HIStalk Interviews Michael McNeal, President and CEO of Emergin

Michael McNeal takes messaging seriously. Maybe you think of messaging as the mundane transmission of old fashioned analog signals from medical equipment, the boring stuff that only a screwdriver-wielding engineer could love. Michael and his company Emergin see messaging as strategic and mission-critical for hospitals. As a result, they’ve incorporated some cutting edge architecture and deployment ideas into their services for hospitals. It’s another formerly separate discipline that’s starting to look a lot like IT.

Hospitals buy a wide variety of message-capable equipment, often with little planning. That’s like cherry-picking favorite individual department IT systems with proprietary interfaces, with little regard to workflow changes, integration, impact on patient care, and optimization. That’s what Emergin addresses: architecture, deployment planning, and tying event notification and alarm management into strategic goals. Quite successfully, as it turns out, as the company is growing at a torrid pace after pretty much defining their own market segment.

HIStalk reader Art Vandelay mentioned Emergin in an article comment right after HIMSS, which is what put them on my radar in the first place. His description of their market is a lot better than I’d come up with, so here’s what Art said: “Emergin has a dynamic CEO and a great vision. If they’d only build a better biomedical data integration mousetrap – a la CapsuleTechnologie, they could set the world on-fire. Everyone in IT, the tsunami on the horizon is integration with biomedical devices and intelligent building technology (as opposed to letting these technologies persist on their own, poorly secured and sometimes poorly supported and utilized, with a few bridge-points spanning networks). It is time to hop into the boats and meet the wave rather than get over-run. We all want discrete data in our medical records systems, these devices generate more than you can imagine and it is a huge win with people who are in your hospitals more than the physicians. Emergin has a well-thought-out profile / use case for biomedical alert integration that should be in every mobile telecommunication and device request for proposal you put out. They also share their information in a brilliant guerilla marketing technique to entrench their product in the industry.”

Good intro, Art. Thanks for Michael for taking the time to chat and to Kathy McCall of Emergin for making the arrangements.

Tell me about the company and yourself.

Emergin was founded in 1995. The name derives from emergency and innovation. Since inception, our focus has been on emergency, real-time information as well as innovation, breaking new ground in new markets with a heavy emphasis on healthcare.

After graduating from the University of Florida as a computer scientist, I worked at IBM on operating system design. Above getting a comprehensive OS background, it helped me recognize the importance of governance structures in organizations, working on a team of up to 4,000 people architecting components into a single OS.

Hospital alarms used to be hard-wired, proprietary, standalone, and connected only to a desktop system or audio alert. How has that changed?

It really hasn’t changed. We’re hopeful that Emergin will be the driver of that change in healthcare. Most hospitals still buy monolithic, discrete systems. Phase II or III is workflow and optimization. We’re trying to get hospitals to think more strategically about planning and design. Healthcare hasn’t really changed that frequently.

We flew around the country over three years to really educate the hospitals on SOA and IT architecture in general, how they can be thinking differently about controlling their own destiny, focusing on work process design, human factors, and performance management.

We’re working strategically with customers, thought leaders like Texas Children’s, University of Chicago, Cedars Sinai, Memorial Sloan-Kettering, William Beaumont, New York Presbyterian, and Boston Medical Center. We need to work with them because it’s not one size fits all in the early innovation stages. We’re looking at alarm patterns, message discrimination, and improved patient safety.

The only problem is that there’s no category for Emergin [laughs]. We’re creating a market around of a category of alarm management that doesn’t exist in the US market.

The company has promoted and sold into a number of industries. Manufacturing, with Six Sigma and Lean. Aviation and the FAA. Government agencies like E911 for broadcasting of critical events. It’s the same business models being applied to healthcare market.

We researched the market six years when we decided to focus on healthcare. We realized that there were many discrete systems but nothing to orchestrate them all. Add on top of that the ability to create governance structures or committees or how to orchestrate nursing, IT, biomedical engineering.

How do you pull it all together into a master technology plan? You start out with a clean sheet of paper, a governance structure such as committees, and then build an architecture. Get representation from all departments to get everyone on the same page. Then, build around the hospital’s key strategies, like patient safety or financial performance. When departments and budgets are decentralized, departments choose their own technologies, which create fiefdoms. Then it becomes a battle to see who has the most power.

We’re taking it to next level, building IT architecture, mapping traditional alarm systems into medical architecture with a focus on workflow and performance management. I just received the initial alarm reports from Texas Children’s today. We’re assembling them to look at the rate of alarms on physiologic monitoring alarms, nurse call systems, IV pumps, and how effectively that info is being communicated to the nursing staff.

Do you have an example of what you do?

A example is William Beaumont. We visited their facility, then did an inventory of systems. We asked questions of IT about how they perform certain workflows. We put together a bunch of questions to ask care units to determine whether there was consistency in workflows. Often you’ll find that IT organization will claim that workflows are consistent until they do the research. We designed tools for them to collect the information and then give us the evidence of what’s happening. Hospitals also do research of individual systems, common nomenclature for bed labels, or staff classification or alarm categories.

What that uncovers is that they don’t really have a plan to drive the standards. They’re governed individually. Emergin created templates and tools to set standards and architecture to drive conformance over time. It’s easiest to go into new construction or renovation, but in many cases hospitals are retrofitting existing systems. When they realize how painful that is when there aren’t standards, they’re more apt to do it at the beginning of any new deployment.

Much of that isn’t tools, it’s a workshop. We meet for half a day with nursing and talk about workflows, care models, and response to alarms. Then, half a day with IT for education on service-oriented architecture  An issue that IT has is that they’re typically responding to capital equipment already purchased. Someone’s already bought physiologic monitoring and needs to get IT involved. When IT isn’t involved upfront, workflow changes aren’t uncovered until implementation. They may need network changes, interfaces, or workflow changes.

We’ve gone through 1,000 deployments with 200 best-in-class systems. Emergin has learned in six years how to do technology lifecycle management and change management. We understand that when you’re planning or designing your architecture and third party systems, you have lots of things to consider. Most hospitals won’t consider process flows from the beginning.

Maybe you’re sending an RFP for a nurse call system or IV pump system. Each monolithic system is being deployed. There’s no real consideration of workflow until afterward. All of a sudden, nurses are carrying four or five devices or entering the same data into three or four systems. That creates workflow challenges for nursing and frustrates them because they want to spend time at the bedside and technology makes it more difficult.

The next phase of electronic medical records seems to be the incorporation of digital device information. How does that fit in with your focus on alarms and events?

Most of the technologies are used to import information from data from medical equipment into EMRs for charting. Emergin’s value proposition is around messaging and notification, within five seconds for an emergency. Our core technology is the Emergin Enterprise Service Bus. For the mobile worker, which is 90% of caregivers, getting information is critical for patient care and safety. The EMR will collect info to record it as part of the patient record, but it’s traditionally a data repository for that information. Some EMRs can trigger rules or events, but not usually real time in five to 10 seconds.

What do you think of the work of IHE?

They’ve just created a medical device subcommittee of IHE. Some of our customers are part of it. They’re trying to drive some standards around how medical devices interface alarms and events. We were invited last week to help work on those standards.

IHE started on cardiology, pharmacy, and lab and is now expanding into the medical device domain, which we consider our core competence. Because we’ve integrated a lot of the medical equipment, we’ve created a standard integrated profile that we’d like to make publicly available. Some customers are including those specs in their RFPs. We’ve found that interoperability, not to overuse the term, is normally not considered until Phase II, III, or IV of a deployment cycle. We’re trying to coach hospitals to include it in the initial acquisition. Maybe not in the Phase I deployment, but interoperable by design.

Failure to rescue is an often overlooked phenomenon.

That’s the core area we’re focused on. We’ve done tremendous amounts of FMEA studies and are involved in clinical trials with medical equipment manufacturers. We’ve found that failure to rescue is often because of communication errors. We’ve built the ability to trace back on patient activity when the alarm was generated, who it was assigned to, which system, which device, who read it, who acknowledged it, and when the caregiver responded. By integrating with systems, we can produce an RCA transcript that can re-create life cycle of a patient alarm.

In the years of workshops, we were often asked about how long does it takes to do an RCA. It’s six to eight weeks with a reliability rate of 40%. 60% of the data was anecdotal. Hospitals couldn’t recreate the incident to avoid having it happen again.

I co-presented with Darren Dworkin, CIO of Cedars-Sinai, at HIMSS. A network engineer stood up in the audience and said he didn’t really understand the clinical domain, but said if he couldn’t find network problem or security breach within 15 minutes, he’d be out of a job. It takes six to eight weeks to find the cause of a patient’s death? That’s a great question. It’s a very interesting analogy.

Is alert fatigue and false alarming a problem?

