HIStalk Interviews Susanne Madden, President and CEO, The Verden Group

Tell me a little bit about your background and about The Verden Group.

Primarily I come from the provider side of things. I’ve worked for hospitals and small group practices from surgeons to pediatrics. I spent a long time there. Then I went out as a kind of independent consultant in a lot of process improvement stuff for physician practices. I ended up at United Healthcare for a couple of years, focusing on managing the provider side of things, looking after the network and tracking of physicians, being somewhat of a physician advocate from within.

About two years ago, I left United Healthcare and established The Verden Group. The idea behind The Verden Group was twofold. One was to continue the consultant services that I had started a few years before that. The other was to try and bring together information in such a way that it would be usable for physician practices.

It seemed to me, from the United Healthcare side, that there really was a disconnect between what insurance companies were communicating and how they were communicating, and what physician practices, hospitals and obviously the providers of care were actually doing in terms of being able to see that information, understand that information, and act upon that information.

The Verden Group was born as a way to take information flows and make them usable by what should be the receiving party. What makes that so difficult is that most insurance companies simply post changes on their Web site. Those changes take the form of everything from updating medical policies to updating payments and administrative policies. Some of these just post a notification on their Web site and some of these Web sites are a thousand pages deep, so it’s very difficult for providers of care to really keep themselves updated with all of the different things that are changing but can’t find it on the site.

Even when they do look at, say, a newly posted policy, it’s very difficult for them to interpret what it actually means, how it actually breaks down in terms of how they are supposed to bill, how are they supposed to code things, and what they are supposed to be doing in terms of providing care.

What we do at The Verden Group is something called the Verden Alert system. Providers of care subscribe to this service. They give us their e-mail address, their specialty, and the insurance companies they participate with. From there, we match them up with all the changes for these insurance companies.

We track 186 insurance companies nationally, 75,000 Web pages that we’re actively monitoring every 24 hours to pick up any of these changes. We break them down into what specialties they actually belong to. The insurance company themselves don’t break down by specialty. It’d be really nice for me to go to an insurance Web site and look under cardiology and see everything that applies to me. Unfortunately, it doesn’t work that way because a lot of medical policies apply to multiple specialties.

So we take this information, massage it a little bit, break it out into the individual specialities, and then further break it out into categories: administrative change, clinical change, formulary change. Then obviously our subscribers only receive the information that’s relevant to them. So if you’re a pediatrician participating in Oxford, Cigna, Aetna, and United, you’re only going to get information relevant to pediatrics for those four insurance companies.

It’s really not much incentive for insurance companies to be too user friendly because if practitioners don’t take the time to look up these obscure changes, they’re probably going to have their claims rejected.

You got it.

Insurance companies could do this if they wanted to.

That’s exactly right. There’s two schools of thought on this. If you talk to anybody at the insurance company, they’ll say, “No, no, we’re committed to transparency and getting this information across.” And you look at it and say, “Well, if that was the premise that you were coming from, then why haven’t you figured out a better way to do it,” you know? 

We’re seeing pieces here and there. The insurance companies are doing things like rapid updates, where you can sign up to get e-mail alerts every time they publish their newsletter. Unfortunately, a newsletter may have data that’s three months old, letting you know that three months prior, in the previous quarter, they implemented a whole bunch of policy changes that are now showing up in your inbox in the form of denials on your explanation of medical benefits.

That’s really how insurance companies make money. If they don’t have to pass through the premium dollars, then they get to hold onto much more of it. There are some that say, “No, no, we’re working for transparency. We really want this to work better.” But at the same time, they have not organized themselves well enough to actually prove that is the case.

They’ll say things like, “We’re trying to keep costs down by posting it up on our Web site. It means we don’t have to mail things and that keeps the cost of healthcare down. It’s an efficiency tool as opposed to anything more sinister than that.” You look at that and say, “That may be true in one regard, but it also works to their advantage.” So it really is a double-edged sword.

When we launched the Verden Alert, we had some mixed responses. There were some insurance companies that called up to make sure to make sure we were tracking them. They wanted to make sure that they were part of the Verden Alert because, “We want to know more about your services and we want to be part of this.” There were others that really were very suspect and wanted information about what we were doing and why; how we were managing the policy information, that sort of thing. They really wanted to protect their own interests a little bit.

Every quarter, we rank insurance companies. We grade them in terms of transparency. What is their clarity of communication? What is the notification period? Are they making changes 30 days before they implement them, before the effective date? What’s the cost to the provider? Things like adding prior authorizations onto medical policies. That’s obviously adding costs for physicians. Moving around criteria, making it more complicated to actually get paid for services. We pick them up on points for that.

We started ranking insurance companies and, very quickly, we were seeing which insurance companies wanted to engage and say, “OK, how do we actually move the dial on our rankings? How do we do better because we want to be perceived as a company that’s good to business with?” And others that simply wanted us to go away.

It’s a little ironic that some of the insurance companies have invested a lot in information technology, but in the form of keeping things more secure than making it easier for people to use.

How similar, or not similar, is what you do to what athenahealth does?

Athena does it a little different. What they are tracking are claims. They are looking at lines of data with claim sets, what they pay, how quickly they pay, what percentage is disappearing down the rabbit hole, and the percentage you’re getting denied.

They’re really looking at it from the claims perspective only, which is very reactive in a way. Everything comes back to them after physicians and primary care have actually billed out those claims. They can modify their engines based on what comes back so they’re capturing the edits that way, but their ranking system is really based on this reactive data.

What we’re doing is getting a jump on the insurance companies and being proactive, in terms of saying, “OK, we are now looking at your policy decision-making, your strategic decision-making really, and we’re tracking how that’s playing out.” So in addition to our rankings and really being able to quantify what they are doing, we are also able to have a bird’s eye view in terms of how these strategies are playing out.

We see various insurance companies pick on specialties. We see which specialty is going to be targeted on or dragged in on for cost saving quarter-to-quarter. Last quarter, the ophthalmologists seem to get hard hit by a number of insurance companies that applied a bunch of medical policies and put in a lot of prior authorization stuff. The quarter before that, we were seeing a lot of stuff in oncology and cardiology, so they are very often the hardest hit anyway. There’s an awful lot of activity around those specialties.

We’re almost able to gauge what will happen the next quarter based on how they’ve done financially. You see the profits begin to tank in one quarter, so you think OK, next quarter we’re going to see a whole round of prior authorizations, notifications, referrals. All of these administrative burdens go into play because that means it will be more difficult for providers of care to utilize those services and actually have those members take advantage of those services and for them to get paid for it.

All of a sudden an insurance company institutes a referral process or a prior notification on that. You’ll find the person will get their treatment, but the person who rendered the care is not able to get reimbursed on that. They realize that there’s been a policy or procedure change and then they adjust themselves. But it means that the insurance company had that 30-45 day window of these services that they don’t have to pay for because they can point to the policy changes and say, “Sorry, that was effective on September 1st. You should have checked the Web site or known magically that there was some kind of change here.”

If you like, it gives you the opportunity to do something about it, such as actually engage with medical directors at these insurance companies to say, “This is a bad policy. We don’t want this to go on your site.” For example, the American Academy of Pediatrics is very active, but some of their users are Verden subscribers and they really love the fact that they can get this information ahead of time, give them the jump on things, so that they can go to these insurance companies and say, “Wait a second. What do you mean you’ve decided that developmental a screening is part of the E&M code and not separately reimbursable?”

So do you think insurance companies are basically fighting and winning a war with providers by out investing them on the technology side?

I think it’s a very unlevel playing field. I think physicians really haven’t invested in the technology that they need. They haven’t even invested in the processes that they need to keep up with the technology. So you have very well-capitalized, well-funded insurance companies that are able to take advantage of all sorts of Web technology and put a whole bunch of stuff on the Internet.

The typical practice has maybe four physicians in it. You have somebody at the front desk who has a high school education, who really isn’t terribly savvy about accessing information and being able to utilize things like online eligibility and verification or claims adjudication. There’s a real disparity between the educational level of the folks that are working in physician offices compared to other folks that are in these insurance companies.

With that nice capitalization obviously comes the best and the brightest. With physicians, its kind of like, “OK, we’re paying $10 an hour,” depending where you are in the country, for folks to meet and greet the patients and take care of some of these things. So you have a real disparity there.

I think insurance companies really use that to their advantage instead of them dealing with physicians and saying, “Look, we’re bringing out all this neat stuff. Let us come into your office and show your staff how to use it, or let us put forward unified platforms across insurance companies where there’s one way of doing certain things.”

It’s simply not there. Each company has built out their own ways of doing things and than expects physicians to comply. If you’re an insurance company doing what you’re doing, I guess you get real fluent at that. If you’re a physician and you’re participating with 10 or 15 different insurance companies and you need to do the same things 10 or 15 different ways, you begin to see how very complex it becomes. Even though there is a lot of fairly easy to use technology there, it really becomes very cumbersome on behalf on the providers of care trying to actually utilize and access those information systems.

So is there any hope for a small practice that has minimal staff, other than just not accepting insurance?

Ha. Well, that’s certainly one way to go, to just say, “We’re not gonna deal with this.” I think that there are more and more smaller practices that are really having to go down that road.

There are a couple of things happening. They are either becoming cash-only businesses and limiting the number of patients that they have; they are merging because they need to stay alive somehow; or they are really hitting the wall. We hear, particularly in primary care, that they can’t cut it between the reimbursement rates being as low as they are and then the high costs involved with managing all of these different plans. They really are isn’t any margin left for these physicians. That why we’re obviously seeing fewer and fewer doctors going into primary care more and more into specialties.

I think the hope, though, is being able to move the educational dial, so to speak, on physician practices. Finding ways of getting education in front of them so they can understand the world of managed care. That’s really where that huge canyon stretches. The doctor’s focused on providing medical care. The staff and the office are focused on meeting and greeting patients, getting patients in and out of the rooms. If you’re in the billing department, that’s about the only touch point that you have with the insurance company. So being able to get information in front of them in such a way that they can understand what’s going on.

Unfortunately, sometimes I’ll have conversations with physicians that’ll say, “Why do I need to know about medical policies? How does that affect me?” The single biggest thing that’s going to affect your reimbursement are these policy changes. They’re really unaware even of that.

They don’t read their insurance contracts. They just sign on the bottom line and say, “OK, I just have to take this plan. I’ll just sign the contract but I don’t understand it anyway. What’s the point in reading it?”

I think if there are great efforts made to really educate physicians about the business of medicine, then I think we can have a real groundswell that will help turn the tides. For the last 10-15 years, it’s been about how much the insurance companies could take out of the system. That’s really what it’s come down to. Being the middlemen that they are, they’re the ones that make all the profits of this deal.

Certainly there are some physicians and some specialties that are doing just fine, but if you look at healthcare across the board in the United States, obviously you don’t need to be a brain surgeon to understand how much trouble we’re in. The expenses that are attached to healthcare, predominantly, is attached to the profit that the insurance companies are making out of the deal. The premiums that people are paying aren’t being passed through to the providers of care.

So you have these providers of care that aren’t able to understand the business of medicine. They aren’t able to engage on a level that says, “Wait a sec. This doesn’t work. This is not what we want to see happen here.” And consumers aren’t able to engage on that level either. I mean, even if you just read your own benefits package, do you know what it’s telling you? Can you understand what is actually covered and what isn’t? Of course not, because it really is made as convoluted as it can be and, of course, the insurance companies retain the right to change these at any time, which is why there are all these policy changes.

We’re processing anything from 600 to 1,000 policy changes a month. Some months it’s double that, depending on whether it’s close to the end of the quarter or not. It’s a very dynamic environment where the insurance companies are constantly moving the goal posts. Consumers and physicians really can’t keep up, so the only hope is that can come in there is in the form of transparency and better education.

When we talk about things like consumer-directed health plans … as well as being adopted, it’s failing miserably. It’s being adopted so the employers can get their costs lower, but in terms of the people that are on the receiving end of those plans, they don’t realize they have $3,000 deductible before their benefits are going to kick in. They don’t have the $3,000 to meet those deductibles, so they are simply not acquiring care.

They’re not able to shop around because there isn’t pricing transparency with the insurance companies. One of their single biggest proprietary pieces of information is their fee schedule. So you can’t say, “If I go to the Dr. Smith down the street, it’s going to cost $200. If I go to Dr. Jones in town, it’s going to cost $100. Therefore, I’m getting something worthwhile by keeping that $100 in my pocket.” There just isn’t the transparency there between the physicians and the insurance companies and the consumers.

It doesn’t operate like anything else. There’s nothing else in any other industry to compare this to, this complete opaqueness that has occurred with the insurance companies. There’s no transparency in pricing; no transparency in contracting; no transparency in rules.

It’s really pretty under-regulated. It depends obviously on which state you go to, but here in New York State, they’re really not regulated in terms of being able to change their premiums and pricing any time they want.

There’s a bunch of things that need to happen for there to be some hope that the healthcare system can survive in its current form, but it has to come in the form of transparency. The only way it can be more transparent is by getting better information and better education out of the insurance companies.

Employees think they have healthcare, but what they’ve actually got is health insurance that pays less and less of the cost. If there was a total restructuring of the system where the insurance companies were left out of the picture or made less profit, could people afford healthcare even then?

I think we’ve seen the tipping point. We have finally seen the insurance companies kind of fall off a cliff, where they have gotten so overzealous with their pricing that their market has really shrunk.

Earlier this year, we heard Angela Braly, the CEO of Wellpoint, the biggest insurance company in the country, saying that they will not sacrifice coverage for profit. Basically meaning, “We will continue to price as high as we need to make good profits and we don’t care if fewer and fewer people are covered,” which really goes against the central philosophy of why the insurance companies are there in the first place. They are there to be able to cover people, so it really just shows you where the large, publicly traded insurance companies are at in terms of their culture.

