk to two different access points to determine which is stronger, that’s taking time on the network. Our advantage is that we can put all our access points on a single channel. The end user device sees it as one big network.

There’s no handoff. We make that decision for the end device in our controller. If you’re walking between 15 access points, that entire campus may be on one channel and you’ll never know it’s happening. The advantage is a four to five times performance increase because you’re not asking questions where to go next. Also, it’s seamless between access points. The opportunity to drop a call or device is almost completely negated.

If you think about what’s happening with clinicians walking down the hallway and looking at vital signs on the laptop and they hit a dead zone, they’ve lost information. We take that away because our coverage is more pervasive. We have quality of service upstream and downstream and we guarantee delivery of those packets for critical devices like a patient monitor or voice call. We can assure the delivery of that piece of information.

This all plays into clinical adoption. We’ve seen the reports come out. In the 100 Most Wired, technology today is having a positive impact on health, safety, security, and mortality rates. Much of that’s due to the deployment of technology solving errors at the bedside, medical conflicts, wrong medications, those kinds of things.

Another key thing we find in hospitals is that they’re amass in assets – wheelchairs, infusion devices, phones. The biggest question is “where are they?” COWS and crash carts move to emergency situations, congregate around nursing stations, and then get pushed into the hallway. We can do some locationing with our management software that lets you determine where those devices are.

Because we’re able to do a single-channel architecture of the standard 12 channels, that gives you 11 available. You can stack channels like a stack of pancakes. You can segment your traffic. As an example, you could put voice traffic on Channel 1, data on Channel 6, and telemetry on Channel 11. That increases your capacity on the network and segments them. They can still talk to each other.

Because we don’t have channel conflicts, when you need more coverage or bandwidth, you don’t need more RF planning. You plug in a new access point, it figures out what’s around it, and it becomes part of the community. That’s a low cost of ownership.

Hospitals spend as much upfront with our competitors doing surveys and channel planning as they do on the actual product. We can almost eliminate that. You don’t need as many of our access points to get the same or better coverage as our competitors. The cost of an access point may be equivalent, but you don’t need as many.

When you look at a clinical environment and recognize that a critical care nurse will take 1,000 data points in a shift and there’s five or six of them trying to do something and they congregate, do they have the bandwidth to get their job done? As they move out on the floors, do they have the quality of connection to get their job done?

Also different is that we have an ability to create fairness in the networks. That offers us the ability to do backwards compatibility. You have the b-rated radios that operate at 11 megabits per second. The g-rated ones are at 54 megabits per second. If a guy comes in to your g-network area with a b device, everybody goes down the lowest common denominator. Everybody gets slowed down because of that guy.

We can give all users their full capacity at the same time. We can offer 802.11n megabits, but still allow g and b clients to work on the same network together. In many industries, but especially true in healthcare, devices stay in service for many years. They’re not going to rip out technology to replace the radio cards. That gives us an extensible architecture and investment protection for existing clients.

Describe 802.11n and what impact it will have on healthcare.

It’s the next generation of speed. It will give you six fold the bandwidth of 802.11g. There’s a lot of technical stuff around that, but from an end user perspective, you’re bringing true desktop wired speed to the wireless world.

Most connections to the desktop are 100 megabits. You’re going to have wireless signals that are three times as fast. If you’re building a new facility, do you need to put those wires in place? You can go to the all-wireless enterprise and have speeds faster than that of the wired world.

In healthcare, most of the devices we see are operating very well at b- and g-rated speeds. Ascom has a great g-rated phone purpose built for healthcare with messaging and made for clinicians. On your hip, the display is upside down so you can read it without using your hands. The next generation of phones will have n-rated radios, so you can have more of them out there.

The biggest impact will be in imaging and video. Today’s early generation networks don’t have the capability to take full-motion video or large images. In a shared PACS environment, you might need to look at large images in real time. 802.11 n will allow you to do that.

How important is wireless voice over IP to hospitals?

We’re seeing it as becoming a much bigger element. They view the network as being able to carry everything. We’re seeing dual-mode phones – cellular outside, Wi-Fi based inside. Doctors look like they have Batman utility belts with 15 pagers and devices. You will continue to see an explosive rate of devices coming down and then a convergence period. Blackberry is coming out with a dual-mode device.

Voice is becoming a much bigger element of these networks in healthcare. In many cases, it’s the driver for upgrades. Then, you get into, “What’s the quality of the call? Is it comparable to toll grade? If a bunch of users make calls, is the network degraded?” We have technology that protects the quality of those calls.

What patient care quality issues can result from ineffective wireless architecture?

Time. Let me go back to the nursing station to see what’s happening. If an application is readily available on a tablet PC, laptop, phone, or multi-use device, you’ll save time. The opportunity for errors is reduced. Where you find a low adoption rate of handheld devices and point of care by clinicians, you find higher error rates. Those have an impact on care delivery and quality of care.