Part of the Texas Children’s study is measuring the amount of false alarms. A key part isn’t just technology or relaying of an alarm, but looking at its impact on vigilance, what the fatigue lines are.

That’s another common workshop question: what’s the fatigue line for a 12-hour shift? No one could answer. Texas Children’s is writing an AHRQ grant for further research over three years. They’ll study the rate of alarms on a per-care-unit, per-patient basis. How many alarms can be physically handled during a shift? What’s considered an adequate staffing level to provide care?

Texas Children’s is also studying by system and by vendor and looking at trends. They recognize that, in a population of 12 patients, two patients generate over 80% of alarms. When you do staffing levels and look at what causes delays in response, which is unmeasurable in most hospitals, what is their average response time per patient? If they have two simultaneous alarms, what impact did that have on the second patient? You have to measure failure to rescue to determine response.

Hospitals struggle with throughput. What systems can improve that?

A Stanford graduate wrote about complex event processing. How do you know when certain things hit thresholds, like ED at capacity or census at capacity, and then do just-in-time management? Emergin is studying this as well. We started out with life-critical alarms — V-tach, asystole, or apnea —  and expanded beyond that to look at other critical events, such as critical lab results, getting them to caregiver, and having them call back receipt. As you’re looking at bed turnover and dirty beds, how do you streamline the overall operation to effectively respond?

When Emergin looks at an enterprise, we look at any input event and output event as discrete units, whether from physiologic monitors, nurse call or lab system, EMR rule, ED capacity alarm, or RFID alert if an infant leaves a certain zone, Emergin can take that data from discrete systems and take action on it, delivering it to whatever device is appropriate, such as a Cisco or Spectralink phone or Vocera badge. Some departments use LED signs in the hallways for real-time status updates. Doctors may have a RIM Blackberry, Treo, or cell phone that is their preferred device. How do you orchestrate these devices that carry events?

What are some creative uses of alarm systems in hospitals?

The pneumatic tube. If sample is sent and the tube gets stuck, it alerts the biomed department. Or, the Pyxis machine hits a threshold number of meds that need filled and only two pharmacists are working. We can alert the director of pharmacy to pull in more pharmacists to make sure they meet SLAs. Or the blood bank. If the temperature goes above or below thresholds, then notify maintenance. Customers generated these ideas.

How important is service-oriented architecture to your products?

We were hired by Motorola in 1996 to become the architect of their next generation platform called Heir Apparent. We’ve been SOA-driven since Day 1, a core messaging and notification engine with service adapters that became the interfaces to third party products. As the platform evolved, it enabled Emergin to continuously evolve and add more systems to its architecture without changing the foundational architecture over a 12-year period. We went from zero integrations to over 200 because we build a service model from Day 1.

There’s a lot of hype talking about SOA, but you’ll find that most companies that are doing it are in middleware, traditionally in logistics, financial services, and manufacturing. It hasn’t been applied well in healthcare. To build true SOA is to take a step back, study the inventory of systems acquired in a hospital over time, then build reference architecture, plugging systems into it, then looking for ways to increase operational efficiency.

SOA is a foreign concept to most hospitals. We’d ask, “Who’s the most important person when you build a house?” The joke answer was always the wife or general contractor. Often, no one thinks about the architect as the most important person, even though they build the plan and design. That ensures that when you build a bedroom or bathroom or kitchen that you’re using the same plumbing and electricity for economy of scale.

Think about the blueprint from Day 1. If hospitals step back and build an architecture, figure out how systems fit into it to ensure that you’re not buying the same components over and over. You’re able to leverage some of the systems that you’ve already purchased. When you have a core engine like an enterprise service bus, there’s certain user functionality that should be part of the core engine and not the individual systems you attach to it or you’ll duplicate job functions.

What involvement should CIOs have in alarm systems?

When we first kicked off the workshops, we thought our target audience was the CIO. We found that getting a CIO to spend an entire day to learn about SOA won’t happen. Later, we changed it to IT directors, biomed directors, and nurses moving into informatics. We fund that the IT director was the right audience, the right-hand technical gurus to the CIO. The CIO is more business-minded, with a holistic, vanilla operational focus. They don’t need to know details, they just need a team who knows details.

We found that when training directors of IT, they can translate language to the CIO and demonstrate the importance. We thought the CIO would be the strategic eyesight of the domain and would have to pull it all together, but we found that you have to speak different languages. Nurses don’t understand techno talk, but when you talk about care models and workflow and patient complaints, that’s what they related to. With IT or IS, we talk about networks and servers and databases and how systems interconnect. For biomed, it’s medical equipment, maintenance, and how they’re deployed and used. For facilities, it’s fire alarms, security, blood banks, and pneumatic tubes.

How do you get all those audiences with domain expertise on the same sheet of music? The workshop accomplished getting the group together for a common vision. SOA explains everyone’s responsibility for the architecture as it relates to their job functions.

Emergin was just named to the Healthcare Informatics 100 and one of Deloitte’s fastest growing technology companies. What are your goals going forward?

To continue accelerating our growth rate. We’ve had 70% to 75% for past three or four years and we’re still shooting for a triple-digit growth rate. We will probably hit closer to 80% this year. Those are ambitious goals. We’ve worked hard to build a market. We focus on customers. Doing the right thing has really helped us not only sustain the company, but build a solid brand recognition to set us up for phenomenal growth in years to come.

Most companies are happy with a 30 or 35% market share as a market leaders. We’re taking the Cisco approach. We don’t just want to be market leader, we want to set the standards.

As far as competition, there’s not much out there. We’re finally working with certain reporting organizations that are creating alarm and event management as a category for the first time. Joint Commission had written the effectiveness of alarm systems into one of their National Patient Safety Goals in 2006. Because there weren’t any vendors that could achieve those goals for hospitals, they removed it. We would suspect that after publicity from Texas Children’s and Beaumont, it could be written back into the charter and will fuel demand.

Your a technical guy. Are the skills you need to run a fast-growing company a lot different?

I’ve learned quite a bit on the job and I’m an avid reader. I’ve read about great companies, business leaders, strategies, leadership, marketing, and sales.

I’ve taken an interesting path from computer scientist to product manager, looking at business models and market segments for what we want to build, then putting the pieces together. My passion is getting more intimate with customers and leading sales and marketing initiatives for the company. It’s a unique transition for someone technical to grow into the business side.

Through the transition, I’ve recognized that hiring the right leaders, administration, and the engineering and services group really freed up my time to focus on sales and marketing. It allows me to spend every single week with customers.

When you look at personality types and skills, I’m a visual mathematician. I can take complex patterns and figure out formulas.

With the complexity of healthcare and the vendors in the ecosystem, we can help hospitals put a strategy together. The more you listen to customers and have them drive your roadmaps, the more successful you’ll be as vendor.

News 6/20/07

Wednesday morning update: Misys just announced results. I’ve posted details in the discussion forum. 

From Duuude: “Re: HIMSS Summit announcement listing the accomplishments of keynote speaker Michael Murphy, Sharp Healthcare CEO and winner of the CEO IT Achievement Award. Shouldn’t it also say, ‘ … and kicked IDX out due to poor product interoperability’ as an accomplishment?” Not by HIMSS, but the rest of us can feel free to do so.

From Lefty’s Lament in PA: “Re: Verus data breach. Rumor has it that Verus, Inc., vendor of on-line bill payment and Emdeon partner, has e-mailed its customers to tell them they are closing their doors due to insolvency. Apparently, investors fell through?”

From Irritated in Iowa: “Re: Allscripts. We recently went on a site visit for Allscripts Healthmatics ED to North Fulton Hospital in Atlanta and we were under the assumption that the ED medical director there was leading the site visit. He was actually an Allscripts employee who left the hospital several months ago! This seems very deceptive – no wonder we don’t like people in sales!” I omitted his name, but checked it out: he used to be North Fulton’s ED director and still has staff privileges there. He’s also consulting with Allscripts. No problem there as long as he wasn’t passed off as still being in charge during your visit, although some clarity about his role would have been appropriate. He’s still listed on some Allscripts material as being the hospital’s ED director, but that could just be outdated information or referencing the position he held during the implementation he talks about. Thoughts?

From Benny Hill: “Re: interviews. I really enjoyed the NYU and Allina interviews. They provided insight into what is often times the misrepresented world of implementations and go-lives (misrepresented by the vendor trying to see you what you have to implement). Any Cerner or Siemens Soarian clients stepping up to the plate? I think a Cerner client would have an interesting story. It would be even better if you could interview a CIO from ”across the pond’ on how their Cerner implementation fared.” Thanks! Inga and I enjoyed doing those interviews, too. If you’re a hospital CIO, we’d be happy to interview you (we’ll tag you as anonymous if you insist, although we’d rather not.) You may not think you have anything interesting to share, but we can always turn up fun stuff to talk about (and make you semi-famous in the process.) Since Benny wants to hear from Cerner and Soarian shops, we’ll give you high priority. E-mail me. We promise to make it fun.