But their membership has been shrinking and shrinking. United healthcare alone in 2008 has lost 750,000 members. That’s a huge number of premium-paying customers. And so it looks like the market is shrinking very severely for them, so they are coming out with a lot of these products that are really bare-bones products. The employers are saying, “Now I can still offer a plan to my employees, but at less cost to me and with greater costs sharing for them and higher deductibles, but I’m still able to offer that plan.”

People are really beginning to catch on that what they are now cost-sharing for, what they are now kicking in part of the premium on, and what they’re now having to pay these massive deductibles on, really gets them nothing for their money. So you have a real call in the consumer arena beginning to come in the form of, “We want options. We want the ability to purchase our own health insurance because it gives us greater control in terms of what we select for ourselves and what we’re willing to pay for.”

That said, there are so many people that can’t afford healthcare. The typical premium for an average family of four is close to $13,000 a year. If you have even just two parents working at $35-40,000 a year, that’s a tremendous amount of their income that’s going on just healthcare insurance alone. So I think the restructuring has to come in the form of paring it back to insurance. It’s no longer an insurance vehicle.

What we’re doing right now is paying insurance companies for the privilege of holding onto as much of our money as possible. What we need to be doing is saying, “This is an instrument that should operate like any other insurance.” You pay a modest premium for the unlikely event that you my end up catastrophically ill. If you want to pay additional, so you have things like well care covered, your annual visits, those sorts of things, you should be able to add that to the policy of that’s what you seek.

Certain states mandate that certain things have to be included in insurance companies that you may or may not use but you’re paying for. Insurance companies that are basically pointing to an underwriting cycle saying, “Yeah, we might be making massive profits this year, last year, and next year. But in five years, we might not be, and therefore, we need to really stock up on our reserves to make sure we can manage that.”

We need to start looking at: what is the purpose of insurance? What actually needs to be covered? How can people actually go about purchasing insurance for themselves that actually works for them? What are the products that need to be available and out there, and how can we understand what those products are?

Let’s keep it simple. Let’s not talk about benefits that have 10 tiers to them, where you have drugs that have four different tier levels. If your doctor prescribes you this, it will cost you $5, or if he prescribes you this, it’ll cost you $50. There’s just far too much complexity in it. It’s time to simplify it once again and bring it back to being a insurance instrument rather than the financial world that it’s become.

On that note too, a lot of insurance companies now are looking to becoming banks. Wellpoint has investigated having part of its company actually listed as a financial institution. They wanted to get into banking and the reason they want to get into banking is for HSAs, health savings accounts, because they realize if they control the money that is in those accounts and they can make a percentage on that, they can also charge for the management of those accounts. And then they’re also in charge of what they are actually going to pay the providers of care. So it means they lock up every single dollar potentially that is available in that healthcare pool coming from consumers to insurance companies.

You mentioned that few medical students are going into primary care. How can we fix the problem where doctors have to do more procedures to make more money?

I think that’s precisely what we’re seeing in primary care. It’s a thinking specialty. It’s not necessarily a doing specialty. Specifically, pediatricians. They’re having to see more and more patients faster and faster, just to keep the volume up to be able to meet the bills. But what they really are doing is this encounter base as opposed to performing procedures, being more procedure-based.

We really are seeing the death now of preventative medicine in the United States. Part of the shift has been because insurance companies found it a lot easier to be able to cut reimbursement to pediatricians, to family practitioners. They’ve really taken a lot of money out of that system. They’re not paying for those sorts of things. And so these doctors have a low incentive to go into these specialties in the first place. They have a much higher incentive to go into things like anesthesiology or cosmetic dentistry, those sorts of things you get paid for and you get paid handsomely.

At the same time, you have insurance companies putting dollars into things like disease management programs and pay-for-performance and quality measures. You look at that and say, it’s fine that you are quantifying and measuring these things, but unless you’re going to put money into those things, ultimately what you are doing is paying for catastrophic care. You’re paying for illness to be treated as opposed to preventing illness in the first place.

Some insurance companies seem to be waking up a little bit to that, but are still focused on the high-dollar specialties. They erode the preventative medicine as close to the bone as they could. It wasn’t just cutting the fat, it was actually cutting to the bone in terms of primary care while they pursued other initiatives in the specialty care.

They’re looking at oncology drugs and formularies and all of those sorts of things. It’s almost like they took their eye off the ball and didn’t realize that they really are game-changers in terms of how care is going to be delivered in the United States. If you’re not paying for certain things, then the delivery of that stops. If you’re not investing in preventative medicine, then the delivery of preventative care goes away. And that’s where we’re at.

Even if the insurance companies turned things around tomorrow, just looking at any of the data coming out of our medical schools in terms of physicians going into primary care, you’ve got this huge gap. It’s going to take at least a generation to fix. If we had folks going into medical school today that had decided they were going into primary care, they’d still have to go through the four years of college, internship, and all those sorts of things before they’re coming out into the world of owning our own practices and delivering that care back to society.

So there’s a real time lag that we should all be very rightly concerned about that the insurance companies have by dint of their policy-making and their strategic decision-making have actually created this situation for us. Part of the mission of The Verden Group is being able to track that strategy and see how its playing out and being able to get that information in front of medical societies and regulators and various other entities that we work with, to basically say, “Hey, you’re going down the wrong route on this strategy. If you’re going to throw million of dollars into measuring diabetes care but you’re not going to pay primary care physicians to actually spend the time educating the diabetic and following up on the treatment of that care, you’re going in two different directions at once and wasting a lot of money with that.”

That’s the neat thing with being able to work with these medical policies and these administrative policies. We’re getting a jump on the way things are going to play out in the next quarter, the quarter after that, and the next year, for example, based what we’re seeing in terms of where the revenue is flowing and how difficult it is for physicians to be able to provide care and get these services to people that need them.

So to answer your question, where do we go from here and can insurance companies really turn this thing around? I don’t think that they can. I don’t think that they should any longer be trusted to do that. They have driven the market. They have driven care in this country to a very precarious place.

It’s really time to take back that responsibility to stop continuing to pay hand over fist. For what? For payment of services? We can figure out a better way to pay providers of care. It doesn’t have to go through an insurance company that really has a vested interest in holding onto that money and making decisions that are going to be very contrary and the health of society at large.

What do you think the motivation of insurance companies is when they offer to subsidize electronic medical records or they offer personal health records and patient portals?

In many ways, they have to do that, in terms of being seen as progressive, to engage the consumer, to really show that they want to partner with the people that are in the business.

But electronic medical records are a really difficult thing for physician practices and providers of care to really implement well. Just having an electronic record doesn’t do much for you. It’s only the implementation and how it’s used. So unless you have the level of sophistication with the folks that are actually going to use the system, the systems themselves are relatively useless.

It comes down to: what’s the purpose of it? How is it going to be used? How easy is it to be used? Can it actually be fit into delivering care to the patients, or is it simply that something that the insurance company built that looks good, that gets them some kudos to show that they are being good responsible citizens, being part of this IT wave to make these things more accessible?

I think there obviously a lot of benefits to electronic records. Just being able to have your own personal history depending whichever physician you need to go to. There is a real value component there to being able to manage care more comprehensively. That’s certainly goes without saying.

But having an insurance company offer to implement and make available those electronic medical records raises a couple of questions. Part of it, too, is that physicians are very reluctant to want to participate in programs such as that, because what happens if you want to drop that insurance plan? The more insurance plans tie you up in their network, the less able you are to extract yourself from that, so you may end up making very large concessions such as lower and lower rates because now your medical record system in your office is tied to this insurance company. How do you break away from that?

You also then have a responsibility to abide by the insurance company’s demands in terms of how that information is used. What are you signing up for and what are you trading off in order to actually have that medical record in your office? So I don’t think insurance companies are the right people to be offering those sorts of things. I think they do it because there is a certain amount of goodwill that may occur with it.

But also, they need access to data. Right now they rely on claims data. That’s how they are getting their data. It’s very expensive for them to audit paper records. And so, when they are doing these pay-for-performance programs and looking at various things that way, they are really relying on the quality of the claims data that’s coming through.

We see that is really a problem too, because if you’re a doctor and you don’t know much about the business of managed care, and you’re just checking the box on a code but you don’t really know what that code represents, and you’re not keeping yourself up to date with coding and changes and how your CPT and ICD-9 code combinations should go along, pretty soon the information that you’re submitting to the insurance company that you’re getting paid on really isn’t representative of what you’re doing.

Further, you may not be billing for certain things because you know they are not paid for, rather than having to write them off every time. You just stop billing for them, such as developmental screening or visual activity screening, these sorts of things, so they don’t get captured. And so the insurance companies are grading you based on the quality of your claims data as opposed to the quality of your actual charting.

If they have access to that medical charting, they can link these physicians in, it gives them another source of data to pull from to really see what is actually being provided to patients. So that could be another angle to it in terms of what they’re doing and why they’re doing it. It doesn’t look like there’s too many insurance companies that are offering to make medical records available to physician practices anyway at this point.

What about the ICD-10 coding system?

I think the ICD-10 coding system is great in terms of getting to a greater level of granularity in terms of being able to really accurately pinpoint what those disease classifications are. It’s been around for a decade or more. I think England adopted it in ’99 or ’95 or something. It’s been around for a long time, but again, it comes down to education. I don’t think there’s been enough education around this so that offices are really going to able to accurately code and use them.

You’re going to find, I think, that folks are going to end up with a lot of denied claims, so it obviously benefits insurance companies, but a real problem for the physicians until they figure out why something is denied. If you call an insurance company and say, “Why was my claim denied? I need you to explain this to me,” all they will tell you is you billed with the wrong code. They won’t tell you what the right code to bill with.

From their perspective, they are saying, “If we tell you the right code that gets you paid, who’s to say that’s the actual code that you needed to use because that may run contrary to what the diagnosis was from that person?” So I understand the hesitation, but there isn’t a transparency there to basically state, “For CPT codes XYZ, these are the applicable diagnosis codes that go along with that.” That piece is missing. So how are these doctors officers really supposed to digest, absorb, and then use the ICD-10 coding?

If you have a good practice management system, you’re in luck, because a good practice management system used with technology can help you code better. If you punch in three digits instead of five, or five instead of seven, you know that there may be other options there and you can search through and pull up the right code. But again, there’s going to be this steep learning curve for physicians to do this.

Ultimately, though, I think it goes a long way to being able to capture with more specificity what exactly the diseases are, what exactly we’re seeing in healthcare and being able to record that more accurately. I think it’s necessary just for societal programs, being able to really pinpoint how chronic disease like diabetes or ADHD, these sorts of things.

We think we’ve got some good data, but again, it’s relying on what physicians have coded to date, so how detailed is it? How robust is that data? Adding ICD-10 to the mix doesn’t add anything by dint of just adding it. It’s really how is it going to be used? And if we don’t spend a lot of time and energy in educating physicians on how that should be used, then once again, we’re only getting halfway there. We’re not actually able to take advantage of what something like ICD-10 can do for us.

What technology should practices use that they typically don’t?

There’s a lot of tools out there that insurance companies make available, such as verifying eligibility. There are plenty of tools available where someone at the front desk can key in your number, pull it up, see what your benefits are. In a perfect world, that person would have a conversation with that patient about what their benefits are, what their deductible may be for the day, and really be able to utilize the information that they’re seeing.

We’re not seeing doctors’ offices take advantage of that, and part of the reasoning is they don’t participate with just one plan. If it was just one plan, it would be fine. But if you’re participating in 15-20 different insurance plans, you’re not going to learn 15-20 different systems. There are a few aggregators like NaviNet that have 10 or 15 different insurance companies. It may be a lot more by now, I’m not sure. But you have some aggregators where you can key in and it will pull it down from different insurance company Web sites.

I think if there were a much better job done in terms of having a consistent platform that all these insurance companies had to conform, rather than having one physician office having to conform to 15 different ways of doing something. I think we would see the adoption of technology uptaken an awful lot faster at these doctors’ offices.

We’re all human, right? You learn something once and you stick with what you know. You’re not going to take the time to actually learn how to do different, over and over, the same sort of thing done differently over and over again. And then to keep up with how all these things are changing – it’s really an enormous task, I think, for a lot of these doctors and their staff.

The technology is available, it’s just not in a way … again, it comes down to information, but also how this stuff is put together. It’s available, but it’s very difficult to actually adopt even in the simplest case of eligibility, because of the fact that there is just such variation across the spectrum of insurance companies you might participate with.

If you look ahead 5-10 years, what changes do you think will happen with regard to reimbursement in practices and what could change in healthcare that will have a technology impact?

Well, I’m hoping that, in five years, we’re going to take the insurance companies down and reshape the landscape. I think at this time we don’t have any other choices.

From a technological perspective, I would hope that within five years we would have these consistent platforms. We don’t even have a practice management system. There are 200 different types of EMRs out there. There are 500 different insurance companies in the United States. The variation and the degrees of variation are enormous. So I would say that in five years, anything could be improved.

From a technological perspective, we would have insurance companies and practice management software companies all being able to work off of the same platform so that these different pieces of these different applications can actually talk to one another and there’s a consistent way of being able to use it. Everyone knows Internet Explorer. You understand what you’re going to get. You know where the URL goes. You know how to get to a site. The same sort of thing. If there is that consistency across all the insurance companies, just being able to do the one repeatable exercise over and over and get the same consistent output, that would really go a long way to being able to remedy a lot of expense that’s in healthcare today.

Personally though, I would like to see things changing in a much more radical way. We talked a little bit about insurance companies actually being insurance companies again. Why have networks? Why is there a need for physician networks? There’s no benefit to that except the insurance companies are really figuring out who they are going to pay, what, and when, depending on your specialty, depending on the size of your practice, depending on the area of the country you are in. There’s an awful lot to manage for an insurance company and it adds a lot of expense. From their perspective, they are able to control the dollars a lot better.