If I’m a hospital CIO, why shouldn’t I just buy Cisco like I’ve always been doing?

Cisco has a great product. I used to work for them myself. But this technology is truly differentiated. When you look at a Cisco product, you have no single product in the top five. You’re not really getting best-of-breed in any segment.

We use Cisco products in our demos. We can make their wireless phones work better than they can because our wireless network is so robust. Our technology is extensible and backward-compatible. There are no forklift upgrades. Once you’re set up, you just stick an access point in the ceiling.

CIOs have multiple vendors and multiple levels of code. With us, you have one level of code that runs all controllers and access points. The controller code is broadcast out the access points. You set a corporate policy for HIPAA or JCAHO or whatever is required. Let’s say you allow a certain number of guests, but you have to keep them away from the business office and lab. You set those central policies and the access points come online, assume those rules, and apply them universally across the network however you’ve set it up. Once you’ve set it up, you don’t have to do it again.

We can also suppress rogue access points. Somebody runs down to Best Buy and buys a D-Link box and plugs it into the wall. Suddenly you have a new wireless hotspot with no security policies applied to it. Somebody in the parking lot has access to your network. We have rogue detection.  We determine it’s there and don’t let that person come in. We go one step further. Once we recognize that the access point is there and it starts to broadcast, we jam the signal. That keeps devices from taking time away polling the access point. I see that guy broadcasting, I’m going to jam the signal so the end devices never see it and can’t take up bandwidth.

How do you justify the cost of your technology to a hospital that already has a wireless network?

Does your existing wireless network have the capacity to deal with what’s coming? Most tell us no. People with a network in place for 18 to 24 months are having to replace it because of the applications coming. They have to put in an extensible one for the next speed or the technology required.

The advantage we have is that most have already come to the decision that something has to change. We come in and say, “We can solve a lot of these problems with coverage and speed and ROI and save you money as compared to the other vendors, and provide you a better of quality of service.” Our value proposition is strong. Clients are feeling the pain by finding low adoption rate by clinicians on new devices. The end user doesn’t know what’s behind it, it just doesn’t work. We try to build the most robust infrastructure at the lowest cost to make sure those applications work.

Cisco convinced HIMSS to create The Community for Connected Health, which seems to be a thinly disguised Cisco trade group that paid HIMSS for exclusive access to its members. Does that make it even harder to complete against the Goliath?

What’s interesting about that … they did that with HIMSS and had tried to do the same thing with the AMA, who pushed back and made Cisco take down some of their marketing. A week later, Cisco announced their endorsement by AHA. Everyone I’ve talked to on the client side and vendor side says this is an abuse of .org facilities and people. The industry is policing that themselves.

I’ve instructed my team to not even respond to those questions because it’s how Cisco markets today, defensively and protecting their ground. Frankly, I’ve talked to folks like yourself who view that as very offensive, “Cisco has infiltrated HIMSS and I can’t believe HIMSS any more.” I think the industry will self-police that. People who have drunk the Cisco Kool-Aid will buy it no matter what. For those wanting a best-in-class solution, I don’t think them doing that with HIMSS or AHA will influence them in making a purchasing decision.

Wi-Fi companies seem to have had mixed IPO success. Meru was considering IPO this year. What’s the most likely outcome?

We are going through a rapid growth spurt. We just tripled the size of our sales team. There have been some successful IPOs, some not so good, some consolidation. The opportunity for us to move forward and grow this company is excellent. There’s a lot of opportunity out there. We have a disruptive technology. I’m sure the company and its founders and its venture funding would like to see us go out. I’m not privy on whether it’s this year or next or whenever, but when it’s time and the market dynamics are correct, I’m sure we will go out.

Any final thoughts?

Our wireless technology is unique. We’re fully standards-based and we help drive a lot of those standards. We’re innovative in our technology. You’ll find that many if not all of our customers are raving fans of what we do. We have very large hospitals like University of Miami, Wake Forest, and St. Johns. We continue to add and grow in this market almost on a daily basis.

We’re something of a positive disruption. We’re getting a lot of positive write-ups and are getting attacked by people you’ve mentioned [laughs]. When we’ve reached the point we’re being attacked by Cisco, that means we’re a thorn in their side and are disrupting their business. That’s good thing.

The challenge is getting the word out. We’re a small company compared to Cisco. We only do wireless. Customers are benefiting financially. I’m happy with where we’re doing. We’re focusing not only on the IT buyer, but how the products are used by the clinical staff. As we well know, doctors walk in with a great application they found or something they use that they want you to support. We’ll see more and more of that. Having a network that is extensible and easy to add capacity to will have an amazing capacity on the IT staff of hospitals and the budget.