From Ilich Ramaraz Sanchez: “Re: FCG. why is it a surprise that they might go after some old employees? Consulting vendors and HIS vendors have done so for years. If you have signed a non-compete and then take a list of current and former company employees and start contacting them, why wouldn’t they go after you? They have sent cease-and-desist letters – it’s nothing new. Some former employees have been pretty blatant in their new businesses. Competing against your former boss utilizing their former employees takes serious cojones. Yet, at the same time, one wonders perhaps FCG does not want to make waves, considering they have people lurking in the shadows of their own hallowed halls waiting out their non-compete from rival companies.”

From The PACS Designer: “Re: Azyxxi. Dr. Bill Crounse’s HealthBlog site has a new post on Azyxxi. Since it has been awhile since there have been any discussions on the subject, it now looks like activity is picking up with the announcement that Johns Hopkins has jumped the the Azyxxi bandwagon. For those that are interested, the site has an audiocast with the key players comments on why they chose Azyxxi.” I was supposed to see it awhile back, but that never panned out. I haven’t heard much lately, either, although I’m sure work is being done to bring it up to Microsoft’s standards.

From Russell Casse: “Re: Healthvision. Major layoffs at Healthvision appear to be happening today (20-40 total). That leaves just three people on the executive staff. Verisign is not giving them any more cash and VHA seems to have all but disowned them, as they sent a memo to their members stating that they are no longer affiliated with HV.” Confirmed: restructuring occurred today on the low end of your range. I’ve redacted the names you mentioned since I sure wouldn’t want mine put up on some idiot’s blog after I’d already suffered the indignity of losing my job. Nobody likes layoffs, but it’s a fact of life, unfortunately, even though both employees and management are doing the best they can. Otherwise, life goes on: the company still has customers and work to be done. Condolences to those affected (and to those who had to orchestrate the unpleasantness.) There are plenty of jobs out there for the displaced. Some of the sponsors whose ads are to your left would love to talk to you, I bet.

Reader Matt wrote this response to a New York Times article called Who Pays for Efficiency? “In Steve Lohr’s examination of the costs and benefits of electronic health records (‘Who Pays For Efficiency’, June 11, 2007), he addresses physicians and payers, but he is missing the most important stakeholder – the patient. While insurance carriers may bear the greatest financial benefit from the use of electronic health records, patients experience safer care and improved outcomes – all of which help to defray overall healthcare costs. When combined with recent efforts in healthcare information exchange and the ability for physicians to see a patient’s record along the continuum of care – all enabled by electronic health records – the benefits to patients extend beyond the physician’s office to other venues of care including the hospital and most importantly to the emergency room where quick access to a patient’s medical history is critical in providing timely and accurate care.”

Misys will provide a trading update Wednesday that should tell us how healthcare is doing.

Healthcare companies on this year’s Computerworld’s 100 Best Places to Work in IT: Sharp HealthCare (#3), VHA Inc. (#16), Sutter Health (#18), Norton Healthcare (#34), Partners (#37), Memorial Long Beach (#42), Cerner (#59), Palmetto Health (#62), Moffitt (#68), Englewood Hospital (#94), and Duke University Health System (#100).

Fred Trotter has posted a guide to sharing medical software via FOSS licensing.

eScription recognizes its customers who have saved big money through the use of its products. Lots of familiar names are on the list: Carle Clinic, Charleston Area Medical Center, BIDMC, Brigham and Women’s, and UNC Health Care (those are the ones I know very well.) One winner said they’d chopped transcription turnaround time from two weeks to 24 hours. Speaking of eScription, the Columbus paper mentions that a local hospital improved transcriptionist productivity so much that it’s doing outside work for doctors. Said one of its customers: ‘When Mid-Ohio Surgical Associates signed up with Mount Carmel as a customer for the service, the company was told that turnaround time would be 24 hours, said David Hafler, administrator for the practice. ‘We were like, we’ll believe it when we see it,’ Hafler said. ‘Well, we see it.'”

Sumter Hospital update: they’ll move to the interim hospital just over three months from now. The oncology clinic has seen its 1,000th patient since its relocation. Some NFL players helped out with a charity golf tournament – the winning team from Depot Car Wash donated its winnings back to the hospital. They held a silent auction and black tie dinner this week, raising $16,000 from the auction alone. Pictures of Sumter Regional East are here.

Housekeeping issues:

To your right (on HIStalk2 only) is a new “Subscribe to Updates” box. That gets you on the “new” e-mail update list. The old one may go away eventually, so I suggest signing up (the new one is more powerful, so that’s why the change.)

I’ve heard from a few readers that IE7 is giving errors when displaying this page. It’s apparently common because of the way the sponsor ads are formatted, but it gives no errors in Firefox and only minor errors in earlier IE versions. If you’re having to click OK a bunch of times, you can turn off script error checking and debugging in IE (or download Firefox.)

I added a link to HIStalk Discussion at the top of the page (Inga’s good idea.) Also, notice that if you hover your cursor over the discussion topics to your right, you can read the first part of each item without clicking (I just discovered that.)

Why post to HIStalk Discussion instead of leaving a comment? Better formatting, automatic quoting, polling, your title shows up on the main HIStalk page, and you can easily include links. Best of all, you don’t have to wait for me to approve your message – since you’re registered, your message comes up immediately.

Today is HIStalk’s fourth birthday, an obnoxious little hellraising toddler with the sweetest face you can imagine when it’s asleep.

As Inga reported on the discussion board, Misys Healthcare names Gary Larson to run its homecare division. He was CEO of a Kodak subsidiary.

Here’s another excuse for physicians to keep paper-based records: a law journal says EMRs raise malpractice liability risks. Reasons: data loss, inappropriate corrections, inaccurate entries, unauthorized access, and problems when transitioning from paper. All sound like advantages of EMRs over paper to me, but I’m not a smart lawyer. One reason that does make sense (rightly or not): EMRs provide a permanent record of overridden clinical warnings that could be used as evidence. I know I’ve had to cough up electronic evidence of such warnings and responses in the past, but I don’t know if it ended up being important to the case.

West Virginia Governor Joe Manchin writes a good newspaper piece on EMRs.

News, rumors, e-mail me.

Discuss today’s HIStalk.

Last week I mentioned that Mark Anderson and the AC Group just released the 2007 PMS and EHR Vendor Functionality and Company Rating Report. For those not familiar with The Healthcare IT Futurist Mark Anderson, he is CEO of the AC Group, which publishes rankings of PMS/EMR/EHR products. The evaluation is based on surveys with several hundred questions on product functionality. Unlike some other rankings (such as KLAS,) the emphasis with the AC Group rankings is functionality, though client satisfaction and company viability do come into play to some (unclear) degree.

For grins, I cross-referenced the KLAS rankings with the AC Group rankings and determined that strong functionality does not always equal client satisfaction (assuming that KLAS rankings really do represent client satisfaction – and I am not going to address that already well-addressed topic here.) Not all the products were assessed by both rankings, by the way.

The takeaway, I guess, is that if you are looking for an EMR solution, best not to depend too heavily on just one set of rankings.(Which brings up another topic … do you think there is a need for some sort of on-line vendor guide that compiles various rankings and commentary from users – such as HIStalk readers?)

Anyway, back to the AC Group. Here are a few takeaways from the rankings.

Who is hot

NextGen stands in a league of its own, with top ranking in all the categories in which it was ranked (which was everything except for 1-2 doctor solutions and “charting systems”- in other words, EMRs that were not considered full-fledged EMRs.) Note that in the KLAS rankings as of the end of 2006, NextGen ranked 12th for 1-5 doctors and 6th for 6-25 and 25+ docs.

The also-hots

Allscripts, with strong functionality rankings for both TouchWorks and HealthMatics. The HealthMatics products were ranked between 3 and 8 in various categories; TouchWorks 2nd and 6th. Predictably, HealthMatics was higher ranked for solutions for fewer physicians and TouchWorks did better in the large solution categories. There was some similarity in KLAS and the AC rankings for the Allscripts solutions. TouchWorks was ranked 2nd in the KLAS 25+ category. HealthMatics was ranked 6th for 1-5 doctors and 3rd for 6-25 doctors in KLAS.

eClinicalWorks had solid rankings and good KLAS numbers. Others with relatively strong functionality ratings included Streamline MD, MCS- Medical Communication Systems, and McKesson Practice Partner. Streamline and MCS were not ranked by KLAS; Practice Partner had average KLAS scores.

Middle of the pack

Others with solid though not outstanding rankings included Omni-MD, Bond Technologies, Misys, Greenway, GE Healthcare, and Epic (although Epic was #3 for FQHC and >100 doctor solutions).