Instead, get rid of the networks. Move more towards consistent platforms where consumers can have access via IT, via Web sites, to be able to see what are the fees that a doctor is going to be paid if you were in charge of your own healthcare spending; if those dollars are yours to spend.

For example, instead of an employer putting all this money into the insurance company, if it goes into HSA accounts and you get to spend that on your healthcare and you have an insurance plan that rides that. If you’re able to use technology to compare what insurance company is going to pay for, say, an office visit, a new patient visit to a dermatologist – you can see, using technology, what any dermatologist in your area is going to charge you for those services, then you can decide, “Am I go to the dermatologist that’s going to accept a $100 payment that my insurance company is going to pay, or I want to guy to the guy that came highly recommended but he’s going to charge $150 and I’ll pay $150 out of my pocket?”

To me, that’s where technology can really help us here. We do it with everything else. We go comparison shopping for everything from computers to even grocery items at this point. We can buy cars online. We’re able to compare all these things to see what the real costs that are involved in it, what people are charging, what you need to pay out to acquire certain products and services.

If there could be a better use of technology five years from now, I’d love to see something like that. Get the transparency in place with the insurance companies. Stop with the complexity of IT that’s being used to really keep costs high and keep physicians and consumers in the dark and really open it up so the health system can be more of a commodity than a luxury that it is for so many people today. It’s probably the most expensive service that they can possibly utilize.

Is there anything else you would like to mention?

As you can tell, I tend to have a somewhat diverse way of looking at the market. I think information technology is so important to so many things, but we’ve really cracked the code in terms of how that’s supposed to work. How it’s supposed to work with purchasing transactions over the Internet, those sorts of things.

Where we seem to not be applying ourselves very well is having consistency in our systems to costs in the healthcare industry. If we focused on that and, through it, forced a lot more transparency with the insurance companies, than I think we’ll really start seeing some tremendous changes in the healthcare industry. The costs don’t have to be what they are. They are what they are by nature of the complexity that we’ve built into the system. Information technology is a great leveler and a great simplifier of complexity in all other industries, so cracking the code in terms of healthcare and how to apply it to healthcare and make things a lot more transparent.

This is what we at The Verden Group are trying to do through our policy tracking and ability to actually get that information out to the different entities. Right now, we work with everyone from brokers to politicians to providers of care, to really highlight and show how the insurance companies are operating, what their policies are looking like. Start asking those questions, “Why?” as opposed to things that have happened after the fact and you take it on the chin and move on.

This is forcing much greater dialog at all levels of society. It’s not just between the insurance companies and the physicians. It’s not just between regulators, the insurance commissioners in different states trying to keep up with regulations. Now it’s putting all these things together and saying, insurance companies have invested a lot of time, money, and energy in making this as opaque as possible in order to reap as much profit as possible. So we can deploy IT for purposes of transparency and I think we’ll win the war on this one.

News 11/5/08

From The PACS Designer: "Re: Skyfire. If you want the PC look for HIStalk and also TV viewing on your cell phone, check out the demo from Skyfire, which is a free download. They claim to be better than most other cell phone Web and TV viewers and can easily outshine the iPhone and Opera-mini viewers." Link.

From Hari Seldon: "Re: product placement. There was a huge HIT product placement in the movie Serenity (above). I wonder how many other movies and shows have featured HIT products?"

From Fourth Hansen Brother: "Re: layoffs. 74 at Columbia St. Mary’s (WI)." Link. Add to the list from just the last couple of days: Shasta Regional Medical Center (CA), 150 employees; Charleston Memorial Hospital (SC), closing completely, 14 employees; RJ Reynolds Patrick County Memorial Hospital (VA), 40 employees; and Cooley Dickinson Hospital (MA), 47 employees.

The European Commission’s high-level, invitation-only conference will merge with the World of Health IT conference of HIMSS. I was going to make a joke about France surrendering to HIMSS next, but at least one person e-mails me a nastygram when I drag that joke out of mothballs, so I’ll claim new global enlightenment.

Wristband maker Precision Dynamics acquires healthcare label vendor TimeMed Labeling Systems.

AT&T is offering free Wi-Fi for buyers of some of its smartphones (including the new BlackBerry Bold, out today), with details of its Wi-Fi services here. Coincidentally, my AT&T contract just ran out last week, so I’m seeing what’s out there, although I’m too cheap for anything more than basic voice-and-text-message service.

 
Panasonic announces the $2,999 Toughbook H1 mobile clinical assistant, claiming six-hour battery life and featuring RFID and bar code readers, a 2-megapixel camera, a smart card reader, and fingerprint readers. Cool feature: it has a utility that sends wipe-down reminders to users and marks them as done in a database.

Cincinnati Children’s (OH) will use Click Commerce’s eResearch Portal to automate grant application and budgeting.

Uganda is considering implementation of an e-health system.

Sunquest names Richard Batch, formerly of Cardinal Health, as VP of product development.

Emageon will pay CEO Charles Jett $1.2 million in severance when the company’s sale to Health Systems Solution, Inc. is finalized.

Only in hospitals: a clergyman is taken to a British hospital ED to have a potato surgically removed from a rather private area. He claims he fell on it while hanging curtains naked.

E-mail me.

HERtalk by Inga

An AMA survey concludes that PQRI process needs to be made easier for physicians. Most could not download reports and less than half of those who did found them useful. Physicians also complained that reports took 12 months to receive, which didn’t leave them enough time to make adjustments to qualify for bonuses.

It sounds like MedcomSoft is running out of options for staying afloat long-term. The company will keep trying to find a buyer (at far less than the $15 million of new capital originally sought) or initiate a wind-down of the business. Each of MedcomSoft’s board members has also resigned.

Virtual Radiologic signs a deal to be VHA’s preferred provider of teleradiology services.

The six-county Mississippi Coast HIE will use Medicity’s MediTrust clinical operability platform and ProAccess clinical applications suite to exchange clinical data.

Versant Ventures invests $13 million in CodeRyte.

eClinicalWorks is hosting its four-day conference in Orlando, sold out with nearly 1,200 attendees. New products were announced for next year: eClinicalMessaging (physician-to-patient messages) and eClinicalMobile (smart phone access for physicians). Also announced: a new deal with Continuum Health Partners (NY) and its 3,300 docs. The nice folks at eCW invited Mr. H and me to attend this first national conference, but unfortunately neither of us could make it happen. I personally hate missing a good time, so if you are there, send us an update.

A construction journal discusses some details of Epic’s expansion, which will feature three 150,000 square foot buildings, a 177,000 square foot building, and a 752,000 square foot underground parking deck. Pedestrian tunnels will connect the buildings and geothermal fields will heat and cool the whole complex. It will be finished in 14 months.

Siemens Healthcare Diagnostics will lay off 151 Los Angeles-based employees on December 30th, according to reports.

The Minnesota Department of Health’s Office of Rural Health and Primary Care awards $3.5 million in grants to 21 EHR implementation projects.

The NY State Department of Health extends CSC’s contract to support the state’s Medicaid system with a $322 million, three-year contract.

Whitmore Lake Health Clinic (MI) faces closure over a $110,000 IRS bill. The clinic blames its large number of uninsured and underinsured patients.

A couple of Dallas area readers forwarded me this story. A Baylor Healthcare laptop taken from an employee’s car in September contained names and treatment codes for 100,000 patients and Social Security numbers for another 7,400. Leaving a laptop in the car is against Baylor’s policy and the employee was fired. Meanwhile, Baylor’s offering $1,000 for the laptop’s return and free credit monitoring to those affected.

Lakeland Regional Health System (MI), already a user of the agent-based healthcare exchange platform of Novo Innovations for its 70 affiliated physicians, signs a new deal to offer it to its remaining 200+ affiliated providers.

Oklahoma University Medicine is live on MEDSEEK’s consumer portal, just three months after starting implementation.

ABEO, the country’s second largest anesthesia-specific revenue cycle management services company, purchases Pasadena Billing Associates.

Hard to believe, but Mr. H and I are already starting on some HIMSS-related projects. One big one is our pre-HIMSS HIStech Reports, which highlight individual companies with an interview and Mr. H commentary. We include a magazine-style reprint that several companies handed out at HIMSS last year to great response (until they ran out because everybody was picking one up). If you’re interested, e-mail me.

E-mail Inga.

An HIT Moment With … Dan Nigrin

An HIT Moment with ... is a quick interview with someone we find interesting. Dan Nigrin, MD, MS is senior VP for information services & CIO, Division of Endocrinology & Informatics Program, Children’s Hospital Boston; assistant professor of pediatrics, Harvard Medical School; and affiliated faculty, Harvard-MIT Division of Health Sciences and Technology.

Mainstream applications always struggle with peds-specific logic. Does pediatrics really need to be that much different and are vendors doing enough to support it?

Yeah, pediatrics definitely requires specific functionality that, in the past especially, didn’t come "out of the box" for many systems on the market. Good examples include growth chart support, weight-based dosing, gestational-age based dosing, and for some centers like ours at Children’s Boston, being able to document interventions performed on fetuses while they’re still in utero!  

Overall, I think that vendors have made strides in many of these areas. For example, our Cerner system now includes good functionality for weight and gestational age-based dosing and decision support to go along with them, and the growth chart functionality allows for custom, disease-specific growth charts to be loaded by the client.

But we’ve still got a way to go. Case in point: in 1997 I wrote a Web-based application called GrowthCalc to allow specialists at our institution to calculate various anthropometric values on their patients. Today, over 10 years later, it’s still used on a daily basis at institutions around the world because nothing better is out there. It’s not that my work was that fancy or special; it’s just that it fills a niche that hasn’t yet been included in the EMR systems on the market.

What are the five most promising systems or technologies being used or considered right now at Children’s?

Five?  OK, you asked for it – I’ll move from the micro level, the patient, outwards to the hospital level, and then to the macro level, the region.

• Our MyChildren’s patient portal, which we are now rolling out to all of our patients. In addition to the usual stuff found in tethered patient portals (e.g. appointment requests, billing inquiries and online payment, demographic updates, secure clinician messaging), we’ve also seamlessly built in Indivo functionality to allow our patients to have a secure, portable, personally controlled health record (PCHR) that is automatically fed by our Children’s clinical systems. We’ve had discussions with eClinicalWorks, whose systems we are putting into our affiliated pediatric practice network offices, to likewise automatically feed those patient’s Indivo records with their primary care information. Most importantly, with the patient’s consent, clinicians within Children’s will have single-click access to the patient’s Indivo record from within our EMR environment so that, unlike most personal health records out there now, our clinicians will have ready access to the information that our patients are maintaining.
• Discern Pages. It was called Discern Desktop and new rumor is that it will be renamed again to Millennium Pages. This is a new Cerner technology and API that allows for custom HTML development to be done within the Cerner application environment. This includes support for Javascript, including Ajax, all while operating within a patient context, so you can easily query for patient data and generate your own interactive and rich UIs. We’ve already created several very promising proofs-of-concept, including one where we display our Philips bedside monitor information right from within PowerChart.
• iAware. Another new Cerner offering, this is an always-on system intended to be displayed at the patient’s bedside, likely in a critical care environment. Our intensive care unit clinicians had found it difficult to get a good overview of the patient when they had to click through various parts of the chart to find the bits of data they needed to synthesize the patient’s status. This new approach aggregates the key data elements, including vital signs, labs, meds, and inputs/outputs, and shows them in a very intuitive and graphically rich way. From a technology point of view, there’s nothing to it – we deployed it live in three weeks in our intermediate care unit – but from a clinician’s point of view, it’s priceless. It actually takes the data that we work so hard to collect electronically and presents it to clinicians in a useful way (what a novel idea!).
• MA-SHARE. Building on the success of the New England Healthcare EDI Network (NEHEN), which allowed New England payers and providers to exchange administrative transactions in a secure way, MA-SHARE (Simplifying Healthcare Among Regional Entities) is allowing organizations in the New England area to exchange clinical data. Our primary focuses right now are on exchange of CCD documents between organizations as well as the facilitation of ePrescribing in our region. This is a RHIO done right – a sustainable, beneficial model.
• Catalyst / i2b2 / SHRINE. Harvard University was recently awarded one of the NIH CTSA grants to further clinical and translational science across the country. A major focus of our proposal (now called Catalyst) centered on IT and its ability to tie together the various people and projects Harvard-wide. Using i2b2 querying tools developed at Harvard and now deployed at four major Harvard teaching hospitals (Beth Israel, Brigham & Women’s, Children’s, and Mass General), we also are working on SHRINE, which will allow us to execute clinical queries across these institutions. So investigators will soon be able (with IRB approval) to ask questions like, "How many patients are seen at each institution with disorder X who also have lab value Y and who are on medication Z?"  Powerful stuff …

Children’s has a notable informatics training program. What influence does their scientific work have on the practical side of the healthcare IT market?

The Children’s Hospital Informatics Program or CHIP is a biomedical informatics multidisciplinary applied research and education program that’s been in place at Children’s since the mid 90s. Although its roots were definitely in clinical informatics, it is now also a leader in functional genomics, public health informatics, and personalized medicine. What’s more, its members understand that all of these things are interrelated and that their true benefit comes when they’re not looked at in isolation. For example, the genotype is worthless without phenotype information to go with it.

