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.

News 8/15/07

From John Winger: “Re: Ingenix and Healthia. I don’t see the fit. Healthia’s focus is professional services, primarily Epic implementations although they do other work at United. Not too surprising to me that their CFO would be here – I’ve seen their COO on site and just assumed it was related to consulting business development.”

From Jessica Bradford: “Re: Initiate. Anybody making any bets about why Initiate is going public? Could it be that Oracle is shopping for a strong partner for their healthcare EMPI business? God knows Oracle has bought enough companies recently that acquiring one more wouldn’t be beyond their business strategy. Or could IBM be the suitor? Inquiring minds would sure like to know ….” Maybe the CIA, the company’s investor, wants to bank some cash before the next election.

From The PACS Designer: “Re: RFID. TPD has been following the trend of incorporating radio frequency identification tags (RFID) in healthcare processes. It appears to make sense since there is so much equipment in hospitals and sometimes it can’t be found when needed. The RFID industry is expecting increased business the rest of this year and next year, according to a recent Frost and Sullivan Report, as the solution is finding its way into an increased number of institutions other than the traditional distribution channels. Since healthcare needs to improve efficiencies due to tight budgets, RFID makes sense, where knowing the location of valuable equipment can guarantee having the right equipment at the right time and place in such places as the OR and ED department. By having things handled more efficiently, institutions can cut down on new purchases and help the budgeting process.”

From Peter Smythe: “Re: HIMSS. Since you mentioned the amount McKesson’s paid for lobbyists this year, it might be interesting to see what HIMSS is paying for lobbying and advocacy, instead of using member dues and fees to help its membership. It seems that HIMSS has become what it professes to be against. The organization caters to vendors and spends money on the lobbyists instead of catering to and educating its membership. The number of almost daily HIMSS emails to members is bordering on spam, with the vast majority selling something. It might be that it has grown too large to fulfill its primary mission or it might be the leadership is more interested in personal recognition. HIMSS could take your lead and offer an RSS feed and brief weekly email that offers value.” They don’t put their 990 forms online that I can find. I’ll see if we can’t scare up a copy.

The Portland, OR city-wide RHIO (Health Data Exchange Group) is comatose and not expected to survive. Nobody wants to pay the $3.4 million needed this year or the $150K annual cost that each hospital would have to chip in. CIO Dick Gibson of Legacy Health was honest in saying that, in addition to the costs, hospitals would lose up to $10 million in those avoided duplicate tests that they still get paid for. Those involved can’t even reach consensus on why it’s tanking, which isn’t a good sign.

Good news from Sumter Hospital. The insurance company has agreed to replacement of the destroyed building. There’s work yet to be done, but that’s encouraging. Fundraising is underway to cover the $10 million shortfall.

Updates from Medicity from their newsletter: the Delaware Health Information Network (a Medicity client) received its state funding, despite earlier reports suggesting otherwise. Medicity’s Clinical Clearinghouse is mentioned, an ASP solution that routes information from hospital clinical systems to physician EMRs. There’s also a new version of ProAccess, 4.0.

Thanks to the readers who tipped me off early on the Perot acquisition of JJWild. HIStalk ran it first, of course, both as a rumor and as fact (that second part because a reader somehow found the announcement buried on a public Perot site even before the press release hit the wire). $89 million? Sweet. That’s quite a testament both to JJWild and to Meditech. Where else could you build a business worth that with one vendor package as your focus? Perot picks it up for 1x revenue, although that’s probably a good for a consulting outfit. FCG’s market cap is $247 million, which is just less than 1x revenue, but they’re a publicly traded company.

The KLAS Mid-Year Report ranks eScription’s EditScript software #1 in Transcription and Back-End Speech Recognition with a score of 90.74. That’s four years in a row.

Last reminder for now: the Brev+IT weekly newsletter comes only to those who sign up to your right. Also: I have some interviews coming up, but would like to do more with those on the provider side (informatics, IT leadership, hospital visionaries, etc.) If you’re interested and interesting, let me know.

McKesson’s Relay Health announces its NotifyRX product. It sends critical drug company announcements to pharmacies, such as recalls and packaging changes.