Charting systems

The top charting systems included MediNotes, SynaMed, Medinformatix, Cerner, and SSIMED. Again, charting systems are considered to be those EMRs that are not full-featured EMR’s.

I am curious what others think about the value of these rankings, so please share!

I have enjoyed talking to a few of our sponsors over the last couple weeks. If they did a KLAS ranking for sponsor satisfaction, I think HIStalk would be Best in KLAS. Take note, all you potential benefactors who are considering joining the coolest sponsorship group out there … our sponsors love us because they get great exposure, personal attention from Mr. H (and me),  and the rates are a lot less than many, many other options out there! And Platinum sponsors have the opportunity for a personal interview by Mr. HIStalk to introduce you to our big audience (come on, you know you have always wanted to talk to him!) Let me know if you want to hear more.

Speaking of sponsors and KLAS, congrats to Hayes Management Consulting for their #1 KLAS rankings in the categories of Planning & Assessment and Implementation Supportive. Hayes was also ranked second in Technical Consulting and Overall Professional Services in KLAS’ Mid-Year Top 20 Report.

Also, kudos to sponsor InterSystems for Ensemble’s #1 ranking in Other General Market Software and Interface Engines.

A round of applause for sponsor eScription for EditScript’s top honors in Transcription and Back-End Speech Recognition.

Anyone care to comment on the recent KLAS rankings?

NHS’s Granger Announces Resignation

Richard Granger, head of NHS’s Connecting for Health in the United Kingdom, has announced that he will leave the program at the end of the year. Britain’s highest paid government employee says he had always planned to give the position, which he called “relentless”, five years and that he wants to spend more time with his children.

Granger says he’ll go to work in the private sector in 2008.

Monday Morning Update 6/18/07

From Father Pablo Martinez: “Re: top CIOs. eWeek’s got a Top 100 CIO list and here is the extract of the healthcare IT top movers and shakers: #24 John Glaser (Partners Healthcare) edging out #41 John Halamka (pick one – CareGroup Health System, Harvard Medical School, and Harvard Clinical Research Institute) and #94 Dan Drawbaugh (University of Pittsburgh Medical Center). In the retail HIT space – #63 Denise Wong (Walgreen’s) beat #73 Jonathan Roberts (CVS/Caremark) and #86 Michael Laddon (Long’s Drugs). In the pure HIT space – #69 Randy Spratt (McKesson) barely sneaks past #72 Jody Davids (Cardinal Health).”

From Aristotle Sarajos: “Re: Google. Google VP Adam Bosworth said at the AMIA Spring Congress that Google would create a PHR because the medical and HIT communities hadn’t managed to do so. An ironic twist will be if whatever they cook up answers a question he posed about doctors: ‘How do you know who is well seasoned?’ and the answer is … not Dr. Zeiger who indicates that ‘about once a week, I still practice as an urgent care doctor at a county hospital.’ Of course, if you’re at an urgent care clinic, you probably won’t have time to Google your provider. As for me, I really would prefer the doctor that is devoted to practicing full-time, not just for licensure reasons or for street cred among other physicians (although that is a common practice).” I bet Google’s paying him plenty well to preclude his need for additional work. Plus, there’s all those cool perks, at least if you don’t mind hanging around co-workers not yet finished with puberty.

NHS’s Richard Granger says IBA will take over iSoft within a week, although he’s still considering dumping them for Cerner Millennium. Interesting: he revealed that he’d already put a team on the ground in India to start developing an internal solution in case CSC blocked the IBA takeover of iSoft.

Check it out: HIStalk Discussion. Register. New topics are listed to your right.

Kardia, a Rochester startup, has licensed Mayo Clinic’s echocardiagram software to sell to other hospitals. Mayo gets a 15% stake in the company.

An investment group puts money into Meditab, along with the obligatory installation of its own people. The company makes physician office and retail pharmacy systems, among others. It offices are in California, India, and the Philippines. A pharmacist customer is quoted: “You can fill 500 Rx’s per day with one Pharmacist, one intern, one tech, two clerks and one ScriptPro.” In states where that clinically dangerous workload and supervision level is not illegal, that is. Still, it must be an efficient product to allow it. I see its EMR product is CCHIT-certified, although that’s hardly exclusive territory these days.

Odd: a doctor in Australia gets caught exposing patient information on his MySpace blog, which included the name of an 87-year-old patient along with details about the rectal exam he gave the patient.

Emergisoft will partner with Capsule Technologie (as I always say, spelled right, despite how it looks) for that company’s DataCaptor Connectivity Suite, which will collect and reformat medical device data for use in the EmergisoftED application.

The worst state in the US for healthcare: Mississippi. The bottom four are in the Deep South, probably as a result of infrastructure upheaval caused by imperialist US aggression, i.e., the Civil War (my joking theory.) Speaking of which, who names wars anyway, why do other countries have civil war but we have The Civil War, and what was World War I called before World World II started? But I digress.

As I speculated, the Patent Office gives VISICU a favorable ruling, although CEO Frank Sample seems to hold a grudge with his quote about “negative and misleading publicity.” The stock dropped on the news for some reason. The market cap is only $355 million, which one might expect to be attractive to potential suitors (Cerner? GE? The usual suspects?) now that the legal challenges to its intellectual property appear to be over.

More on King-Harbor Medical Center: security cameras recorded ED staff ignoring the women who died after 45 minutes of writhing on the ED lobby floor with the janitor sweeping up around her. The medical director was fired after a brain tumor patient was held untreated for four days in the ED before family sought emergency surgery elsewhere. The hospital is close to being shut down, only a few years after it should have been. It’s a teaching hospital – I bet residents there have scary stories.

Novo Innovations is offering a one-hour webinar covering the Novo Grid and community integration. Lots of folks were curious about the company after I interviewed CEO Robert Connely, so I’m sure they wouldn’t mind if you listened in.

News, rumors, pointless pontificating: e-mail me.

Discuss today’s HIStalk.

News 6/15/07

From Jean Roberts: “Re: AHIC. I am in complete agreement with Rep. Stark – ANOTHER setback. We all know the big vendors talk the talk, but don’t walk the walk on interoperability. It’s NOT in their best financial interest to interoperate.” Rep. Pete Stark is not happy with HHS secretary Mike Leavitt’s decision to privatize AHIC, the government’s main advisory board on HIT, from which David Brailer just resigned. From Stark’s announcement: “If the private sector was interested in developing or able to promote interoperable standards for health information technology, it would have done so years ago – and private companies wouldn’t today be asking the government to pay for it … It is well past time for federal leadership to fix this market failure.”

From Rogue: “Re: katrinahealth.org. A sponsor told me they plan to make the prescription database an ongoing thing. Pharmacies, PBMs, payers, and government agencies all feeding terabytes of data to Big Brother. Is anyone else fearful of a national database, accessible by tens of thousands of people, cataloging every medication I’ve ever had filled at a pharmacy? The medical director of the life insurance company to which I’m applying will now know everything. Where is the patient control of all this data? The list of participants at katrinahealth.org is downright scary. Your right to share my data with someone has to depend on my right to opt in. I’d love to hear from SureScripts, the Markle Foundation, or one of the other sponsors of this atrocity. How about the Privacy Foundation?”

From Tim Thomerson: “Re: new design. The new logo character looks like you, I assume?” No, I just asked the art person for a 50s looking, square-jawed doc with an old-school white coat, the reflector thingie, and an ironic smoking pipe. It’s a boring industry sometimes, so I like to make it fun.

From Duuude: “Re: GE. I’ve heard similar talk from GE about Centricity Enterprise, formerly Carecast: ‘The Stark law will boost sales of our product, don’t forget RHIOs, etc.’ I’m not seeing much of anything. Am I missing something? $1.2 billion is a pittance for GE – do you think GE is rethinking the whole IDX thing? Did they just want Imagecast and thought the rest was throw away?” So far, it’s Soarian II. If great things are happening at Intermountain, they’re good at keeping secrets. Isn’t it about time to back that baby out of the garage?

Speaking of which, from Lefty: “Re: GE. Te massive GE Project at Intermountain Healthcare seems to be a big-time disaster. One of our affiliates has an office in Utah. They are innundated with resumes from IHC people who are trying to jump ship. When these computer guys come in for interviews, they express complete disdain for GE while complaining about what they have done to IHC.”

From Abe Froman: “Re: FCG. I don’t think there is any truth to the ‘FCG going after ex-employees’ rumor.  FCG would be crazy to do it. I did hear two additional VPs have resigned.” Thanks. Outstanding phony name, by the way. A couple of former FCG’ers emerge again: Jeff Schaefer goes with IT consulting firm BluWater and Ken Light joins OmniComm Systems.