Examples of ways in which CHIP’s work has had influence on mainstream healthcare IT include:

• Distributed querying. Some of the earliest work from CHIP included a system called W3-EMRS, which allowed queries for a patient’s data to be distributed across multiple organizations. It was implemented first as a pilot and then successfully used at Caregroup, when it was first formed to virtually integrate the disparate EMR’s that each institution brought to the table. Similar models are now used in several RHIO efforts. In addition, this distributed query approach is now the basis for SPIN, the shared pathology information network; and SHRINE, described above.
• Secondary re-use and mining of clinical data. We realized long ago that the treasure trove of clinical data being acquired by EMR systems was largely underutilized. In the late 90s, I developed the Goldminer system at Children’s, which allowed for much easier investigation of the data stored in our systems for clinical research. This was soon followed by work at Partners in the Research Patient Data Registry (RPDR), and which in turn led to the development of i2b2. i2b2 is now implemented in many institutions nationwide, and although open source, there are commercial vendors out there who specialize in its implementation.
• Public health informatics. We’ve done quite a bit of work using existing data sources for public health related functions. Aegis performs automated, real-time surveillance for bioterrorism and naturally occurring outbreaks. It is the syndromic surveillance system for the Massachusetts Department of Public Health, enabling real-time population health monitoring. HealthMap is another CHIP project that was funded by Google.org to gather and display information from news sources around the world about infectious diseases.
• Genomics. CHIP members pioneered the use of relevance networks in the analysis of both genetic and clinical information, and they literally wrote the book on using microarrays. They continue to lead the field.
• Personally Controlled Health Records. Indivo.

How did Indivo come about and what impact will it have on healthcare?

About a decade ago, researchers in CHIP developed the open source Indivo. It was actually called PING back then. It was, essentially, the world’s first PCHR. It enables patients to own complete, secure copies of their medical records. A good analogy is that it’s like a Quicken for healthcare.  

It is amazing to think how far Indivo, and the idea of putting patients in control of their health information, has come in that time. It still seems futuristic to some, but we expect PCHRs to be universally available and used in the very near future. There’s been a lot of buzz around PCHRs since Microsoft and Google announced theirs; what people may not know is that both companies’ deployments are fundamentally based on the Indivo model. There’s even a rumor out there that MS’s HealthVault actually contains some Indivo code under its hood. Both companies were present at our two Personally Controlled Health Record Infrastructure conferences we hosted at Harvard in 2006 and 2007.

As many people know, Dossia has also adopted the Indivo infrastructure, and in fact Wal-Mart just went live, offering our Indivo-based PCHR to 1.4 million employees and their dependents.

Indivo and PCHRs in general will have a major impact on healthcare. With PCHRs, patients will be able to aggregate and share almost all of the information in their medical records such as lab tests, medications, and clinical notes, which in the past has been largely inaccessible to them. We see this leading to improved communications and continuity of care with clinicians, and the ability to provide more complete and accurate information to health care providers than the current system allows.

We also see this as exciting for the biomedical research enterprise. With PCHRs, researchers may be able to recruit with patient consent hundreds, thousands, possibly millions of patients from all over the world for their studies, potentially speeding up the time it takes to bring research to the bedside.

While this is all very exciting, there is a lot of work to be done if PCHRs are to reach the full extent of their potential. In a recent New England Journal of Medicine article, my colleagues Ken Mandl and Zak Kohane call for attention and regulation as various PCHRs are developed and adopted. Without it, it’s possible that the tremendous benefits of PCHRs could be overshadowed by problems arising from the unethical and uncontrolled use of valuable medical information.

Which title have you found to be the best for impressing strangers: doctor, CIO, Harvard professor, or the guy behind the Defective Records electronic music label? How do you find the time to do all that stuff and which ones require wearing a tie?

The last, by far – the first three things are a dime a dozen! Seriously though, my music creation and record label stuff, and more recently software synthesizer development, are all great hobbies that I wish I had more time for. How do I do them all? Jack of all trades, master of none?? Oh, and about the tie – if you believe my friend and across-the-street colleague John Halamka, you don’t need a tie for any of ’em, just a black mock turtleneck!

CIO Unplugged – 11/1/08

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

Caught, Not Taught
By Ed Marx

We read a tremendous amount of books in my division. Each quarter we start four new book classes, and they fill up within twenty-four hours of release. We teach everything from leadership and teamwork, to service and creativity. As shared in the post “Chief Intake Officer,” it’s imperative for an IT leader to continuously learn and refresh knowledge. Attending conferences and such are other ways of doing this. But I’ll be the first to admit that these traditional learning methods will never offer a comprehensive package for professional development. Why?

Because some things can only be caught, not taught.

Ready to go deeper? Do you have a desire to take your leadership development to the next level? I’m about to get intimate here, and if that makes you uncomfortable, then I suggest you flip to the next blog or run Joost. Otherwise, grab a cup of coffee, kick off your shoes, prop your feet on the desk, and let’s get personal.

First, I confess that I’m not the pro in this area, but it’s something I wholeheartedly believe in and aspire to improve on. Like you, I’m on a continual learning curve. So let me ask you the questions I’ve asked myself. Deep down, why do you do what you do? Are you in it to make a buck or make a name for yourself? Are those around you simply steppingstones and worker bees that your eyes glance over when you come to work each day and then never think about once you’re home? Do you truly care about your people, your team—other than for what you can get out of them?

I’m talking about compassionate leadership. The American Heritage Dictionary defines compassion as a “Deep awareness of the suffering of another coupled with the wish to relieve it.” If what I do isn’t benefiting humanity, beginning with my own circle of influence, then I’d have to question my purpose in life. My heart motivation. I won’t be taking my plaques and recognition awards with me when I die, which means all earthly laurels have fading value in the light of eternity. Life is too short not to care about others. Life is too short not to care. Period.

Action, not talk. I want those of my staff who desire to one day become managers to know that management is about service. They can listen to me expound on the virtues of servant leadership but my teaching will have little impact unless they see me demonstrate it. When we study compassionate leadership, it is not enough just to analyze Mother Teresa. If I want my team to adopt her attitude or sympathy, then I have to do what she did. So I start by serving my team in tangible ways. Involvement with my staff shows them I care, I’m interested. This involvement materializes in ways both simple and complex.

An excuse to party. It is not unusual for me to surprise staff with an ice cream fest. I not only serve them, but I also handle the shopping and delivery of goods. On occasion, my employer gives me tickets to professional ballgames to which it would be politically correct to invite peer execs and direct reports. Instead, I turn those opportunities in to hang time with staff, and offer the tickets to people who may not normally have the resources to attend a game. I find it easier to talk when we’re not disguised in stuffy work attire. I love doing this! And I love showing them that my wardrobe does include shorts and jeans. Other times I attend symphonies or late nights at the club when my staff is playing in the orchestra or band.

On a more serious note, I try to be the first at the bedside of staff who have fallen ill. I mourn with those who mourn by attending funeral services for people related to my team. When possible, I take along direct reports to these affairs. I call it “modeling the desired behavior.” It’s critical that I walk the talk with sincerity because this is how such actions are caught, not taught. Besides, any hypocrisy will stand out like an inferno.

Another area begging for a model is the social scene. Directors seeking to become Vice Presidents should know how to handle themselves in a “cocktail party” situation. I coach them on how to interact in such environments, but then I’ll also take them with me to an event. This is one reason my wife and I frequently host parties in our home. We offer them a safe place in which to practice so they can learn to be comfortable mingling among executives. It’s also another occasion to get acquainted with their significant others.

I hope you’re taking this in as you sip your coffee. Are you visualizing any changes you might be able to make to become a compassionate leader as well as develop them? What are you proactively modeling for your staff? I realize it can be difficult if you haven’t been mentored to model. But you can still learn. Find someone who does model compassionate leadership and ask them to mentor you. Be intentional. You may outsource the teaching but you can’t source the active modeling required to move people to the next level.

It’s caught, not taught.

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

Monday Morning Update 11/3/08

From Barry S: "Re: Breakway Company comment. I have the same question. The focus group that they hosted seemed to be all about ‘how’ they can get into healthcare and trying to figure out what the next best thing would be, not about what they can do for us or the industry. Granted, the groups are designed to give them feedback. However, I was disappointed that it wasn’t very substantive. I am thinking that it just may be fluff."

From Sophie Sheridan: "Re: DR Systems patent lawsuits. I’ve heard from one industry source that the payoff (and settlement) for admitting you infringed on the DR patent is $500,000. However, a credible – and successful – defense to dismiss the suit would cost about $1.5M in legal fees. I wonder how the presumed income of $500,00 a couple of times a year fits into a business plan?"

From Frankie Saluto: "Re: ICD-9 vs. ICD-10. Looking at the list of ICD-10 codes for insect bites, it seems like a classic example of what may happen when one does not NORMALIZE a data model. The whole list could have been translated into three interrelated entities: anatomy (scalp, abdomen, etc), pathology (insect bite in this case) and visit/encounter  (first encounter, subsequent, etc.)"

Thanks to everybody who responded to my 2009 marketing survey. Some interesting facts from it:

• 29% of companies anticipate spending more on advertising in marketing and advertising in 2009, with 43% expecting to spend the same and 29% planning for less
• 93% will spend as much or more on blogs in 2009 as they did in 2008
• 67% of respondents said they will spend less on magazine advertising, which was also rated as the least effective program and the lowest return on investment
• HIStalk’s sponsors ranked their sponsorship as their most effective program (tied with trade shows)
• HIStalk was ranked #1 in return on investment by current sponsors
• The most important benefit reported by sponsors is mentioning company news and announcements

Also a surprise: readership shot up again in October, breaking the all-time record (September) by around 15%. Thank you for being part of that – I personally appreciate the support. It’s always slower in November and December, so if you want to help offset that, click the "Email this to a friend" graphic to your upper right to tell a few friends about HIStalk. Thank you.

Listening: Calexico, recommended by Tom. Kind of like Nick Cave meets a mariachi band on the way to a Pink Martini concert. Easy to listen to, unlike some of my weird picks. Like it lots, great suggestion.

Premise announces its patient flow solutions consulting services, led by Barbara Bryan. I keep predicting that credit problems will force hospitals to increase capacity virtually rather than physically, something that experts can make happen.

Lehigh Valley Physician Group (PA) chooses MDaudit compliance audit software from Hayes Management Consulting.

eHealth Ontario names Sarah Kramer, previously VP/CIO of Cancer Care Ontario, as president and CEO.

Jobs: Senior Software Engineer (WA), Senior Product Manager (UT), Client Services Director (NC), PMO Eclipsys, Cerner, or Epic (nationwide). Weekly job blast signup is here. In this economy, it’s best to be prepared.

Former FCG CEO Larry Ferguson joins the board of business intelligence systems vendor Accelrys.

Husband-and-wife professors from Case Western Reserve University want the federal government (CMS specifically) to oversee electronic health records with "rigorous regulation", citing security and privacy issues.

The SVP of Medtronics says the end of the line is near for medical devices. "You can’t keep stuffing gizmos into people to treat end-stage disease. When biotechnology gets right, we’re finished. Because it’s restorative, not palliative as devices are.” He also said easy investor money rather than American ingenuity led to this country’s leadership in such devices, noting that most of them were invented in other countries.

Hospital layoffs: Valley View Regional Hospital (OK): 127 employees. Newark Beth Israel Medical Center (NJ): 100 employees.

A UCF professor develops computer-generated patients that will be used to help medical students learn to make better decisions.

Odd lawsuit: a former hospital priest is fired after a woman claiming he seduced her files a $25 million lawsuit. She says he had Viagra mailed to her apartment and complained by e-mail about a groin rash he said he got from having sex with other women.

Another odd lawsuit: Washington Adventist Hospital (MD) is sued by the family of a heart patient who coded on the toilet of the locked bathroom of his hospital room and staff couldn’t find a key to get to him before he died.

Merge Healthcare announces Q3 numbers: revenue up slightly, EPS $0.01 vs. -$4.17.

WebMD’s Q3 numbers: revenue up 17%, EPS $0.18 vs. $0.19.

Shands-Jacksonville Medical Center (FL) fires 20 employees for accessing the medical records of pro football player Richard Collier. I noticed that the TV station’s story, which spelled out what HIPAA stands for, abbreviated it first as HIPPA, then changed it to PIPAA, shattering any illusion that that highly paid talking heads who read the news to you actually know what they’re talking about.

The CEO of Saddleback Memorial Medical Center (CA) gets a writeup in the business paper for its $60 million push for electronic medical records.

Intel has a November 11 announcement, apparently of its FDA-approved Health Guide PHS6000, which allows patients or caregivers to enter and transmit medical data.

A BlueCross BlueShield venture fund’s first investment is $5 million in Initiate Systems.

A hospital’s cancer care manager, testifying in an inquiry about the hospital’s lab mistakes and its failure to notify patients, has been on the stand for 129 days.

Vendor Deals and Announcements

• Midwest NeuroSurgery & Spine Specialists (NE) selects Intergy EHR by Sage for its eight-physician group.
• MedAssets releases a new Alliance Decision Support solution to help healthcare providers analyze and utilize operational information to improve financial performance.
• Patient Placement Systems partners with Iatric Systems to develop interfaces for to connect MEDITECH’s solutions to Patient Placement’s web-based admissions and referral management systems.
• The 30-physician CORE Institute (AZ) signs a three-year agreement with MedSynergies for revenue cycle services.
• A study by The Mary Imogene Bassett Hospital (NY) shows the implementation of its SIS perioperative system raised on-time first case starts by 35% and turnaround times by 33%. The hospital was able to reduce supply cost by $200 a case and increase surgery-related charge capture by 30%.
• Johns Hopkins is implementing iMDsoft’s MetaVision Anesthesia Information Management System.
• Methodist University Hospital (TN) has installed ForHealth Technologies’ IntelliFill I.V. for the automatic preparation and labeling of intravenous doses.
• NextGen announces Q2 earnings, with a 9% increase in net income over the previous year and a 31% rise in revenue. The company met analysts’ expectation for EPS and beat revenue estimates by $1.4 million with its $59 million performance.
• Henry Ford Health System is purchasing MRO’s RAC Tracker Online to manage its recovery audit processes.
• Innovative Consulting Group announces (warning: PDF) it is expanding its service offerings with the additional of an Epic practice. Serving as Epic Practice Director is Todd Shavor, an Epic Certified Ambulatory consultant who has worked on multiple projects including implementations at Baylor College of Medicine and the Harris County Hospital District.