Google Health has been previewed to a few clinicians, some of whom spilled the beans. What it contains: a health profile, suggested treatments, drug interaction lookup, exercise regimens, pages for sharing information, prescription and appointment reminders, and provider directories. It had better be more exciting than it sounds since just about every starry eyed kid with web skills has come up with these ideas already. It may be more like a consumer magazine than an IT application and those always put me to sleep.

Irish wireless applications vendor Valentia Technologies will open an office in Dubai’s Healthcare City in November.

Merge Healthcare will restate revenue and faces delisting yet again after delaying financial reports after a review of accounting rules for maintenance revenue.

A senior diplomat in Korea’s Chinese embassy dies after receiving a Rocephin IV injection that a Chinese clinic gave him for a stomach ache (for some reason).

A big shareholder in Quality Systems, Inc. complains to the SEC over board governance. I didn’t realize that the company’s market cap is $1 billion, pretty much all it from the NextGen product, I assume. Founder Sheldon Razin’s shares are worth $98 million.

Workers at a hospital in Scotland are taking heat over their YouTube video “MRSA”, which features staff dressed like the Village People and singing altered lyrics to “YMCA”. The hospital is the third highest source of healthcare-related infections in Scotland, so we were not amused over there. I couldn’t find the video.

News, your great ideas: e-mail me.

Inga’s Update

I have enjoyed reading the first couple of Brev+ITs. Even though I read every word of HIStalk, I must admit that some topics don’t interest me as much and/or I don’t understand it all (!) Thus even as HIStalk Queen (as Mr. H likes to call me), I find that the quick and dirty summary is very helpful.That being said, I found that I had a bit of difference in opinion from Mr. H last week when he applauded the recommendations for EMRs to include anti-fraud tools. Not that I disagree with the need to reduce fraud. However, shouldn’t HHS worry as much (or more) about such things as insurance underpayment as they are seeming to worry about fraud? Which is more prevalent – fraud or insurance underpayment? Am I being cynical to think that the big insurance company lobbies are behind the efforts to reduce fraud … yet another way to not pay out as much? If HHS is going to serve as Big Brother to watch for fraud from the providers, shouldn’t they also ensure EMRs assist providers to receiving all the reimbursement to which they are entitled?

Northrop Grunmman Corporation is awarded a $10.3 million contract with the Department of Defense to deploy, enhance, and maintain the Clinical and Health Data Repository initiative to help the Defense Department and VA share patient information.

Misys PLC founder and former Chairman Kevin Lomax is now Executive Chair of Enigmatec, a UK-based company that provides policy-driven automation solutions for resource management.

Private equity firm Galen Partners has raised $250 million for investing in healthcare information technology and outsourcing, medical devices, and specialty pharmaceutical companies. Hope they are HIStalk subscribers since our readers always let us know about the hottest companies and trends.

SugarCRM, a provider of commercial open source customer relationship management (CRM) software, announces finalists for their Best of SugarCRM awards. While this has next to nothing to do with HIT (a couple of finalists did include athenahealth and Purkinje), I liked the creative names of a couple of the other finalists: Geeks on the Way and Eject-Stop-Divide.

Speaking of athenahealth, I have been reading the various comments on the HIStalk Forum that Dr. Kato started. The discussion started when Dr. Kato asked for other readers’ impressions of athena’s PM and EMR solutions. There has been some great commentary, some of it more globally about PM/EMR’s rather than just athena. I am not all of with it all, but many good thoughts that anyone considering a PM/EMR vendor should consider. Some things that came to mind for me:

• Is it more important to pick a quality PM first or have an EMR that works for your doctors and practice? Personally, I believe that you must have an EMR that your doctors embrace or they won’t use it. Unfortunately, that means that the administrative and office staff could potentially end up with a billing system that is lacking some functionality (though truly most PMs all offer the basics).
• I definitely agree that it is best to make sure have your PM solidly in place before starting on EMR, though with a brand new startup practice, you often have to get both going simultaneously.
• I am glad to see that Dr. Kato is considering the financial stability of the vendors. Implementing an EMR and PM is too costly and disruptive to make a mistake.

Talk to Inga.

Perot Acquires JJWild for $89 Million

 Perot Systems has announced its acquisition of Meditech consultants JJWild of Canton, MA for $89 million in cash. According to Perot’s announcement, “The 190 JJWild associates will enhance and firmly position Perot Systems’ MEDITECH Solution Center as a market leader.”