From T2: “Re: FCG. Heard that FCG has put out a financial ‘book’ on themselves in an attempt to sell the company. Any truth to that?” 

From MrMisyster: “Re: Misys. Now that Paul Lewis is trying to breath life into Misys as a services company, seems that the pressure is even greater to put Hospital Systems group (the only one making money, by the way) on the auction block. Expect more on this around the yearly client conference in Dallas
next month.” As I reported earlier, there’s little doubt that they’re looking for a buyer. OK, all you smart readers: who should buy the hospital group? Discuss here – I’m listening.

From Father Pablo Martinez: “Re: secret shoppers. Beth Israel Deaconess Medical Center has a two-year-old Mystery Shopper program giving good results. Customer service jumped from 2.6 (fair) to 4.8 (excellent). And, these people are more than customer service sleuths — they are sniffing out potential PHI violations, safety issues, etc.” It takes guts to implement that kind of program — you’re somewhat obligated make changes from what you learn. Hospitals aren’t good at holding employees to standards, demanding that obnoxious doctors tone it down, and firing malcontents. You don’t have to go undercover to see lots of opportunities for improvement.

Like in this case: our favorite third-world hospital (LA’s King-Harbor, formerly King-Drew) let a patient bleed to death unattended right in the ED. The patient’s boyfriend, who spoke no English, managed to get through to a 911 operator, who told him (justifiably, IMHO) that emergency services doesn’t deal with hospital quality issues. Relatives claim they asked for help from police, who then arrested the woman for a parole violation. She bled to death of a perforated bowel. I wrote a really long, impassioned, and vitriolic rant about King-Drew a couple of years ago, blasting wide enough to hit LA County, FEMA, Navigant, and Halliburton in just a few wincingly direct sentences. That wasn’t the only time (1, 2, 3, 4, 5). I don’t know if I was right, but I was definitely worked up. My vote for my own best line: “Why would someone not paying their own medical bills anyway risk their lives in a dump of a hospital like King-Drew, who admits that it killed several patients with medical screwups? Take a cab to a better one (Medicare or Medicaid is probably being larcenously billed for the ride as medical transportation anyway.)”

Remember: HIStalk Discussion is open. Anyone can read the messages and you can register to add one (it takes only seconds.) Over to your right, here on the main HIStalk page, the newest forum messages are listed under “Latest Topics from HIStalk Discussion,” if you’re reading the new format, anyway (still working on the old one) and you can click any title to jump right to that message. What can you do there? Add a comment about today’s HIStalk, read or post news or rumors, talk about vendors, start a poll, upload an attachment. Inga and I will meet you there.

A dedicated physician reader is heading off to Australia and generously asked if I’d like an on-the-scene report on anything HIT-related down there. I know a tiny bit about a few Australian vendors, but little else. Ideas? Let me know.

Maybe these guys: the South Australian Department of Health launches big upgrades of its patient and nursing systems.

Fred Trotter points out that Google is dropping some healthcare hints on its blog. (I notice that Roni Zeiger, their physician product manager, comes from the Palo Alto VA and Stanford, of course, specializing in informatics – sweet job!) Fred’s interpretation of the post is that Google is planning a PHR. I don’t read it that way. It sounds to me more like a carefully controlled and categorized medical search for laypeople with some kind of personal folder option (Google already has tools to save information for future reference.) Whatever it is, you know it will have ad capability.

athenahealth will hold a free webinar on Thursday, June 28 from 12:15 to 1:15 PM Eastern time. They’ll talk about their PayerView Rankings: how fast payers pay, their denial rate, industry trends, and how PayerView is improving efficiencies between payers and providers. You can register here.

Here’s a picture of folks in Cerner’s new Dubai office. Looks like Doug Krebs in there.

McKesson CEO John Hammergren’s 2006 compensation: $23 million. At least his shareholders did well, too, unlike those of several other richly compensated CEOs.

Some great quotes from this article by Andis Robeznieks on patient privacy and electronic records. John Halamka on interopability: “We have only one opportunity to build a healthcare information superhighway that patients and providers can trust. We should let the patients decide if they want to drive on it.” Peace Health’s Marc Pierson on information sharing: “We have yet to see anyone say they don’t want the ER doc to see anything. They’re not dumb. They want the ER doc to see everything—but why should their dermatologist know about the gonorrhea they had in their 20s?” And Pierson on cost: “They could probably give every patient in the country a PHR for what it would cost to give every doctor in Chicago an EMR.”

Siemens will partner with Partners (ha!) on service-oriented architecture technologies. Siemens brags that Soarian is SOA (or is that DOA?)

Michigan’s Trinity Health signs with MEDSEEK for web stuff.

Millennium Pharmacy Systems (PA) has interesting medication error prevention technology for nursing homes. “Its technology, used in nursing homes, tracks drugs from the time doctors prescribe them to the instant patients ingest them, documenting each step in real time, with warnings to prevent various errors, including drug incompatibility. It also creates electronic medical records for each patient, including a photograph, with a system of checks and balances in the dispensing and administering of prescriptions.” The company has 145 employees and just raised $40 million for expansion.

Kaiser says two of its hospitals — West LAMC and Santa Rosa — are fully running HealthConnect. 24/7, the press release says, although reports place that number closer to 23/6. Kidding.

The idiot whose botnet infected Cook County’s healthcare systems, including hospital radiology and pharmacy applications, is indicted on two counts of computer fraud. He’s facing a maximum 20 years in jail and a $500,000 fine.

News, rumors, biting satire: e-mail me, or use the confidential Rumor Report form to your right.

Discuss today’s HIStalk.

eClinicalWorks announces it will be releasing its unified EMR and practice management solution on Microsoft SQL Server 2005.

Cerner opens a new office in Dubai to supplement its Solutions centre in Abu Dhabi. Plans are to continue expanding their healthcare IT presence in the Middle East.

Eclipsys India has opened a new office in Pune. More support services will be off-loaded to the offshore operations for North American clients in order to improve cost efficiency and improve turnaround times.

E-mail Inga (you know you want to.)

News 6/13/07

From Alias: “Re: comments. To read all the comments, you have to go to both sites (HIStalk and HIStalk2). Hmmm … I would not think that was intentional.” It was, actually, but as part of a bigger plan. I can’t just delete the original HIStalk and its four years of content and comments (they are vastly different platforms.) Also, I have issues to work out, like the e-mail updates. It’s complicated to explain, but mostly invisible to everyone but me. I’ve already changed www.histalk.com to take you to the new site. Continue to read whichever version you like and stay tuned for more improvements.

In fact: take the poll of which version you’ll read going forward. It’s to your right (only on the original HIStalk since I don’t have a polling application for HIStalk2 yet).

Also part of the plan: the HIStalk Discussion Forum. I’m still setting it up, but feel free to register and start reading and posting. Why not start by discussing today’s HIStalk? Inga and I will be frequenting there, so please join us. If you don’t wander over, Inga and I will just whisper conspiratorially among ourselves.

From Father Pablo Martinez: “Re: data breach. Everyone starts to try and identify how the breach happened, who let it happen, what was breached, what are required to tell the state, the feds, the customers, etc. When NH-based Concord Hospital recently had a breach, it was their data but not their systems, and it brings up an interesting point – how do you guard someone else’s systems when they have your data? In the corporate world, you send out a small army auditors to periodically to review their business and accounting practices for any irregularities. Do hospitals need to do that? Their problem was with billing company Verus. Other hospitals reporting a Verus-related breach: Stevens Hospital and Kennewick General. The company turned off a firewall for maintenance.”

From Buck Ripley: “Re: Clarian. Any word on what system will be used as a replacement for Cerner’s Care Doc?” The hospital’s announcement said they were going back to paper while they wait for Millennium improvements. I can’t imagine running a standalone application, so that makes sense. I also wonder how jaded they are toward Cerner now. Probably not enough to replace everything, but I bet they’ve muttered about it. I haven’t heard if they have performance penalties in their contract. If not, they should have known better.

From Rose: “Re: GE. he latest PAG CIO meeting in Seattle had attendees feeling better about GE and the accquition of IDX Carecast than a long time. They have added well over 100 additional resources to jump start as well as build some basic development process and testing methodologies long needed for the Carecast product. Doing some creative things, but can they execute the needed catch up in time turn it around? The GE Energy guy brought in for the turnaround talks a good game and looks like he’s making the needed cultural changes. But, still many are looking around.”