E-mail me.

News 10/31/08

From JoJo: "Re: Frost & Sullivan’s HIT senior analysts/consultants. They appear to have lost them all. After years of being able to offer different content and provide strong insight (we used them for advisory for a new product introduction and emerging technology information), it seems like this ‘group in a corner’ of an otherwise lackluster place found new revenues elsewhere. We have been reluctant to seek others such as Advisory Board, Sg2, Gartner, or even the smaller joints since we had a such a strong machine running with them. Would appreciate any ideas from you or others for a few strong minds in the field."

From JonJon: "Re: The Breakaway Group. Can anyone verify them? They were at the CHIME fall meeting, but I really am not certain what they do. The focus seems to be EMRs, but the only account they could speak to was University of Tennessee and their new CMO came from there, so I am not clear if that is valid experience."

From Tony South Dakota: "Re: [magazine name deleted]. Ha, that’s rich. This was live on their business briefs web site." TSD had sent me a link an HIT magazine’s so-called online news brief that contains a story I ran nearly three months ago in HIStalk (not a rumor, an actual news story). Maybe that’s why 44% of respondents to my 2009 marketing survey so far say their companies will decrease print magazine advertising in 2009 (not to tip off the results early, but I figured that was relevant). Don’t worry, if you completed the survey using a company e-mail address, I’ll be sending out the compiled results this weekend. They are interesting.

From Rene L. Fallure: "Re: CCS. I attended the CCS HIT Spring Summit in Washington, DC. It was not well attended and those who did attend were the sponsor representatives and a few of their guests (expenses paid). Most of the speakers arrived just in time to speak and then hightailed it out the door. Content was weak and very little new. With other venues of more substance, I doubt I would attend another CCS event. The hotel was nice, but too expensive. Lunch was not included either day although the attendance fees were steep enough." Mr. HIStalk’s three critical meeting planner reminders: (1) a good breakfast and lunch will get you high evals even when everything else goes wrong; (2) allow a lot more socializing time for attendees than you think they need since that’s why they are really there; and (3) include an no-pressure, no-agenda evening social event that includes cocktails and even more good food. Running a meeting on the cheap doesn’t work when attendees are paying (and even when they’re not). I’ve been to a couple of events (not CCS ones) where the speakers got comped registration and travel and everybody else had to make themselves available for vendor pitches. The speakers were big name, but they looked at it as a free trip and did pretty much nothing more than show up and sleepwalk through the same old stuff.

From Pierre Doncarlo: "Re: UCI. I can confirm that Joy is out and Jim is back in an interim role."

Listening: Queen’s new studio album, just released. Paul Rodgers (Bad Company) takes Freddie Mercury’s place and the result is pretty good, less pretentious than the Bohemian Rhapsody-era Queen. Also: Margot & the Nuclear So and So’s, eminently listenable and fresh indie pop out of Indianapolis.

RWJUH signs with Lawson for HR, supply chain, financials, and performance management.

I mentioned UTMB’s under-recognized telemedicine program. Turns out that the AT&T Foundation has been funding UTMB’s AT&T Center for Telehealth Research and Policy, which publishes outcomes research, holds seminars, and trains fellows, since 2002. I also noticed that UTMB offers Web-based telehealth courses and the subject areas sound quite practical and useful (like what kind of staff and equipment you need and how to get reimbursement). I’ve talked to a couple of folks there and I’m a fan.

University Health System (TX) gets board approval to buy an RFID equipment tracking system from InfoLogix. CIO Bill Philips is quoted: "These little squares have holes in them so you can put them on a patient’s wristband. Think of psychiatric patients, Alzheimer’s patients. You want to know, I sent this patient to X-ray. Where are they now? They should have been back. My ultimate vision is, you start tagging surgical instruments in the OR like sponges. You wave a wand over them and hear ‘ping.’ You don’t leave them in.” That’s a pretty darned good description if you ask me.

ICD-10 sounds like a great idea, right? Who could be against a more descriptive coding scheme? Rich Elmore provides an example: an ICD-9 insect bite is 919.4. Under ICD-10, there are nearly 100 codes instead of one. 

Results of a new Picis survey say that maybe we Americans are too critical of our health system. About half of people who received healthcare services said they had a positive experience in both the European countries and the US. Most respondents said technology could improve care delivery, ranging from 80% in the US to 96% in Spain.

Geisinger Health will use ForeFront Transfer, Web-enabled patient transfer software from Central Logic Healthcare Systems of Ogden, UT. I see some other big names in recent press releases doing the same: New York Presbyterian, St. Joseph’s in Phoenix, CHW, and WF-Baptist. I don’t know who’s involved with the company because its site doesn’t say.

Continua and IHE sign an agreement to jointly promote device interoperability.

House Democrats, dissatisfied with technology adoption by doctors and apparently not troubling themselves with massive deficits and a wheezing economy, are drafting a new HIT bill.

The folks at Hayes Management Consulting just finished their latest newsletter, including an early recap of the company’s 2008 highlights.

Congressman Paul Ryan (R-WI) is a co-sponsor of a bill that would establish independent health record trusts where consumers could manage their own health records. Anonymized data sales would be allowed, but the proceeds would be split between the owner and the data bank, which would use the money to fund its operation. He would also require EMR vendors to link to those trusts. "The software packages that are out there – Epic, Cerner, McKesson, General Electric – they would have to have patches on their software systems for interoperability, for universal connectivity. To me, a lot of this is simply requiring interoperability among software providers so that these hospital and physician systems do talk to each other. You have to have that common architecture in order to have a system where we can compare apples to apples throughout the health IT system.” Sounds like he knows what he’s talking about, actually. He’s up for re-election next week.

DR Systems announces five new RIS/PACS sales.

University of Kansas researchers get a $2 million NIH grant to see if smoking cessation counseling by telemedicine works.

Cardinal Health’s Q1 numbers: revenue up 11%, EPS $0.69 vs. $0.82.

An interesting quote from a VP of telephone company Embarq (even if the company did just get sold for $12 billion): "My [chief financial officer] observed to me the other day that if I don’t stop the escalation in health care costs, we’ll be spending more on health care than we do on information technology. And in our industry, information technology is the core of what we do. If [Embarq] did information technology like the health care system has been doing it, we’d be giving you tin cans strung together with twine to do your communications.”

Hospital layoffs: Boone Hospital Center (MO), St. Joseph’s Hospital of Atlanta, Valley Presbyterian Hospital (CA).

Children’s Hospital Boston launches a philanthropy web site for 8-12 year olds.

A British nurse faces disciplinary action after hospital IT experts tracked her down for offering her panties for sale on eBay using her hospital e-mail address.

Intel funds a digital clinic in Russia.

St. Vincent Charity Hospital (OH) says its former director of marketing, who committed suicide with her husband in July, had stolen over $4 million from the hospital. The hospital had mailed payment for phony invoices to a PO box, where the woman’s husband picked up the checks and cashed them.

E-mail me.

HERtalk by Inga

From Sam Matalone: "Re: what the candidates propose. I have to start working for CNNmoney and they will talk to me." Sam has been trying for several weeks to get each presidential candidate to provide him some specifics on how they see HIT playing into their plans. Both camps are apparently too busy to respond. This story touches on each candidate’s health care reform proposal and this article summarizes each one’s plans. Both claim they want investment in information technology to drive efficiency, but the details are sparse. Too bad Joe the Plumber is getting all the attention rather than our own Sam the HIT guy.

At the risk of being called out bringing up too much political stuff,  here’s another nice little summary of the candidates’ plans. It comes from a publication called Medill Reports, which I thought was neat because it is written and produced totally by Northwestern University graduate journalism students.

I’ve been reading through the results (warning: PDF) of the 2008 HIMSS/HIMSS Analytics Ambulatory Healthcare IT Survey since it hit my e-mail yesterday. I feel like a bit of a nerd to say this, but I love this kind of stuff. Here are a few highlights from the survey of 500 individuals (primarily office managers) working at ambulatory clinics: (a) there are no dominate market leaders in this space; (b) only 13% of practices are planning an EMR purchase in the near future; (c) thirty percent of all practices had an EMR, 24% of the small ones, and 47% of larger groups; (d) cost was cited as the biggest barrier to EMR adoption (40%) followed by lack of interest in EMRs (25%).

Glen Tullman purchased 100,000 shares of Allscripts stock earlier this week. Now his boss Mike Lawrie has also upped his holdings, purchasing 70,000 shares for about $350K.

Healthvision announces that it added 15 new clients in the third quarter.

Wheeling (WV) Hospital’s board of directors approves the $20.9 million purchase of Eclipsys Sunrise, to be rolled out over three years. The hospital checked out 12 different companies before deciding.

Portico Systems has acquired Ethidium Health Systems. Portico’s offerings include solutions for managing provider operations while Ethidium develops clinical and collaboration tools (including EMR) for providers.

Huron Consulting Group is increasing its healthcare and HIT focus with the hiring of two industry veterans, Scott Kolesar from EDS and John Kavka from CGE&Y.

Women purchasing their own health insurance pay as much as 50% more than men for identical coverage. Insurers claim women use healthcare more than men and maternity costs are a factor for women in child-bearing years. However, women advocacy groups claim the gap is much wider than it actuarially should be.

HealthSouth receives $100 million in cash from UBS Securities as the two companies settle their lawsuit. The lawsuit stems from charges that UBS was part of a $2.7 billion fraudulent accounting scheme that included over a dozen HealthSouth executives between 1996 and 2002. HealthSouth is still awaiting judgments on suits filed against HealthSouth’s former CEO Richard Scrushy and E&Y.

Expenditures for diabetes medications have risen from $7 billion in 2001 to $13 billion in 2007. Patient visits have increased and newer drugs are more expensive.

Cisco cuts the ribbon on its new LifeConnections Center at its San Jose headquarters, which will include health care services, child care, and fitness offerings. Cerner is providing the health care clinic software.

AT&T sent me a text message on my iPhone today saying I now have free Wi-Fi access at 17,000 hot spots, including Starbucks. On their web site, they also mention some other cool spots to connect, including airports, hotels, restaurants and supermarkets. Kind of cool to think that I could be downloading Mr. H’s latest music recommendation while picking up a gallon of milk.

E-mail Inga.

Readers Write 10/29/08

CCS HIT Fall Report
By Pedro Borbon

The Fall CCS HIT summit had its ups and downs. I was surprised at how small it was. Apparently last year there were four times more people, but this year there were probably <50 attendees.

The first day’s content was average, but there were two very impressive speakers. John Geade, the CIO at El Centro Regional Medical Center who has done a great job integrating various HIT systems in his hospital and also installing an EMR in his ER, and Gay Madden, CIO of Florida Hospice of the Suncoast, which appears to have a much more advanced HIT system than many academic centers. Mark Probst of Intermountain Healthcare gave a good keynote, but pretty generic.

I think the problem with these types of presentations for us who are so steeped in the HIT world is that it’s hard to find anything really "new".

The small size made networking easier, especially on the second day, when there was a superior panel on PHRs: Missy Krasner (Google), Philip Marshall (WebMD), and Sanjay Gupta (Dossia).

Naomi Fried, VP of Innovation and Advanced Technology at Kaiser Permanente, has what seems to be a dream job (and who also seems like she would be a great HIStalk interview), and spoke about KP’s telehealth projects. There was also a good payer panel, with Charles Kennedy (Wellpoint), Julie Klapstein (Availity), and David Lanksy (Pacific Business Group on Health).

Dr. Lansky told us that he offered free trips to the Health 2.0 conference to every employer who makes up his group and not one of them took him up on the offer …

I don’t think I’ll be back, but maybe the spring summit will be better attended. Can’t tell if it was the content or the economy. Sofitel LA is a great hotel!

The Cloud Computing Phenomenon
By The PACS Designer

Cloud computing is the phenomenon that is sweeping through the vendor community lately. Some commentators are saying it is a fad that will pass, while others are forecasting a much wider cloud computing community.

TPD has been using clouds to describe design work for several decades, so the concept is far from being new. What is new is the movement of the cloud description from the development side to the public side. In the design workspace, clouds are used to describe future development features, and also the type of outside services that may be employed in the design.

Amazon thought that bringing cloud computing to its customers would expand its product offerings and also help retain existing customers for many years to come. So far, it appears to be working as planned even though there have been some service outages, but with any new service offering there are bound to be some bumps in the road that come up unexpectedly.

Hyperic, the company that designed the "CloudStatus" web site, fully understands the cloud computing concept and has formed their business plans around the aspects of IT services described as clouds. The concept does have some compelling ideas, which include lowering the costs of software support, using proven concepts others are using, and creating the opportunity to simplify the interfaces by eliminating custom interfaces and the costs associated with their design.

Hyperic had this to say about cloud computing: "Cloud computing is a system of technologies and services that have commoditized (sic) IT to make it more readily consumable, scalable, and cost-effective for everyone. It has leveraged the innovation and expertise of Internet giants like Amazon and Google, and is making it accessible to anyone with the next big idea. It removes the investment in physical and human resources to scale up a business. It affords more folks to try their ideas and vet its worth in the market. It also affords these same businesses to scale out as quickly as their business demands. Cloud computing, same as open source, is a way to package products and services to ease adoption so everyone benefits."

In summary, you can expect cloud computing, as a term used to describe outside services, to be around for many decades to come. It will provide a more robust platform for future designs as we move forward toward a more connected world environment.