Monday Morning Update 8/13/07

From Michael Vronsky: “Re: Holy Spirit Hospital. How about a follow up with Holy Spirit Hospital? I think you’d be pleasantly surprised what their CIO (Edith Hunter) and others have to say nine months later.” This was a replacement of Soarian with Eclipsys. I’ll ask Inga to look them up and report back.

I got e-mails from a couple of journalists who were nice enough to let me know that they use HIStalk as a source of story ideas and opinions. That came after a reader accused the HIT publications of stealing ideas from HIStalk. My server records show other incoming domains from HIT magazines, but at least these had the class to tell me. Should I call the others out publicly?

Burt Finkelstein, formerly of Cardinal Health and Johns Hopkins, joins VisualMED as Senior Pharmacist.

NextGen gets a mention in the Pawtucket (RI) newspaper when Blackstone Valley Community Health Center goes live, claiming to be the first place in the state with all electronic records. Most of the state government seemed to be on hand to see a demo (must be an election year).

EMR/PHR vendor Ethidium Health Systems announces its acquisition of the VLink health information exchange product from Vaceris.

McKesson spent $560K on federal lobbyists in the first half of this year.

The White Stone Group announces an upgrade to its TRACE communication tracking system for eligibility and benefits that allows capturing images of entire web pages, documents, and e-mails. TRACE can now fax those images directly to payors or physician offices to handle payment disputes. Payor changed their website since the service was rendered? You’ve got a picture as proof.

I’ll put out this week’s Brev+IT shortly. If you’re quick on your trigger finger on Saturday afternoon, it’s not too late to sign up to your right and get your copy. Otherwise, I’ll just tease you about how great it was next week. Hmm, what were the five most important HIT news events this week?

Marty Belscher joins Emerson Hospital of Concord, MA as VP/CIO. He comes from FCG. Seeing his Ed.D. credential made me remember that he worked on an engagement for me once. Seemed like a good guy.

WorldVistA EHR is CCHIT-certified, but still not ready for release. The issue: drafting a user agreement that allows them to modify the software as open source while avoiding nullification of its CCHIT certification. They’re also working out royalties for use of CPT and Zip codes. Somebody must be using it since CCHIT doesn’t certify products that aren’t GA and running.

Parkland Hospital (TX) is using background-checking software to catch patients who lie about their address or income to get free care to which they aren’t entitled. The system flagged 12,000 cases of potential fraud, they’re going after several hundred, and more than a dozen people have pleaded guilty and paid up. Oddly enough, most of those first prosecuted are small business owners from Middle Eastern countries, several of them related, who falsely claimed to live in Dallas County to get county charity care. One guy who owns nine Subway franchises and drives a Mercedes told the hospital he made $8 an hour as a sandwich maker. He paid his $47,000 bill in cash when caught. The criminals mostly seem indignant or indifferent since healthcare services, as we all know, are steadfastly viewed as free by those who can’t or won’t pay.

Another company no one’s heard of is offering free physician EMRs that will supposedly be supported by ad revenue. Actually, I’m probably the only one who’s never heard of them since the product is CCHIT certified. It’s apparently run by individuals too shy to list their names on the web page (why are companies so secretive about who’s in charge?) Here’s a free 60-second strategic consulting session from Mr. HIStalk: ad supported EMRs can work, but not by running crappy Google AdSense text ads like Practice Fusion is trying to do. You need to have a strong marketing arm that can develop ad packages specific to practitioners, like some of those Australian EMR companies have done. To really work, you’d have to throw ethics to the wind and jam the ads right into the care process: popping up medication commercials based on patient diagnosis, suggesting a competitor’s alternative when e-prescribing, or integrating permission-based marketing for patients. Companies would pay for that because it would work and many doctors are crass enough to go for it.

Consulting firm RTI tells ONCHIT that EMRs need more safeguards against fradulent billing.

Lawson Software’s CEO says software-as-a-service won’t live up to its hype.

Oracle says it’s too hard to figure out a pricing model for software running on virtual servers, so it will just keep collecting your money as usual, thanks.

Wisconsin Health Information Exchange has expanded its Executive Director role to full time and is seeking candidates. And, if you like the heat (geographical, not job-related), Qatar Hospital is looking for an executive director of health information systems.

Rumors and ideas? E-mail me.