Is Newt Gingrich’s Center for Health Transformation a free-thinking policy advocate, or simply a vehicle from which he lobbies publicly for his many high-paying sponsors? Says one open-government advocate: “It’s a phony think tank. He’s nothing but a corporate shill and everything he says about health care should be regarded with complete skepticism.” Of course, I’ve said pretty much the same thing here, despite my highly conservative views. Many positions for which he advocates directly benefit his sponsors, among them drug, medical equipment, and insurance companies. He left Congress in at least partial shame for similar activities. “He admitted he had failed to seek proper legal advice on using tax-exempt projects to advance his political goals and that inaccurate statements ‘in my name and over my signature’ had been submitted to the House ethics committee. He was reprimanded by the full House and assessed a $300,000 penalty.” HIT members of Newt’s for-profit: GE Healthcare, Siemens, Allscripts, Misys Center for Community Health Leadership, CHIME, Emageon, MedAssets, Quovadx, and others.

I see that 91% of you wouldn’t invest your retirement money in David Brailer’s equity fund, according to my reader poll.

Wanted: interview subjects (CIOs are especially encouraged.) Also, anyone willing to write regularly here along with Inga and me: CIOs, maybe a salesperson, a physician or nurse informatics person, or anyone with industry knowledge and easy, skillful writing. Where else could you get a ready-made audience for your industry expertise? E-mail me. It’s harder than it looks, but fun.

An interesting profile on NHS’s Richard Granger, described as “Short, stocky and pugnacious … focused but prickly.” He’s worried about iSoft, tired of criticism of Connecting for Health, and insistent that the project’s vendors aren’t enriching themselves.

Bizarre lawsuit: a cardiac patient’s angiograms are burned to CD, but mislabeled with another patient’s name before being delivered to the OR. The surgeon performs a triple bypass using the wrong images. The patient finds out afterward, gets mad, sues the hospital, gets a $140,000 settlement, and passes on the surgeon’s offer of $85,000 and takes him to court. The surgeon says he fixed her problem, but a cardiologist found she had 90% blockage in one artery and stented it. If you sell systems that are better than CD sneakernet, you might want to give the hospital a call.

Manual Lowenhaupt is named CEO of RFID vendor Radianse. MIT degree and Harvard MD, although long stints at Accenture (“thought leader”), Capgemini, and Deloitte take off some of that luster in my admittedly biased book.

Fun story: a programmer who wrote the operating system for the first portable defibrillator in the 1980s is saved by one last year when he collapses during a basketball game. The article brings up an interesting point: laypeople, even children, can save lives with automatic defibrillators, but in some parts of the country, even ambulances don’t carry them. That’s one of those translational research issues that plague US healthcare, I guess – convincing people to use stuff known to work.

DoD’s AHLTA EMR system (formerly CHCS II) is running in 138 military treatment facilities.

Henry Schein tries to expand its medical software line with an offer for Australia’s Software of Excellence International, which sells dental systems. I used to do business with Schein with all they had was a crummy paper catalog of medical supplies and drugs. Guess they’ve done well since the article mentions their revenue of $5 billion a year.

The Methodist Hospital, University of Houston, and Cornell’s medical school form the Institute for Biomedical Imaging Science, which will train scientists on biomedical imaging such as MRI, CAT, and nanotechnology.

Noteworthy Medical Systems will integrate DrFirst’s e-prescribing technology into its NoteworthyEHR.

It appears that the Patent Office has made a ruling on the patent suit involving VISICU. No official word yet. Could be good news for them, but you never know.

QuadraMed grants piles of shares as “additional compensation” to executives David Piazza, Jim Klein, Steve Russell, and Jim Milligan. I’m not clear on purchase vs. exercise price, but it sounds like free money for them after vesting. Shares are at $3.15, up exactly 50% from one year ago.

HIMSS and AMDIS (Association of Medical Directors of Information Systems) form some kind of alliance (that usually means HIMSS bought you or is about to).

Connecticut struggles to get accurate reports of Lyme Disease as its implementation of public health and biosurveillance information systems drags on. The problem: two big commercial labs have obsolete software.

Rumor is that First Consulting Group is going after some former employees who are starting their own outfit. Details, anyone?

News, rumors, pithy asides: e-mail me, or use the confidential Rumor Report form to your right.

So, I shared with Mr. HIStalk some personal opinions I had about the relaxation of Stark Laws, etc. Somehow that discussion turned into a request to share some of my “expert” opinions on the subject with readers. So, here are some musings …

When I first heard that not-for-profit hospitals could purchase EMR systems for physicians without risking their tax-exempt status, I thought, “Wow, great news for EMR vendors!” After a few weeks of contemplation, I have concluded there are a few ramifications that could muddy the waters a bit for vendors and perhaps cause frustration for many. For example:

n the short term, the relaxation of Stark laws may actually lead to a slowdown in EMR sales, because:

• Hospitals are not known to move fast. It will likely take months for many hospitals to decide what type of incentive they can/want to offer and all the associated guidelines.
• Many practices will not move forward on an EMR decision if they expecting to receive some sort of financial assistance from hospitals.
• In more urban areas with multiple and competing hospitals, there may be more wide-spread slow downs as physicians wait to see which facility can offer the best incentives.
• Some hospitals may decide that rather than allowing each physician select his own EMR, their incentives will include recommending and/or supplying the EMR solutions … back to the first bullet point that hospitals are not known to act fast.

If hospitals are selecting the EMR solution, look for the “name-brand” players, especially those that already have a footprint in the hospital space, to win more business than they might have if the practices were making their own selections. Because:

• Hospitals are more conservative. They will not want to risk upsetting doctors across their community by promoting a small niche player that may not have long-term financial stability and/or the resources to continually advance the product offerings.
• Hospitals are more likely to align with an existing vendor. If a hospital has Epic, Cerner, etc., then they have already formed an opinion of that organization and their products and support. They will likely hear their vendor stress that integration between the hospital and ambulatory products is easier with one vendor rather than multiple. Even if they are not totally happy with their hospital products, sometimes the known devil is better than the unknown one.

The EMR vendors must have an interoperability strategy, because:

• Hospitals want to build ties to their physicians and want those ties to be hard to live without. They want physicians to believe their practice won’t run as efficiently without an interface to the hospital system. Thus, few hospitals will commit to an EMR that does not have a proven track record sharing data.
• RHIOs are a hot topic. A physician’s office may be a huge proponent of a RHIO, but will have a limited voice and resources to push for a RHIO creation. On the other hand, hospitals can be key drivers in this movement. Traditional ambulatory care EMR vendors may need modify their message when working with hospitals to ensure they can address how their solution fits into the bigger RHIO picture. Having an alignment with at least one RHIO software vendors can’t hurt either.

Look for shrinking profit margins from EMR vendors. Because:

• Many hospitals have been and will continue to negotiate big bulk purchases of EMR licenses at a discounted price.
• Traditionally, EMR vendors have provided all the training and on-going software support for the physician offices. Look for hospitals to increase staffing on help desks and with training resources, since they are now able to provide this “benefit” to physicians. Training and on-going software support may not necessarily be profitable, but they can affect over all revenues.

All this being said … is the relaxation of the Stark laws a good thing for EMR vendors? As long as the interested parties understand that the floodgates for EMR sales and adoption are now suddenly open, then, I still say, “Yes, it is a great thing!”

Monday Morning Update 6/11/07

From Scot Silverstein: “Re: DHIN funding. Are you sure about that? The link does not work and I can’t find any other news stories via Google news.” The WMDT story has been pulled from their site, but it said: “The Delaware Health Information Network, funds for nursing expansion and Medicaid were also eliminated.” No mention on the RHIO’s site, but then again, the newest information there seems to be from early 2005 (ironically, most RHIOs have bad, outdated websites).

From TG: “Re: company dividends. Don’t be fooled. A growth company that issues a dividend is basically throwing its hands up and saying, “I don’t know what to do with the cash. Acquisition unlikely, our product is good enough, we don’t see need for infrastructure or human capital expansion, or any other real needs.’ I am reticent to call slower growth in this strong market, but when I see this action and it continues, I always bail on the stock, as it’s 95% a sign of slowing growth. You IT guys really need some business fundamentals. Great site!” You don’t have to convince me – that was Inga quoting someone else. I’m as old school as you. Growing companies borrow money, not rebate it to shareholders (who would vastly prefer growth instead of a few pennies.)

Speaking of RHIOs, Northeastern Pennsylvania RHIO has failed. Ironically, the organization didn’t even have the $26,000 needed to seek IRS non-profit status. It had a shrinking board and, like most RHIOs, little financial or community support. The only guy quoted as sorry to see it go was a vendor selling stuff to it. I’ve been saying all along that this would be the year that RHIOs started to fall like dominoes. Just seven months ago, the HIMSS RHIO Cheerleading Team claimed this particular RHIO was “gaining momentum,” apparently in the toilet-downward direction once the state’s money was gone.

Correction: I said earlier that Hoboken U. Medical Center was in NY. That was my fingers talking; everybody knows Hoboken is in NJ.