Response to "Hallway Medicine"
By The Alchemist

Who would have ever “thunk” that Hallway Medicine is safe and good for the economy by simply moving patients to corridors while waiting for a room as a way to unclutter ERs? Just peruse this screen shot for the top 20 countries from the WHO Report Annex Table 1: Health System Attainment and Performance Ranked by Eight Measures (click to enlarge).

Anyone would agree that the U.S. is the leading country for health expenditures and proudly number one for the Responsiveness Level for Attainment of Goals. I knew that Management by Objectives would prove successful:

The reader can formulate their selective opinions on what are important metrics to define the U.S. Health System. Hint: The Middle East is not too impressed with U.S. ranking in Health Systems around the world but they will buy our products.

News 10/29/08

From Houndoggie: “Re: UCI. The Eclipsys install got pushed again at UC-Irvine Med Center and the first casualty was Joy Grosser, long-time CIO. No word yet on what is going to happen. Jim Murry was brought back in the interim spot.” Unverified. I’m happy to run either confirmation or correction, whichever is appropriate.

From Slap Maxwell: “Re: AM/PFM. Yes, AM/PFM is the old SDK. It is quite functional and effective for Bridgeport and numerous other users. It does not get much press, but you can ask Eclipsys why. It seems to me they should be marketing the heck out of it.”

From The PACS Designer: “Re: RIS/PACS and EHR. TPD has mentioned in the past that some PACS suppliers include a mini-EHR in their systems. When a RIS is added to the PACS, the EHR becomes more robust in collecting  information, which can result in improved efficiency for the institution. Sectra, a RIS/PACS supplier, is taking the next step by partnering with an EHR supplier to bring more information into the RIS/PACS system. This move could start a new trend that others may emulate in the years ahead.” Link.

McKesson just announced Q2 numbers: revenue up 9%, EPS $1.17 vs. $0.83. Earnings beat expectations even when one-time items were excluded. John Hammergren bragged that the company was doing just fine despite the economy, but then mentioned that some of its IT prospects are delaying their decisions.

Parrish Medical Center (FL) deploys two solutions from the Thomson Reuters Clinical Xpert suite: CareFocus (clinical surveillance) and Care Navigator (mobile clinical information).

Only in America: the Kansas guy arrested for leaving his girlfriend stuck on the toilet in his mobile home for two months wins $20,000 in the lottery — for the second time this year.

Fred Trotter calls attention to the National Dialogue site, which is conducting a discussion on HIT and privacy through November 3.

If you’re a vendor marketing person, here’s a last chance to complete our seven-question survey on what 2009 looks like in terms of budget, priorities, etc. We’ll send you the aggregated results if you provide your e-mail there. I doubt anyone else can give you such a quick read on what to expect next year.

The insurance company that refused to pay for a woman’s $4,000-a-month, last-chance cancer drug helpfully volunteered to cover physician-assisted suicide drugs if she chose that option, a bargain for them at only $50. The cancer drug has proven to be nearly worthless in extending life, showing only a couple of months of extra life vs. placebo. If you’re the patient, naturally you want all the stops pulled out, even if it buys you only a little extra time. Should the rest of us have our rates raised for that? Beats me. Anyway, another hot issue is whether insurance should get involved with physician-assisted suicide.

Advanced Technology Consortium, a “virtual entity” of National Cancer Institute-funded organizations (Washington U. in St. Louis, UC Davis, MD Anderson, UMass, and others) will implement TeraMedica’s Evercore clinical enterprise suite to manage its patient case data sets including its DICOM archive, DICOM RT objects, and metadata.

Defaults on hardware and software loans are increasing. CHRISTUS CIO George Conklin says some software vendors are now asking for 50% down. Others are self-financing customers for competitive advantage.

Jobs: Eclipsys Clinical Consultants, Epic Consultant, SIS Project Manager.

Former Navy hospital CIO David Yovanno is named CEO of Web widget start-up Gigya.

The local paper runs a nice article on Children’s Hospital of Wisconsin’s teledermatology program, where dermatologists use videoconferencing to treat patients 100 miles away. It quotes an article suggesting that 28% of ED visits could be managed by telemedicine instead, which I don’t doubt at all. I’m surprised that telemedicine isn’t bigger than it is, particularly since I think I read somewhere that reimbursement isn’t the issue it once was.

Here’s a list of Mac-specific medical applications.

A research report from RTI International says that large databases, such as EMRs and anonymized claims data, can improve drug safety by alerting researchers of the adverse effects of specific drugs.

Lawyers may beat doctors in EMR adoption. A Florida company announces its Internet-based utility to send patient medical records from doctors to personal injury attorneys. Note that the “About Us” and “Our Team” sections of the Web page names and shows no one other than some stock photo people, although some sleuthing seems to indicate that it’s the same folks who run Rehab 1.

Wolters Kluwer announces its Brand Probability File, whose entire purpose is to analyze a given drug and decide whether it’s a brand vs. generic product for purposes of formulary coverage. As screwy as it might sound, that’s not an easy call sometimes.

The political race for board seats of Washington Hospital (CA) gets ugly. A cardiologist launches her campaign with a documentary claiming the hospital delivers poor care. The hospital responds by pointing out that her own medical privileges were revoked by other hospitals because of improper care. The CEO showed pictures of another candidate, an attorney, who she accused of promoting the movie, while the board chair started a political action group to criticize both candidates, saying the attorney candidate is “defending sex offenders, drug violators and white-collar criminals.”

The world’s most lucrative healthcare market? The Middle East, this conference says (and which software vendors are already aware). Beds will double by 2025 at a cost of $10 billion and the industry will be worth $60 billion. Maybe Inga and I need to expand our news coverage there.

Covenant Healthcare (TX) will lay off 91 employees. Medical Center of Central Georgia axed 208 people last week, including 17 managers earning an average of $120K. Texas Health Resources just cut 49 people.

IBM is working on browser-based mashup applications in its Opus Una project, which allows users to share audio and video in real time. The article says one version being tested involves doctors collaborating while viewing x-rays, sending their markings back and forth. A hospital will be one of the three industries participating in the proof of concept early next year. I found this site, which takes forever to load but apparently doesn’t do anything.

CPSI is named to the Forbes 200 Best Small Companies list.

UMDNJ is under investigation again as subpoenas are served for allegations of additional Medicare fraud.

HP is apparently doing a lot of infrastructure stuff with hospitals.

The Welsh Clinical Portal is rolled out to another hospital in Wales. I hadn’t heard of it, but it went live earlier this year.

Michael Frankenberger has joined Ascension Health Information Systems as CIO, moving from Alliance Information Management in Fargo, ND.

Four of the ten board members of LMS Medical Systems, the Montreal-based vendor of the CALM OB system that seemed to be getting some US traction, have resigned, one of whom was just appointed two months ago. The company announced three weeks ago that it had terminated its US distribution agreement with McKesson. Shares are down 25% to $0.06, off 94% from their 52-week high.

The Worcester Business Journal runs a profile of eClinicalWorks as one of the fastest growing Central Massachusetts companies.

E-mail me.

From Jay Volk: “Greetings from Cleveland. I am the president of Workflow.com. I read your column from 10-20-08 and I was surprised to hear that you visited our booth at MGMA and no one approached you to offer you a demo of our product. If you are interested in hearing more about our company, please feel free to call me at any time. I hope you enjoyed San Diego as much as all of us did. Cleveland seems a little colder than usual as a result.” Thanks for the note, Jay. Hanging out in a booth all day is not the most exciting thing and perhaps with all my free tote bags, stuffed animals, and pens they assumed I was just looking for trinkets (busted!) I’ll catch you at the next show. Meanwhile, I still think your booth looked great.

HERtalk by Inga

A University of Colorado Hospital study of 49,000 patients reveals that its use of Picis EDIS decreased ED length of stay by 15%.

Mr. Green Genes is the name of a genetically modified cat that glows in the dark. The fluorescent effect is part of a gene therapy experiment designed to combat diseases such as cystic fibrosis. The scientists claim the special glow does not harm his health. Mr. Green Genes would sure be a cool addition to my Halloween party.

VeriChip, the guys that make the RFID chips that go under your skin, is out of compliance with Nasdaq. The stock price has fallen below the required $1/share mark for more than 30 consecutive business days. Nasdaq will give it extra time because of market volatility, but the company has to comply by April 20th or risk de-listing. Shares are at $0.31 with a market cap of just $3.5 million, 93% off their 52-week high.

Alliance Imaging names industry veteran Richard Hall as president of Alliance Oncology. He comes from US Oncology and has served in leadership roles at PatientKeeper, McKesson, General Medical, and BrightStar Healthcare. Alliance also announced that Mark Carol, MD is the company’s new chief medical officer.

Lloyd Dean, Catholic West Healthcare CEO, says the 41-hospital health care system will spend $6.5 billion in capital over the next five years. A big chunk will be for connecting physicians to the system and for electronic medical records.

The integrated workflow automation solution from Sonitor and PCTS now supports over 400,000 high acuity patient visits a year.

Eighty-three percent of companies have at least one woman or minority on their boards, but only 38% of women are among the five highest-paid executives, according to this survey. At HIStalk, we are bucking the trend, as I am the second highest-paid executive. Furthermore, if we had a board, I bet Mr. H would let me be president (of course, he’d be CEO). Power and money, what else does a girl need?

Baptist Health System (AL) is live on Sentillion’s clinical workstation solution Vergence. By the end of the year, Baptist expects 3,000 clinician users of the SSO solution.

The Loftware guys are recommending a November 11th seminar for anyone wanted to know more about the movement towards GS1 standards in healthcare. The title says it all: “Improving Patient Safety and Supply Chain Efficiency with Data Standards: The Basics of GS1 Standards in Healthcare.”

Sunquest Information Systems plans to expand to Europe following an initial agreement to purchase UK-based Anglia Healthcare Systems. Anglia is a provider of lab connectivity, orders, reporting, and messaging solutions and has a 60% market share in the NHS Acute Trust Hospitals, as well as a presence in Denmark.

MedData, a provider of emergency medicine and hospitalist RCM services, acquires competitor Summit Health Care Services.

Virtual Radiologic announces its Q3 earnings. The company’s $0.21 EPS was $0.09 better than analyst estimates, with total revenue of $29 million versus the consensus $27.4 million. Revenues were up 21% year-on-year, largely due to a 24% increase in the number of hospital and facilities served. Adjusted EBITDA also rose 16% from last year.

Now available from your physician: the HairDX test that indicates if a man is at high risk for pattern baldness. If a man tests positive for a particular gene, he has a 70% chance of going bald. If identified early enough, the hair-challenged man can begin prescription treatment for hair loss prevention. I am sure it will be a huge hit with the 20-something crowd, though personally I find the Mr. Clean look incredibly sexy. I could never figure out why a guy would want hair plugs or a rug or (heaven forbid) a comb-over.

Outcome Sciences is partnering with Greenway Medical to facilitate research and patient registries through Greenway’s PrimeResearch network. Outcome has developed technology that uses EHR’s for clinical research and quality measurement.

A doctor is accused of practicing without a license, and badly at that. Vikas Jain moved to Las Vegas after Ohio revoked his medical license for failing to meet minimum care standards with 22 of his ophthalmology patients. He is now being sued by two patients, each who claim their vision has been compromised following his negligent pre- and post-operative care. One of the patients is his former office manager. Vikas is counter-suing the office manager for removing her personal medical records from the clinic.

Allscripts CEO Glen Tullman and friends presided over the Nasdaq opening bell Tuesday. I say keep bringing him back since the Dow was up 890 and Nasdaq jumped 144. He just purchased an additional $511,000 worth of company stock, which represents a 17% increase in holdings to around $3.3 million.

Troubles with the NHS’s Connecting for Health continue. Health ministers are no longer scheduling new trust installations until existing implementation issues are addressed.

A new study concludes that moving emergency room patients to upper-floor hallways when they are ready for admission does no harm. “Hallway medicine” on the appropriate acute care floor is apparently less risky than leaving patients in the overcrowded ER hallways. Are there still people out there arguing that the US has the best healthcare in the world?

The industry’s leading optimist has to be Mediware president and CEO Kelly Mann. After the company announced that quarterly income declined from $463K last year to $218K this year, Mann said, “During the quarter we continued to gain traction in the U.S. and abroad for our new initiatives that will fuel the company’s growth.” Revenues also fell from $10.74 million to $9.83 million.

E-mail Inga.

An HIT Moment With … Tee Green

An HIT Moment with ... is a quick interview with someone we find interesting. Wyche T. "Tee" Green III is president of Greenway Medical Technologies of Carrollton, GA, which provides market-leading physician practice software and services.

Greenway just announced PrimeResearch. What kinds of practices will use it and what’s the benefit?

We believe that, in time, most practices will participate in active strategies that improve population health, such as conducting clinical trials and enrolling patients into electronic disease registries that enable researchers to drastically increase the speed at which new drugs or treatments are introduced, essentially saving time, money and lives.

Through our PrimeResearch network, physician practices that use Greenway solutions will have access to a vast network of clinical research, quality/safety initiatives, and composite clinical and financial analytics, all of which can increase revenue for the practices and foster the physician’s ability to improve the quality of care for patients.

How do you think economic conditions are changing the physician systems market and who will win and lose?

That’s a tough question as we aren’t quite sure at this point how it will affect the market. The good news for companies like Greenway is that we provide solutions that enable physicians to remove inefficiencies in their practice and increase the quality of service and care they provide their patients. Companies that assist practices in providing better care and increase their revenue by doing so should do well in this environment.

While the economy is slowing down, our company continues to grow. During the last quarter, PrimeSuite 2008 became a fully CCHIT Certified 08 ambulatory EHR, including certification for cardiovascular medicine and child health. In September 2008, we finished our largest month in company history with nearly $7 million in new sales.

Is interest growing in revenue cycle products and services for physician practices?