News 8/10/07

From Joseph L. DiNardo: “Re: other sites. I notice that [name removed] has a story on private equity in healthcare IT. Other magazine stories and sites seem to just write about what you do, except later. They’re ripping you off.” Well, I could turn into Howard Stern and claim I invented the genre, but I won’t. Certainly I’ve noticed some remarkably coincident news and opinion pieces over the four years I’ve been writing HIStalk. I’ll attribute that to subsconscious influence, kind of like when one singer hears a song and writes another one very much like it. If I influence them, good for me.

From Doc Hilarity: “Re: you must be flying under the radar.” Link. Somebody wrote a program to chart out the healthcare “blogosphere” and HIStalk doesn’t look like a big deal on it. Reason: it counts links to and from. I don’t link to other sites and don’t expect anyone to link back to me. Here’s the stat that counts: HIStalk has more readers, page views, and sponsors than any site I know. If those slip, I’ll know I’ve left the Blogosphere and entered Suckitude USA.

From Shortwave Coates: “Re: Healthia Consulting. Healthia Consulting Sells to UHG? That was the word from some Ingenix employees (a division of United Health Group).The consulting company’s CFO, rarely seen at client sites, was visiting Ingenix this afternoon.” Since I’ve got Healthia contacts because they sponsor HIStalk, I sent it their way for a response. “As you may know, UHG and many of their companies / business segments, including UnitedHealthcare and Ingenix, are clients of ours, and our entire leadership team takes a strong interest in having close relationships with each of our customers to ensure the quality of our services meet and hopefully exceed expectations. Additionally, UnitedHealthcare manages our employee benefits, so our leadership team communicates with and/or meets with UHG staff regularly. Due to the strong reputation we’ve built in the industry, we do periodically get approached by companies across the industry about strategic partnerships the depth of interest in those relationships varies across the partnership spectrum. In the event we determine that a strategic partnership at any level with any organization is in our colleagues’ and clients’ best interests, we’ll let you know and work with you to publish complete and accurate information, so that the readers of HIStalk are informed.”

From Bill Hafner: “Re: Cerner. I saw the stock rocket upwards Wednesday. Looks like there was an Investor Day at the HQ on Tuesday. These financial guys came away thinking Cerner was doing pretty well. What do you think?” Bill attached a fancy report on the visit from stock guys Thomas Weisel Partners. Some quotes: “Tuesday, August 07, 2007, we met with Cerner management at its Kansas City headquarters. The highlight of our trip, by far, was the tour of CERN’s newest data center located on its corporate campus … Our trip to the Experience Theater was impressive. The company has always proclaimed that once it gets a potential customer to the Experience Theater, the probability of a customer win is high.” Sounds like the Tom boys were so wowed that they just about bought Millennium themselves instead of just CERN, like many CIOs so distracted by the carefully scripted Vision Center sizzle they forget to check the steak along with their checkbook. You’d think investment guys would be more cynically realistic, or at least not report back with such obviously fanboyism. What I think: less than that, certainly. Cerner is managed well and entrenched, but Epic is stealing a lot of their high-margin, big IDN business. They say they’ll make money in the UK, but I doubt it – no one has so far. They don’t play much in outpatient, still struggle with non-clinicals, and have taken only baby steps into non-provider markets to try to find another growth area to prop up the share price. Meditech has the entire low end of the market staked out already, so there’s nothing there for them. I expect clinical sales to dry up because those hospitals who can afford the ridiculous price tags have already shot their wad. If Cerner wants growth, they’ll have to buy it through acquisition. Just my opinion, of course. That fancy data center that the investors drooled over won’t sell much product, especially since most clients run their stuff locally anyway. It’s not that Cerner won’t make money; it’s just that the growth built into a lofty share price will be hard to sustain now that the numbers are a lot bigger.

From Cao Van: “Re: Piedmont. Any update on the OIG Audit?” I haven’t heard a thing.

It’s my pleasure to introduce you to Stratus Technologies, a brand new HIStalk Gold Sponsor. What they do: five-nines system availability, redundancy, and system monitoring and alerting. System availability is critical once you’ve installed all those EMR and real-time clinical systems, so these are the folks who can help. They’ve been around for 27 years and have a big presence in other continuous availability industries (six of the world’s 10 biggest banks and 14 of the 20 biggest telecom providers, for example). Stratus, of Maynard, MA, was the first to offer a 100% availability guarantee for Windows Server in 2002. All you need to remember: continuous availability=Stratus. Thanks to Stratus for supporting HIStalk and respecting its readers by doing so. I appreciate it.