This won’t make the sales brochures: want to deliver lower quality diabetes care? Get electronic medical records. If you believe a new study, anyway. Main gripe: how do you define whether a practice has EMRs and how it uses them to tie that to outcomes? Still, I don’t doubt the article’s conclusion: buying an EMR alone doesn’t improve medical practice (no different than CPOE or any other clinical system, in other words.) It ain’t the size of the pencil, it’s how you write your name.

Former SMS’er Kermit Randa joins SIS as SVP of sales.

Cool new website design: Medicity. I see many vendors freshening up their sites with newer design practices.

David Brailer gives up his last non-enrichening position: vice chair of AHIC. I’m sure he had no choice, really, once he decided to cash in as a fund manager.

Latest news in the UK’s HIT love triangle: IBA is considering suing CSC and Connecting for Health after CSC blocked its bid to acquire iSoft. OK, I’m officially at the “I don’t care any more” phase of this story.

News, rumors, something newsworthy since darn little seems to be happening: e-mail me, or use the confidential Rumor Report form to your right. 

News 06/08/07

From Rowdy Yates: “Re: Kaiser. Kaiser IT is reorging again. Announcements and new org chart went out yesterday with no names attached. Some current VPs have to be out since, by my count, there are fewer slots than VPs. New CIO said there will be jobs lost and jobs added so the new head count won’t be finalized right away.”

From Fish n’ Chips: “Re: COBOL. Per Computerworld, my COBOL skills are dead? I beg to differ. At the ripe old age of 54, I get weekly job (consulting) offers. Mostly for LastWord/Carecast gigs.” That’s what you wanted to hear, though … it will drive all the young ‘uns and foreigners into something sexier, thereby raising your price. Mr. HIStalk loves him some personally enriching supply and demand.

From Father Pablo Ramirez: “Re: PC Connection. PC Connection seems to be legitimizing healthcare being placed in its own business unit by its HealthConnection Summit, following CDW Healthcare’s creation of its own channel. I saw John Wade, former CIO of St. Luke’s, there and he was spot-on fantastic and knows his stuff, both as a CIO and an IT practitioner.” Maybe he should be interviewed here? I’m always on the lookout for interesting folks to talk to with you HIStalkers listening in. Nominees?

The proud unveiling: HIStalk2 is now up and running. Professionally designed (E. Webscapes), illustrated (Samantha Wise), and powered (WordPress.) It has cool features, like the ability to print an article, nice comments display, and RSS feeds (I’ve enabled full text.) It will have the same articles, sponsor ads, and text ads as the ‘regular’ HIStalk, so choose whichever you like better for reading. How’s that for choice?

So why two HIStalk versions? Two reasons: redundancy and design. Blog City is a great host, but the last scheduled downtime was hard. If HIStalk.com won’t come up, just go to HIStalk2.com instead. Plus, it looks very cool, and WordPress is so Web 2.0 that I bet even Scott Shreeve is jealous.

Last HIStalk2 item: most people get to HIStalk by clicking on the e-mail link when I write something new. You won’t get a second e-mail from HIStalk2, so the only way to get to the new site is to type it in directly: www.histalk2.com. Remember that if the original HIStalk goes down.

Here’s another HIStalk sponsor benefit: you’ll get to speak to the lovely Inga! She has graciously agreed to assist by contacting current and prospective sponsors to see how we can help. If the HIStalk value proposition wasn’t already already killer enough, well, there you go.

Speaking of sponsors, a tip of the glass to Hayes Management Consulting on their being named to the Top 100 HIT providers in the country for 2007 by Healthcare Informatics. Other sponsors named: Healthia Consulting, Picis, and InterSystems. Ignore those other 96 companies since they don’t have the strategic insight to join our merry band. This is one of few awards I actually pay attention to, by the way, because it isn’t phony or biased.

Walgreens’ licenses kiosk and EMR software from Ethidium Health Systems for use in its Take Care Health Systems retail clinics.

New poll to your right: would you invest your money in David Brailer‘s equity fund? He’s not saying how much he’s making off the deal. Lots, I’m sure.

EpicTide announces GA of its FairWarning Policy Engine, a security appliance that monitors audit logs out of the box for Cerner, Centricity, Misys, McKesson, and other common healthcare applications.

McKesson flexes its legendary core competency: it brands the Horizon name on somebody else’s cow. I predicted it a month ago: “McKesson licenses the Anesthesia Information Management System from DocuSys. Shockingly, nothing was mentioned about calling it Horizon, although I have no doubt that’s already underway.” Maybe they should buy another of their key technology providers: HL7. As much as we purists beef, they’re still making pots more money than the folks who build stuff, in most cases.

Hoboken University Medical Center (NY) outsources IT to NIT Health.

Cleveland Clinic will manage Sheikh Khalifa Medical City in the United Arab Emirates. Cleveland Clinic’s surgery chair is named CEO and will take four colleagues along to fill key management positions, among them CIO.

Military computing problem: the MC4 battlefield computing system runs on Win2K, which isn’t allowed on some military networks because of security concerns. That’s according to an internal briefing, which also says that healthcare providers are poorly trained on MC4 and the patient tracking application.

HIT may become the first of few national issues to gain non-partisan consensus.

Ex-con Paris Hilton: “… I have my family, my friends, and my fans to support me …” Fans of what, exactly?

CSC finally comes out and says it may bid for iSoft. Happy to reciprocate in the now-consensual relationship, iSoft stops suing them. The company’s character has been established; now they’re just negotiating price.

Bizarre lawsuit: a man buys a Boost Plus drink at a local drugstore (it’s a milkshake-type nutrition drink.) He says he woke up the next morning with “an erection that would not subside.” He’s suing the company that makes it. They’re probably secretly thrilled at the sure-fire millions that news of the suit will bring.

A VA hospital’s education coordinator uses e-mail to send a class roster that includes employee names and the last four digits of their SSN. The whole idea of a SSN being super-secret and a target for no-gooders is recent. Time for an extra layer of security, I expect, once having knowledge of a number and nothing else can open the vault.

Funding for the Delaware Health Information Network is axed from the dwindling state budget.

VISICU names Elaine Comeau as its chief nursing executive.

News, rumors, amusing cynicism: e-mail me, or use the confidential Rumor Report form to your right. Have a great weekend.

Special thanks to Zach Mortensen,who proved to be a guru regarding the whys and hows a company like QSI/NextGen would pay out a dividend rather than invest that same money in R&D. He had several good theories that made sense, including:

• A little-understood fact of the software business is that the incremental cost of adding each new feature increases exponentially as a function of software size, while the incremental benefit of each new feature increases at a much slower rate. Software systems eventually reach a point where the incremental cost of a new feature is greater than its incremental benefit, and it therefore makes no sense to “re-invest” in features. If QSI has come to the realization that continued software development might not make economic sense, they are smarter than the average software vendor.
• Two insiders control 19% and 17% of the shares, respectively. Each stands to bank north of $1MM in dividends without the need to sell shares.

I am intrigued by the newly announced coalition called Health IT Now!. Their mission is to promote the rapid deployment of heath information technology and will be pushing for federal legislation by the end of 2007. The founding members include a couple of former Congressmen and a cross section of influential medical, professional, and other organizations. It will be interesting to see if this group is able to pull together and have some effect, especially in this year of presidential pre-election posturing.

The US Attorney’s Office has settled with the Harris County Medical District for over $15 million, in connection with a lawsuit alleging improper Medicare/Medicaid billing. The original suit was filed in 2003 by an employee who accused his employer of submitting claims to Medicare and Medicaid without first billing the primary commercial insurance carrier.

Duke Clinical Research Institute concludes that extra pay does not improve hospital performance. The study is interesting, but to take the non-patient, perhaps cynical view of things, P4P is important to HIT not just because of outcomes, but, because it affects reimbursements. Let’s assume a physician is already providing quality care. HIT can give the provider the necessary tools (EMR, etc.) to document that care and thus be paid (extra?) for the care. Healthcare IT is thus a necessity just to assure proper payment if P4P is going to be the benchmark for payment.

E-mail Inga.

News 06/06/07

From Terry McKay: “Re: HIMSS and nursing ratios. HIMSS came out against mandated staffing ratios, saying some other acuity-based method would be used. That hasn’t happened, of course. Who will protect nurses and patients? Even California’s mandatory ratios are being gamed, with hospitals cheating and assigning housekeeping and dietary duties to nurses, with big problems (infection control crisis). I have no love of unions for nurses, but I don’t see an alternative to get the attention of hospital executives.”

From Nickie Ferrante: “Forget the rumors about Misys purchasing Bond or e-MDs. Misys is looking for an established ASP EMR and not another turn-key solution.”