Yes. We see physicians not only interested in revenue cycle improvements, but in clinical and administrative improvements as well. A general trend we have noticed is that companies that deliver services that integrate and streamline the clinical, financial, and administrative processes of the practice are growing. Physicians want to be able to work fluidly on a single-database solution and are seeking products that allow them to do so.

What is your reaction when you see big hospital systems vendors buying into the physician practice market?

Smart move for them, I would think. I imagine hospital CIOs are pushing their HIS vendor to roll out usable solutions for their connected, and hopefully interoperable, ambulatory market. 

About a year ago, we launched PrimeEnterprise, which enables healthcare organizations such as hospitals, RHIOs, and IPAs to effectively manage today’s complex healthcare enterprise by streamlining the business process and improving the physician’s ability to make the most informed decisions. Whether these organizations are looking to centralize such tasks as clinical population management, streamline the sharing of clinical information or better manage accounts receivable amongst the many providers in their network, a community-based solution will enable them to better manage their workflow. Furthermore, recent Stark Law changes provide benefits for hospitals and other community health organizations that invest in healthcare IT like PrimeEnterprise.

A recent rumor speculated that the company has attracted interest from larger firms that could result in a sale. Does that match with your vision of where the company wants to go?

Certainly not. That rumor seems to pop up every other year or so. I can only speculate from where it comes. To be very clear, we are not talking with anyone about an acquisition of Greenway. Our investors are excited about our long-term plans, so we will continue to grow as a profitable private company. We should add our 1,000th practice in the coming months, and we currently have more than 20,000 users in 30 specialties and subspecialties in 48 states.

We started out in the small- to medium-sized practice market but during the last couple of years we have seen tremendous traction in the larger practice segment of the market. Our business plan is built on a long term relationship with our customers and we are very excited about our future at Greenway.

Francisco Partners To Acquire API Software

Labor management software vendor API Software, Inc. will be acquired by private equity firm Francisco Partners II, LP, the company has announced. Closing is expected within 30 days.

The Hartford, WI-based API’s product line includes applications for time and attendance, staff scheduling, payroll, human resources, education tracking, and access control. Its Payrollmation and ActiveStaffer systems are top ranked in KLAS.

J.P. Fingado, formerly of Cerner, has been named president and chief executive officer.

Monday Morning Update 10/27/08

From Rose Michaels: "Re: Epic. From a reliable source (you’re probably already aware) Epic will be implementing in Dubai. Not sure of the details but figured if anyone could get them, it would be you. Thanks for doing the fabulous work that you share with us daily!!" I’ve mentioned it a couple of times back when University Hospital first made their selection, but hadn’t heard anything since, other than I saw an Epic user group story that said folks had come from as far as Dubai. More information is welcome. Seems like a lot of big deals are in the Middle East these days, but of course they’ve got the cash and have always been fans of US-style healthcare (at least the kind we deliver to our ultra-privileged patients).

From Al Borges, MD: "Re: Magellan EMR. Jason Murdoch, MD was able to get in contact with John, the owner. The EMR formerly known as Magellan has run into some business problems relating to being a small startup in a vicious EMR world. Magellan EMR has not been scrapped but is on the shelf. John is a reputable guy and took the site down to not mislead people." John e-mailed Inga back after her incessant sleuthing (we help readers however we can). Dr. Murdoch concluded with, "Does anyone know if Inga is a hot, Swedish blonde?" I do, actually, and all I’m saying is that she is indeed hot (and talented, and fun, and smart …) Swedish and blonde? I’ll never tell.

From Cliff Williams: "Re: Lincoln Park Hospital. At a Chicago meeting, I heard the hospital closed up shop, literally an overnight decision. Without warning, they called nurses and told them to come in and get their final check and sent patients to other facilities. Done. Sign of the times?" The hospital couldn’t find a buyer after it failed to find financing due to its $15 million annual losses and high Medicaid patient load. Deteriorating margins and tough credit will take more struggling hospitals out of the picture, although better capitalized groups may take them over if they have a presence nearby. That kind of Darwinism isn’t necessarily a bad thing, but some of the bigger groups got that way by minimizing the amount of charity care they provide. As always, uninsured patients take the biggest hit.

And speaking of closing hospitals, Physicians Medical Center Carraway (AL) also locked the doors on short notice this week for the same reason – it couldn’t get funding. I’ve been warning of that kind of situation for quite some time, but nobody seems to be noticing that it’s happening now (both closings and scrapping expansion plans).

From Al Borges, MD: "Re: HIT stocks. HIT in the USA is still in somewhat of a slump as compared to ‘Other Technology Companies’. HIT companies showed an unweighted YTD average return of -22.4% vs -14.2% for the OTCs." Link. There are probably lots of caveats to the list. Stock price movement within sectors tend to be amplified in both the up and down directions, so looking back one year may not be enough since all you’re seeing is performance in a historically awful market. The companies on the healthcare list are also a lot smaller and more focused than those international giants on the OTC list (Merge Healthcare vs. IBM?) Putting GE, Misys (shouted out as MISYS on the list for some reason), McKesson, Philips, and Siemens on the HIT side certainly muddies the waters since that’s a tiny part of their business and GE and Siemens are highly exposed to general international economic conditions. And, is looks like they simply averaged the individual one-year change, lumping in obvious low-cap losers like Merge (-77%), Emageon (-74%), and whoever I-Many is (-76%) with the big boys (half of the HIT companies have a smaller market cap than the smallest OTC listed). The list is pretty, but I’m not sure it really contains a lot of insightful or useful information. And, lots of the bellwether HIT companies aren’t publicly traded any more because of acquisitions, going private, or preference.

From Mike Donovan: "Re: Bridgeport. Mark Tepping is retiring after a long and successful career, but Bridgeport Hospital does not use ProFit – it uses Eclipsys’ AM/PFM for reg and billing." Thanks for that. I admire anyone retiring in today’s financial thrill ride. I must have confused Bridgeport with a ProFit user, which is surprising since there are so few of them. I don’t know anything about AM/PFM. That’s the old SDK, right?

Welcome and thanks to new HIStalk Gold Sponsor Satyam Computer Services of Hyderabad, India. It’s a big company ($2.5 billion in revenue and 53,000 employees in 66 countries) with a strong US and healthcare presence. Satyam’s services include hospital systems, portals, telemedicine, application development and maintenance, ERP, and consulting services. The case studies on the Healthcare Practice site include a couple from the Centers for Disease Control and Prevention. Thanks to Satyam for supporting HIStalk.

Former Caritas Christi CIO Dan O’Neil is named CIO of Quincy Medical Center (MA). And speaking of Caritas Christi, it gets $100 million in funding from Ascension Health, which probably means they’ll buy it eventually (which is a pretty good example of what I wrote about struggling hospitals being bought by bigger groups, which I promise I wrote before I read this story).

A hospital manager in Ireland quits after signing an unauthorized $1.6 million contract for software that turned out not to work. The hospital found out about it when they got a bill, but could not get out of the contract nonetheless.

Apple takes out Microsoft’s dopey $300 million Seinfeld ad campaign in one devastating blow. And if you’ve missed Terry Tate, Office Linebacker like I have, you’ll like his new Get Out the Vote video (but Palin fans won’t like this one).

Inga and I are curious about 2009 marketing plans of industry vendors. If you’re a vendor marketing or advertising person, please complete our seven-question survey and we’ll share the aggregated results with you (company e-mail addresses only, please, so we know you’re legit). Surely you are curious (like we are) about what companies are doing in a volatile economy.

As a reader reported in an article comment, the FTC’s Red Flag medical ID theft rule has been delayed for six months.

I’ve mentioned the teen metal group Jessica Prouty Band before because her proud mom (who works in the HIT industry) sent over a CD that I liked. Check out the first video on the page from Hard Rock Boston – playing all those gigs has obviously made them tight and confident on stage (remember, three of them are 15 and the other is 13!) Anyway, they’re in a girl-led battle of the teen bands contest, so vote for them here by October 31 and they might get a shot at playing Hard Rock NYC. We could make it an HIStalk party if Fake Ingas are available.

I was watching a video on the Google Android operating system and API and thought the kid in the opening was a bit over the top: big hair, careful grunge look, and not very convincing as someone who would really get it. Turns out it was Google co-founder Sergey Brin, the #13 richest American, who’s worth close to $16 billion. He looks like a guy who might serve you coffee at Starbucks.

CPSI’s Q3 results: revenue up 8.4%, EPS $0.38 vs. $0.30, meeting expectations. Some of that was due to a tax change, but guidance was positive. According to conference call transcript, they’re doing a lot with Linux.

A University of Florida professor develops a "birthing computer" that uses wireless monitoring of uterine muscle electrical activity to advise doctors whether a Caesarean section is recommended.

Dr. Wes isn’t an ICD-10 cheerleader. "Imagine, 290 codes just for diabetes! Yeeeee haaaaa! Diabetes with foot ulcers on the right foot gets one code, diabetes with foot ulcers on the left foot gets another code, diabetes with foot ulcers on both feet, but not involving the shins gets another code… I mean, a new code for every nuance of disease! You get the drift! Isn’t this SPECIAL? Just think of the COST SAVINGS those clever bureaucrats have found!"

I admit I’ve never heard of Pop!Tech, a big-ideas organization (although I see Jay Parkinson was a speaker at its just-finished conference). They just announced Project Masiluleke, which will connect South Africans to HIV/AIDS information via mobile phones (daily text messages, reminding patients of follow-up visits for antiretroviral drug therapy, and patient-staffed virtual call center helplines).

A sad medical error in Ireland, where a resident performing his first unsupervised kidney removal ignores the family’s objections and removes a child’s healthy kidney instead of the diseased one. The doctor relied on an incorrect x-ray that was six years old because all the newer ones were missing and there wasn’t a convenient computer to look them up on.

An English arthritis patient can’t get pain meds or a referral because her specialist’s dictation, which was sent off to New Zealand for transcription, but never made it back to her doctor by mail. Seems like they could have sent the document by secure Internet connection instead of mail.

UPMC will lay off 500 employees this week. If they’re doing it, so will everyone other hospital (and every other business, most likely). UPMC made "only" $5 million in 2008 compared to $612 million the year before.

Shands HealthCare (FL) will close Shands AGH next year, citing anticipated big shortfalls because of Florida’s tanking economy, propped up until recently by unrealistic housing prices. It could be worse: they could be in Detroit, where employees of car manufacturers are being cut loose in giant waves, sure to hit hospitals there hard in uncompensated care.

A nanoengineering researcher at UC San Diego’s Jacobs School of Engineering wins a Navy grant to create a biocomputing "field hospital on a chip" that will monitor biomarkers in the body fluids of soldiers, detect common battlefield injuries, and then administer medications to treat specific conditions.

Varian‘s Q4 numbers: revenue up 15%, EPS $0.62 vs. $0.61, beating estimates.

A former hospital compliance officer is charged with defrauding her two former employers, a Hawaii hospital and a Florida HMO, by issuing millions of dollars worth of compliance contracts (HIPAA, charge master review, compliance training) to sham companies she ran herself. The HMO hired her even though she allegedly applied for the job using a phony name, fictitious work experience, and her former husband’s Social Security number.

Central Washington Hospital (WA) gets a local paper writeup for its use of a tele-interpreter company to provide remote Spanish interpretation via computer screen, cutting cost and wait times.

Vendor Deals and Announcements

• MEDHOST is now offering a patient self check-in kiosk option called Emergency Department Patient Access Self Service (ED PASS). MEDHOST’s first implementation will be at Northridge Hospital Center (CA).
• The Radiology Institute Imaging Center in Puerto Rico is adding Thinking Systems’ ThinkingPACS solution.
• St. John HealthPartners (MI) is purchasing licenses for the Web-based Cielo Clinic software to help manage their patient population and screen for chronic diseases.
• Robert Wood Johnson University Hospital (NJ) is deploying the Eclipsys access management solution. The hospital has been an Eclipsys client for 10+ years.
• Valley Medical Group (MA) has selected athenaClinicals for its 60+ providers. For the last eight years, Valley Medical has used athenaNet for practice management services.
• Arrowhead Radiology Medical Group (CA) is implementing McKesson’s Revenue Management Solutions for its nine physician clinic.
• NaviMedix has acquired TopLine Solutions, a provider of healthcare payment and collection solutions. NaviMedix has a solution that gives providers the ability to perform real-time financial, clinical and administrative communication with multiple providers.
• Olean General Hospital (NY) and Bradford Regional Medical Center (PA) have signed a letter of intent to integrate and create a new parent company.
• HealthFusion introduces a Web-based practice management system that integrates with HealthFusion’s clearinghouse services.
• Billing service Medrium acquires Wilmington Professional Associates. Though no terms were disclosed, Medrium recently raised $10.46 million in Series C funding.
• I like the clever name for MEDSEEK’s December 3rd webinar, “Do eHealth Portals Make a Difference to the Hospital’s Bottom Line: Calculating a Return on Information and a Return on Investment.”
• Presbyterian Hospital of Plano (TX) is laying off 17 people in the face of slower than expected growth. Presbyterian is part of the 18,000 employee Texas Health Resources.

E-mail me.

News 10/24/08

From rbsavage3: "Re: HealthVault. Microsoft scores with Aetna e-records pact. As a member of Aetna and an employee of a large hospital system, I’m not sure I like this. I wonder what the community thinks." Link. The deal connects Aetna’s PHR to HealthVault and adds a connection in the other direction next year. The pitch is that HealthVault lives on even if an employer change requires leaving Aetna’s coverage. I’m not sure how the information is coordinated between the systems, but I’m sure they’ve worked that out.