And speaking of Stratus, they’ve got a case study from Orthopedic Center of St. Louis: “Bonner finds Stratus’ ActiveService architecture particularly helpful because it amounts to having ‘another staff member on call 24×7 to monitor the server .. ftServer system is constantly in touch with Stratus’ service center, which monitors its performance. If the server has a problem, it alerts the service center, which either corrects the problem remotely or sends a ‘hot swappable’ component to fix it … the ftServer, which comprises redundant components running in lockstep, continued to run the practice and clinical management systems with no interruption at any time, including during the replacement. When Bonner finished, the server automatically resynchronized and returned itself to full redundant operation.”

Remember those Bulgarian nurses and doctor who were arrested by the Libyan government in 1999 and charged with intentionally infecting 400 children with HIV? They were stuck in jail until last month, constantly threatened with execution unless Bulgaria sent Libya a few billion dollars, but finally were released last month. The Libyan government now sheepishly admits that their confessions were extracted by torture. “Yes, they were tortured by electricity and they were threatened that their family members would be targeted. But a lot of what the Palestinian doctor has claimed are merely lies.” 

Cerner gets a mention for its surgical tracking system that keeps families informed of the patient’s status. They get a card with a confidential number and can look at the patient’s status on a plasma screen in the surgical waiting room (like “PRE-A” or “OR” or “PACU”).

The St. Louis paper runs an article on Purkinje’s physician office dispensing system. I’m vehemently against that concept from a patient safety standpoint, especially when pitched as a revenue booster for doctors, but Purkinje supposedly has built safety checks into its electronic systems. Like Allscripts, Purkinje got into the business by acquiring a company already in it, back when they were Wellinx. I know next to nothing about them, but they sound like of interesting.

A reader e-mailed me to ask, “What are the top three HIT-centric publications that are well read and well respected?” I honestly couldn’t think of any. I don’t read any of them and my feeling is that most industry people don’t either. What little real news they carry is two months old by the time the issue goes out, plus the non-expert reporters just re-word the press releases anyway in most cases, keeping it friendly to advertisers. Of course, I’m biased.

QuadraMed announces not so great Q2 numbers: revenue up 7%, EPS $0.02 vs. $0.06. The stock headed south, trading near its 52-week low and now down 24% in a month. Some folks on the conference call claimed that Keith Hagen was wishy-washy on the financials of the Misys CPR product that QuadraMed bought, leading to speculation that the deal could be in danger once the bean-counters shine a harsh light on those books. Doubtful, but they still have to figure out how to make money from it.

Pravene Nath is named CMIO for NYU Medical Center. Mentioned by Toni Rienzi when Inga interviewed her. And when looking for that link, I ran across this oldie but goodie phony news issue of HIStalk, which had me cackling even though I wrote it.

HIMSS joins some trade associations in trying to get the President to override the ITC’s ban on imported 3G cell phones containing Qualcomm chips, claiming a threat to public safety. Broadcom probably doesn’t agree: it was their patent that Qualcomm infringed upon, according to a previous unanimous ITC ruling. Doesn’t sound like something HIMSS needs to be involved with. Guess their CPOE and RHIO work has been successfully completed and cell phones are the new imperative.

Merge Healthcare shoots off whatever toes it had left, announcing a delay in filing their Q2 report on the day it was due. Stock board speculation was coalesced around three themes: (a) top management is bailing out; (b) the company will be bought; or (c) everybody in charge is a moron.

Cardinal Health announces Q4 numbers after the bell: revenue up 5%, EPS $2.33 vs. $0.76, although most of that came from the sale of one of its business units to private equity star Blackstone Group.

Interesting: this Mac-based practice management system uses MySQL for its database.

Odd: a surgeon in federal prison for 51 months for healthcare fraud is suing Apple, claiming he invented the iPhone’s keyboard.

Former Sutter CEO Van Johnson joins the board of Visicu. Different Van Johnson: it’s not the slightly dense blonde guy (Lt. Steve Maryk) from The Caine Mutiny, I now know (although he’s still alive and will be 91 in two weeks, so here’s an HIStalk shout-out, you big lug).