From TenaciousD: “Re: Eclipsys. Andy Eckert, Jay Deady, Brian Copple, and others are dumping stock. Are they regular, scheduled sales to take profits or is
something else going on?” I’ve not heard anything, but these are all new guys who were given tons of “welcome to the company” shares, so maybe it’s routine. Anyone know otherwise?

From Seimore Skinner: “Re: Kaiser. I thought you might be interested in this article on more problems at Kaiser.” This one’s about their botched kidney transplant program, but with a different angle: information management problems were largely responsible. Examples: inability to transfer data in for the first 1500 patients; no database of patients to check to make sure records were complete; missing or incorrect data in patient records that caused patients to move down on the national transplant waitlist; delays in completing paper records; extensive use of fax machines as middleware; and no way to track complaints. Kaiser eventually shut the program down and its lawyers are working hard to get suits against it into arbitration and out of the public eye. “Core questions remain, including why it wasn’t until Kaiser decided to close the center that it put in information technology, such as custom spreadsheets and a virtual private network between it and UC, to help manage patient data. Why, despite Kaiser’s pioneering work in electronic medical records since the early 1990s, the new transplant center apparently managed most incoming patient data on paper. Why it didn’t use one of the specialized transplant databases available from health-care technology vendors. Why it wasn’t until the end that Kaiser developed basic policies and procedures, such as weekly meetings and monthly reports, to ensure data didn’t go missing and appropriate parties stayed apprised of Kaiser’s progress with patient records.” Good article by Baseline.

From Richard Gilmore: “Re: Health Quest. Heard through the grapevine that Nicholas Christiano, Jr. resigned as the CIO at Health Quest effective last Friday, June 1. He was also the CIO (and CEO?) of their for-profit IT business known as HealthServe.”

From lolhit: “Re: Misys. Misys may be in the process of acquiring Medicity.” Kipp says no. Strongly. Emphatically. Medicity is doing just fine, at least from my cheap seat.

From Soul Survivor: “Re: Misys. Misys needs to buy something. Call Vern and ask about sales from the physician group the last two months of the fiscal year. Despite the feel-good press releases, sales are at a five-year low. Little new is being sold – all to customers. Boston Consulting Group’s recommendations are not due until August, so the sales meeting was postponed until then.”

Potential sponsors have asked several times about having ads created like the cool ones to your left. I’m graphically challenged, but I finally got smart: I’ve engaged the services of someone who does great ads, banners, and any kind of graphics. Here’s a deal I’ll offer: if you’re considering sponsoring HIStalk (thank you!) but have held back because you don’t have a nifty online ad, I’ll have it done for you at no extra charge. I’m anxious to see how my new guy does, so e-mail me if you’re interested. And as far as value, I strayed onto Modern Healthcare’s price list (warning: PDF): a smaller ad with 1/4 of HIStalk’s page views is 3 to 25 times more expensive there than here, depending on placement.

Speaking of ads, the text ads to your right are getting great page views and clicks. They’re inexpensive, short-term, and very noticeable. Suggested uses: meeting announcements, job notices, links to report downloads, booth numbers for a conference, subscriptions, mailing list signups, etc.  Now’s a great time to run one since the price may go up and lots of folks may sign on. More information.

Needed: a couple of folks willing to test the new HIStalk discussion board and recommend any changes before I open it up. It’s a lot more powerful than the old one (and better looking). E-mail me.

A reader sent over an article from the March 2007 Journal of Patient Safety called “Evaluation of Nurse Interaction With Bar Code Medication Administration Technology in the Work Environment.” It describes a human factors study from University of Wisconsin that looked at how nurses use medication barcoding systems. Conclusions: (a) bedside barcoding is a highly touted idea that few hospitals are using; (b) the most frequent nurse workaround was to scan after giving the med instead of before; (c) non-barcode checked meds were given in a third of the observations, either because the barcode couldn’t be read or the nurse just didn’t do it; (d) 16% of observations found a potentially dangerous practice, like giving the med without scanning the wristband, not documenting administration at all, or recording a med as given when it wasn’t; (e) ‘automation surprises’ occurred in 16% of the observations, including problems with the scanner or network; (f) warnings came up in 42% of observations, most of them legitimate. The biggest problems for the nurses were interruptions, messy or low-lit work areas, scanners that weren’t working, and scanning meds for isolation patients. It’s a pretty good article (small sample size, though) that calls attention to the mostly overlooked human aspects of automation.

I hear from a reliable source that Misys Healthcare is shopping its hospital business around, hoping for a quick sale. I think that’s a good idea, one I’ve advocated all along.

Cerner CFO Marc Naughton says the company is doing fine without GE or McKesson. Analysts threw out names they thought were more likely to acquire CERN: Oracle, SAP, IBM, Philips, and Sismens. Move along, nothing new to see here.

I mentioned previously that I hadn’t seen a study proving that a clinical system can reduce mortality. A reader reminded me of VISICU, whose eICU program I’ve mentioned before. I have no doubt that it really does reduce mortality and I think it’s a great advance medically and not just technically. I wasn’t including it because I don’t really consider it to be a traditional IT system. If I was admitted to the ICU, would I want to be in an eICU-serviced bed? Oh, yes.

An interesting twist to the iSoft saga in the UK: CSC can take over iSoft’s R&D if iSoft’s NHS code deliveries run behind. If that occurs, iSoft is automatically thrown into default on its debt convenants. And if that happens, and if CSC manages to buy enough of that outstanding debt, then guess who gets the keys really cheap, all via a nearly automatic process? iSoft had to sell its soul to keep afloat throughout its accounting scandal.

I had an odd PC problem, the solution to which I’ll describe in case you have it happen. I couldn’t access a particular website from home, but it worked fine at work (I was getting a 404 error in Firefox, IE, and Opera and swearing it was the site going down.) The fix: I flushed my DNS cache (from the WinXP command line: IPCONFIG /FLUSHDNS) and then powered my modem and router off and on again. This help desk moment is brought to you by HIStalk.

Don’t forget Matthew Holt’s Health 2.0 conference, coming up in September.

I’ve got an offer to speak at a conference that I’m considering, thinking about some kind of phony mask (William Shatner from Halloween?) to keep anonymous. All I need is something profound to say. I’m not sure how much I have left after spilling my guts here. Maybe I can just have a reading like those hoity-toity authors. HIStalk turns four years old in a week or so, by the way.

Newt Gingrich’s for-profit Center for Health Transformation has something new to sell: a book called “Paper Kills.” Hint: it’s not about paper cuts. In it, people who sell technology and not paper advise you to use more of the former and less of the latter. Maybe Weyerhauser should do an expose of medical misadventure caused by faulty information technology, of which there is much.

Lancaster General Hospital (PA), loathe to give the residents who own it any of its $98 million surplus (or, God forbid, to reduce rates) will instead spend $60-100 million on electronic medical records. They claim patients expect that.

India’s Apollo Hospitals offers telemedicine to small hospital, providing second opinions free. The only cost to sign up is for a digital EKG machine. Cool idea.

Computerworld names the top 10 dead or dying computer skills: (10) OS/2; (9) PC network administrators; (8) NetWare engineers; (7) PowerBuilder; (6) C programming; (5) ColdFusion; (4) cc:Mail; (3) SNA; (2) non-relational DBMSs; and (1) COBOL. Certainly there could have been more: RPG, TurboPascal, Smalltalk, Visual Basic, FrontPage, Pick … well, obviously this could be a long list, even if covering only healthcare.

News, rumors, top secrets: e-mail me, or use the confidential Rumor Report form to your right. If I don’t say it enough, thank you for reading.
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Inga’s Update

Quality Systems, Inc., parent company to NextGen Healthcare Information Systems, announced a $0.25 per share cash dividend to be paid to shareholders this month. While as a shareholder a dividend is great, I am wondering why a dividend is being paid at all (and am asking for opinions of you gurus.) In this day and age where every IT company is constantly trying to leapfrog one another with the latest, greatest offering, why not re-invest in your products? Or, does QSI just have that much cash on hand?

The New York Times reports that David Brailer is starting a $700 million private equity fund, Health Evolution Partners. The focus will be investments in technology that will reduce healthcare costs.

Healthcare management company MED3OOO, Inc., (MED3OOO) has become a major stakeholder in Scottsdale-based InteGreat Concepts, Inc. InteGreat provides browser-based electronic health record (EHR) systems for physician group practices. MED3OOO will provide InteGreat with substantial capital and knowledge resources for its next generation of product improvements

Allscripts and NaviMedix announce an agreement to provide Allscript’s eRx NOW ePrescribing solution to NaviMedix’s network of more than 190,000 physician customers. eRx NOW will be offered at no cost to users of NaviNet, NaviMedix’s free web-based provider communications solution. As part of the agreement, NaviMedix also will become an executive sponsor of the National ePrescribing Patient Safety Coalition (NEPSISM).

E-mail Inga.