Allscripts announces Q2: revenue up 17%, EPS $0.10 vs $0.05. The stock dropped; analysts expected $0.14.

Emageon’s Q2: revenue down 14.8%, EPS -$0.01 vs. -$0.04.

Odd lawsuit: a Nigerian man who took his sick neighbor to the hospital in Saudi Arabia has been arrested there for immoral behavior by Islamic religious police. Men aren’t allowed to associate with unrelated women, even when saving them.

News, rumors, blogosphere positioning developments: e-mail me.

News 8/8/07

From Victor Melling: “Re: Perot. Perot already has an offshore company dedicated to healthcare. Their plan to aggressively grow the healthcare organization has to include international initiatives. In the international market, you can’t just take something American and expect the rest of the world to follow. You do it with country-specific nationals, and in some countries, it will make the best business sense to acquire. Don’t forget the payer and government side of their healthcare biz. Services are a key.” Victor was talking about Perot’s $10 million acquisition in 2003 of Vision Healthsource. Back then, it was a 500-employee BPO company doing healthcare claims and billing. Thanks for that report.

From Stan Fields: “Re: Are you sick of Misys yet? Last week, four more senior folks left. Not sure if they chose to leave or were asked. All were long-timers and two were on the Wall of Fame. Either they’re cleaning out the old guard or the old guard has had enough.” I’m always uncomfortable naming names, so how about first names only: Tammy, Scott, Stephanie, and Karen. I think I am getting sick of Misys rumors, finally, although their diaspora should have wide influence on the industry.

From The PACS Designer: “Re: CafeScribe looks interesting, as it fosters the shared learning experience that permits updating of text material and experiences similar to how a wiki operates. Through this shared experience, healthcare IT users can expand their knowledge base and interact with others who share the same desire to learn.” Link.

I hope you enjoyed the interview with Vince Ciotti. I should have warned those of you who don’t know Vince that he speaks his mind. Sometimes he’s pulling your leg, sometimes not, but he’s always entertaining. He cracks me up.

Speaking of interviews, if you know someone interesting I should talk to, let me know. I learn a lot every time I do one.

I’d like to recognize a loyal HIStalk sponsor both old and new: InterSystems. Old, because InterSystems has been a Gold sponsor of HIStalk for some time. New, because they just upgraded to Platinum, for which Inga and I thank them very much. As in the case with Vince, I’ve been their customer, although they don’t know that because I’m anonymous. I’ve used Cache’ and it’s a smoking-hot database, running faultlessly under heavy, enterprise use at a big IDN I’ve worked in, and with minimal care and feeding on our part (say the words “Cache DBA” at my old shop and they’ll look at you blankly – it doesn’t need one). You know that already, of course, because it runs what seems like 80% of big healthcare apps already (Meditech, Epic, both lines of QuadraMed, etc.) Equally hot stuff are the company’s Ensemble integration platform and HealthShare for EHR data sharing. Anyway, many thanks to InterSystems for the vote of confidence. Say, I bet CEO Terry Ragon would be a great interview. He’s one of several Boston-area giants of the industry.

And speaking of CEOs, thanks to those who are recommending HIStalk sponsorship to their CEO peers in other companies. I’ve gotten several e-mails out of the blue from CEOs who start out by saying, “So-and-so tells me he loves your site and that I should really consider sponsoring …” I’m blessed. Thank you. That’s really cool.

I’ve received two unverified rumor reports claiming that a well-known Meditech consulting firm is about to be sold. One says the buyer is Perot Systems. I’m not naming names because I’ve received incorrect rumors about this company before. Still, the sources appear to be unrelated and Perot says they’re buying somebody. We’ll see.

Errata: I inadvertently cleaved off a zero from the UPMC server virtualization numbers last week. Their engineers estimated a server cost of $65,000, not $6,500. I said they estimated a cost 98.7% less than the software vendor’s server specs, but the actual number was 87% less (still not exactly chicken feed). I also got a follow-up from Marc Holland in response to some reader comments. He mentioned that UPMC’s high growth (25% in Wintel server count per year) plus software rollouts and end-of-life replacements mean they’re saving big bucks quickly. They’re also feeding an enterprise-wide SAN instead of direct-attached storage to cut costs even more (both cost per gigabyte and cost per usable GB due to easier provisioning from a central storage pool). Thanks, Marc.

Quality Systems (the NextGen ambulatory EMR people) reports Q1 numbers: revenue up 17%, EPS $0.29 vs. $0.28. Wall Street wanted $0.33, though, and the stock is down around 10% since the announcement.

DR Systems announces 10 new small-hospital RIS/PACS contracts worth $5.6 million.

Alberto Kywi is promoted from CIO at Cottage Hospital to SVP/CIO of Cottage Health System.

Cleveland Clinic names Sulaiman H. Sulaiman as CIO of its Abu Dhabi project.

The two organizers of the German HIT trade show ITeG are parting ways and arguing over its name. Issues: location, whether to add HIMSS-like educational sessions, and control.

Dell, Fujitsu, and Lenovo will offer hardware discounts to organizations that receive grants from the Center for Community Health Leadership of Misys.

Joseph Zaccagnino, former Yale-New Haven Hospital CEO, is named to the board of Premise Corporation. They sell throughput and patient flow applications: bed management, bed cleaning, transport, and executive dashboards.

I see quite a few folks signing up on my e-mail lists to your right. The first one is to get e-mail updates when I write something new here. The second is for the new Brev+IT (pronounced “brevity”) weekly newsletter, which you’ll get only if you sign up. Help me spread the word on that one by forwarding your copy to anyone else who might be interested, please. It’s aimed at C-levelers who might not enjoy the insider stuff here that the rest of us love. It looks deceptively simple, but the value is having culled out only the most important news of the week and added some perspective and opinion around it, all in a quick-read package that’s self-contained in an e-mail.

Laparoscopic gastric bypass patients at Sinai Hospital of Baltimore whose doctors used robots for bedside rounding had a mean length of stay of 1.26 vs. 2.33 days for traditional rounding.

A hospital in Belgium is using .NET-Java EE integration tools for its portal, developed on WebSphere and running on Linux with an Oracle database. They’re developing with Visual Studio and compiling to Java (!)

Cool: three foundations donate money to pay for a document-based EMR for behavioral provider for foster children in Kansas.

A Wall Street Journal story describes a neurovascular surgeon who bought an iPhone on launch day to access his practice’s EMR. I also like an unrelated tag-on at the bottom that ridicules common IT terms. “But the word implies that the ‘users’ are utterly dependent on the provider …Today, all the term does is emphasize technology at the expense of the task someone is trying to perform. To an IT person, you aren’t writing a message, you’re using email … We also hate the term ‘solution.’ IT people often say that they have a customer-relationship solution or a supply-chain solution. The word ‘solution’ not only doesn’t tell you what it does, but also doesn’t tell you what it is. A supply-chain solution might be software, but it might be a storage rack in a pickup truck, or it might be a cardboard box.” Amen, brother.

Craig Barrett’s horses aren’t the only ones with an EMR. “Horses treated by Hagyard will soon have electronic medical records that allow their veterinarians to see their history from anywhere in the country. Images taken by the practice’s 11 digital X-ray machines allow veterinarians in the field or working for bidders at horse sales to see a horse’s file from computer work stations set up on site. They can do endoscopies and bone scans, and soon will have MRI capability to help diagnose problems. There’s a hyperbaric oxygen chamber for treating horses with a variety of conditions and a treadmill on which to test respiratory function and lameness. A neonatal ICU cares for newborn foals. The babies get ‘their own little Tempur-Pedic mattresses,’ which tour guide O’Flynn says helps eliminate bed sores.” Say, I could be the first veterinary CIO. Sport horses apparently get better care than a lot of humans, but then again, they’re worth a lot more in real dollars, sadly enough. The short, whip-wielding guy on their back probably has no insurance. At least he won’t be put down if his leg breaks.

Amcom announces its Answering Service module for call center customers.

Bizarre: a Minnesota man decided he needed to have his testicles removed. When hospitals refused, he found some amateurs willing to tackle the job in his home. He awoke, bleeding, in a makeshift OR complete with medical supplies, specimen jars, and a camera. The impromptu surgeons had high-tailed it when police were called and the man wouldn’t name them. Larry, Moe, and Curly?

News, rumors, good HIT sales stories: e-mail me. Thank you for reading.