From Leopold Stotch: "Re: bikers. I know we’re all used to ‘Hospital X lost a boatload of personal information data’ stories, but you never know who you’re dealing with with the Mongols support themselves through identify theft." Link. Federal agents arrest dozens of LA members of the Mongols motorcycle gang on charges ranging from drug sales to murder after undercover agents infiltrated the group (which is an amazing story of bravery on its own). The former Mongols president, who wrote a memoir about his tenure, is a night shift CT tech at LA County-USC Medical Center.

From The PACS Designer: "Re: Web-oriented architecture. You are going to be seeing another fairly new concept gain some momentum in the next few years — Web-oriented Architecture, or WOA. While we have been familiar with service-oriented architecture recently, the move to WOA won’t replace SOA, but will provide an architecture that is resource-oriented rather than service-oriented. Since resource-based solutions are more plentiful, they will give the developers a quicker on-ramp to the Web and provide a easier way to test and use new Web applications." Link.

Inga did a little more sleuthing on Magellan EMR, although I’m not sure tracking down the founder will help if the company is kaput, which seems the case. Somebody put in a ripoff report about a problem with a non-medical software package from them. The founder is scheduled to speak at a technology conference this month. He was looking for a programmer last month. Inga e-mailed the founder and the conference planner but hasn’t heard back so far. She tried both phone numbers we found; one doesn’t answer, the other doesn’t have him in the PBX and the address for the company doesn’t come with their name in Google.

A reader asked about an acquisition rumor earlier this week. We’ll have an answer Monday when "An HIT Moment With …" features the company’s CEO answering five questions from Inga and me (and you just know what one of those questions will be). We haven’t seen the answers yet, so we may all be surprised. Our impression is that readers really like these abbreviated interviews and they are fun to do, so if you have an interviewee in mind, let me know.

I kind of hinted at this when talking about Greenway’s PrimeResearch EHR-to-research connectivity, so here‘s a coincidental prediction that’s similar: a patient’s tumor genes may someday be compared to EMR data to tailor patient-specific treatment, aka personalized medicine. I’m a cynic most of the time, but I think this is eminently doable. With an EMR full of patient data that can be linked to vast databases of other patient records, drug trial results, registries, etc. there is no reason to blindly go down the treatment tree in search of a winner for a given patient. Cancer is not one single disease. Even if you don’t buy the concept that evidence-based medicine works, the idea that looking at one patient in context with a bunch of similar ones to choose the best therapy is pretty compelling.

A Michigan doctor develops a disease database to be used in India, working with the Bill & Melinda Gates Foundation to make it available. NxOpinion apparently suggest a diagnosis from provided data. I don’t really understand parent company Robertson Technologies, but it lists a lot of management people, so maybe it’s big.

If you’re ever in Algona, IA, you might as well drop in and see the EMR you’re paying for. USDA gives Kossuth Regional Health Center $134K for it, calling it a "Distance Learning Telemedicine Grant," which sounds like a stretch. It actually sounds more like an portal-type project, but it’s hard to tell from the political high five-ing.

McKesson launches InterQual in the UK. I always called it case management software, although it’s now a bit more grandly portrayed as clinical decision support (i.e., "are you well enough to go home so we don’t lose money on your stay?")

I’m behind on e-mails, but I still like hearing from folks and, even though my replies are often long in coming (I usually try to catch up on the weekend), I read every one. A few folks have asked about the Brev+IT weekly newsletter and I had to admit that it’s "on hiatus." It was taking up a lot of time I don’t have and the e-mail spam filters were keeping readers from getting it. I may bring it back as a weekly HIStalk post if I can think of some other life activity to give up in its place.

I’ve also forgotten to recently recite the list of stuff you can do here, all to your right: (a) put your e-mail in the Subscribe to Updates box to get an instant e-mail update when I write something new (that list now has over 3,100 confirmed recipients); (b) click the "E-mail This to a Friend" to tell your friends about HIStalk, which I greatly appreciate because I want to be anonymously famous; (c) use the Search HIStalk box to sift through 5.5 years of HIStalk; and (d) click the ugly green Rumor Report button to securely and anonymously send me highly sensitive and scandalous information. And, some of the best parts of HIStalk live in the reader comments below each article, so click Show Comments to check them out.

My guest editorial in this week’s Inside Healthcare Computing, which the publisher said was "very sharp, well-written, and insightful" (I’m preening because I have perpetually low self esteem, maybe justifiably), is entitled Ask the Magic 8-Ball: Who HIT’s Winners Will Be in a Recession, Depression, or Whatever You Want to Call the Crappy Times Coming. Some of the 10 items I listed came from reader ideas here, like # 3: "Consultants of the non-PowerPoint variety. Nobody cares about a five-year strategic plan when financial survival into next week is questionable, so eloquent glad-handers or fresh-faced noobs need not apply for these gigs. We’re talking gunslingers here, the battle-hardened vets who simultaneously impress and scare the bejeebers out of you. When you want a system brought live quickly or a sleepwalking vendor slapped to attention, you need someone who looks and acts like Lee van Cleef in those old Clint Eastwood spaghetti westerns." I don’t put out unless you buy me dinner, so you’ll have to subscribe to see the other nine and to receive my routine literary emanations.

Allscripts posts its last results under the old company. For Q3: revenue up 17%, EPS $0.07 vs. $0.07, missing consensus estimates by a penny (or a pence going forward now that Misys is involved).

Speaking of Allscripts, if you want to support WakeMed in Raleigh, NC, watch this video sometime before Friday at midnight. Allscripts will donate $3 for each viewing to the Just for Kids Kampaign that supports construction of a new children’s hospital.

St. John HealthPartners (MI) signs for Cielo Clinic CQMS software from Cielo MedSolutions.

Bridgeport Hospital (CT) is looking for a CIO. I’m not sure what happened to Mark Tepping, who I’ve chatted with a time or two. Big Cerner shop including ProFit, its seldom-mentioned (and even more rarely praised) patient billing app.

This article describes what’s different about Mayo Clinic ("the Big House on the Prairie"). I like the point that there’s a "firewall" between the money and the doctors, who don’t even know or care what Mayo gets paid because they all receive the same salary after five years’ on the job. "We’re all salaried staff—paid equally. This is very good for collegiality, and people working together. The culture here at Mayo doesn’t encourage egos. There is not the same cult of personality that you find at other places.” I checked its tax forms and the highest paid people, all surgeons, make around $700K. Not exactly starving, but there are lots of boondock quacks swindling multiples of that from Medicare.

Congratulations to Cerner again on some damned impressive numbers. Companies are turning in bad reports left and right and there’s good old Neal chugging along like there’s no economic problems at all while expanding globally. That’s a big story. I noticed in the call transcript that the acquisition of LingoLogix was finally mentioned: "which strengthens our revenue cycle offerings immediately … the NLP component of this technology can change the landscape for clinical search by bringing clinical meaning to unstructured clinical documentation, helping aid research, clinical trials and potentially provide a bridge to interoperability constraints as the personal health record becomes more pervasive."

The local paper writes up McKesson Horizon Enterprise Visibility (which staff call "The View") at Oakwood Hospital & Medical Center (MI).

Patewood Memorial Hospital (SC) goes with Omnicell OptiFlex for surgery materials management, including preference cards and real-time usage tracking. I looked for a good picture but couldn’t find one.

T-Mobile’s G1 phone (powered by Google’s Android operating system) is now on sale. iPhone killer? Too early to say, but the T-Mobile part killed my interest. Medical apps on the iPhone are a big hit (partly because of the "store" concept), so maybe coders are working on stuff for this one.

Speaking of Google, the company joins the Continua Health Alliance personal health group. I should interview someone there.

Natividad Medical Center (CA) chooses the NeoIntegrate integration engine from NeoTool.

Some company is auctioning off "telemedical information management" intellectual property on October 30. Included: a smart card-based EMR, HIM workflow, and a implantable RFID chip reader. Actually, Ocean Tomo seems to be entirely reputable in the IP biz, even partnering with NASA, so maybe it’s worth a look if you’re a vendor. Maybe I should cover it live.

Houston emergency preparedness officials team up with the University of Texas School of Health Information Sciences at Houston, a biomedical informatics school, to develop a medical support system for disaster and to deliver more care by telemedicine. I didn’t know that open source guy Fred Trotter works there on its HealthQuilt project, an HIE prototype. I did know that UTMB has one kick-ass telemedicine program that probably leads the entire industry, yet is rarely mentioned, since we’re talking about the Gulf Coast of Texas.

I must have missed this: a new rule that takes effect in a few days that puts hospitals under FTC jurisdiction in requiring them to check for medical ID theft for patients not paying upfront. That sounds onerous.

Patty Miller, a Sunquest sales exec, is voted president-elect of the Central New York chapter of CLMA.

That’s all I have time for since I’ve now worked directly from the uninspired dinner I cooked for Mrs. HIStalk until boudoir time without a break. She just stuck here head in to see if I was still respirating, so that’s probably a hint. We’ll pick up here Saturday. Have a good weekend.

E-mail me.

HERtalk by Inga

From Janeen: “Re: RelayHealth booth. Did you come by? We were trying to keep an eye out for you at MGMA. We had a theater experience that involved a consumer/patient, physician and an administrator we were hoping you got to watch. Let us know if you saw it.” I did lurk by your booth a few times, and even chatting with someone about how PHR fits into the RelayHealth model. RelayHealth had an “exam room” setup with a cute doctor who explained the ins and outs of RelayHealth’s offerings.

Overheard in the San Diego airport: “MGMA was a really good show for us. Lots of traffic.” Standing in the security line, I stood in front of a guy from Fujitsu chatting with another vendor (sold lab coats, I think.) The Fujitsu guy said that MGMA and HIMSS were their two biggest shows and they were pleased.

On the other hand, I did hear a number of people say that attendance seemed a bit sparse. My opinion was I didn’t go to a single session that was standing room only and didn’t have to push through crowds at the exhibit hall. It wasn’t HIMSS, but there were folks everywhere all the time. With such gorgeous weather, I can imagine a number of folks stepped out for some sightseeing.

Anyway, I am glad to be home. I’m worn out from so much fun and long days in high heels (but I looked good.) I’m trying to tell myself that I’m tired because I am out of practice (not used to all that traveling, walking, sitting, wine-drinking, sleeping in a strange bed, etc.) and not because I am getting to be a 3-letter word that rhymes with cold.

Eclipsys co-founder and Carefx founder Terrence Macaleer joins Allscripts as VP of sales for Enterprise Solutions. I also see that Centra (VA) has selected Allscripts ED IS solution.

The VA contracts with Qwest Communications to provide $60 million worth of voice and data services to connect its 1,300 hospitals and other facilities.

More proof here that healthcare is not totally immune to economic troubles. Several new reports confirm that more of us are delaying doctor visits and tests, and skimping on medicine. Kaiser Family Foundation determined 36% of Americans are skipping recommended tests and treatment, up from 29% just six months ago. The number of prescriptions filled has fallen .04%, the first time in at least 12 years a drop has been recorded. Elective surgeries are falling; ER visits by the uninsured are rising.

Also suffering: Yahoo announces a 64% drop in Q3 profits and a plan to cut at least 1,500 jobs. On the other hand, Google’s are up 26%.

Sentillion adds a record 11 new customers and over 200,000 new user licenses in Q3.

E-mail Inga.

Readers Write 10/23/08

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. Use your real or phony name (your choice). Submissions are subject to approval and become the property of HIStalk.

Personal Health Records are Durable Medical Equipment
By Manfred Sternberg, J.D.
Presiding Officer, Board of Directors, Texas Health Services Authority

There is little debate that knowledge and information have always been among a physician’s best clinical tools. Consistent with this fact, information technology (IT) should be viewed by the healthcare industry as a medical device. With the advent of evidence-based medicine coupled with advances of IT, we are in many ways on the brink of a golden age of medicine.

In the relatively near future, information supporting evidence based medicine will translate from bench to bedside at speeds never before witnessed. We will have more accurate information to treat health issues more appropriately, based on the data, than ever before.

Admittedly, IT is in many ways a crude medical device, but that is today. Many of the now traditional medical devices that were introduced into the healthcare market throughout history started off as crude devices; think about surgical tools.

Like other medical devices, this device is certain to evolve with use, experience, and continued development and innovation. Many predict that the use of this IT device by healthcare professionals will become the standard of practice, like scrubbing in before surgery. The legitimate debate generally centers on how and when.

As with other changes in medicine, the adoption of this new tool will be an evolution. It will not happen by just flipping a switch at the end of any given year, it will evolve. Consumers and their physicians must participate in this evolution for it to ultimately be successful. The consumer’s best platform to effectively and economically engage with the industry is a standardized personal heath record (PHR).

What is a PHR?

A PHR is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. PHRs are distinct from electronic health records, which providers use to store and manage detailed clinical information.

The Benefits of using a PHR

There is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective healthcare. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

Ultimately, this new tool will allow physicians to benefit from improved information about each patient, and consumers and doctors can share that information to make the best decisions concerning their healthcare. Better data (e.g. timely, personalized clinical and billing data) provides better results whether in the hands of a physician, patient, health coach, or measurement program Additionally, care coordination from a process management perspective is critical to improved results

Consumer Empowerment

Consumers have great interest in the subject of healthcare. It is the most searched subject on the Internet, yet the long predicted wave of consumer empowerment in healthcare has yet to arrive.

Consumers, as well as the business community, are generally unaware of the healthcare cost and quality issues and interoperability issues. Nor do they recognize that they have a new, long anticipated, role as purchasers seeking value in the healthcare delivery system. They tolerate the existence of numerous inefficiencies and cost in the healthcare sector far more than in any other market, because of and in spite of its relative importance and their inability to judge value.

Today, the consumer is unable to identify value without information on cost and quality. Quality cannot be identified without measurement and it cannot be compared without standardization.

Since the mass adoption of the Internet, the benefits of IT have embedded themselves into society as one of the most powerful tools that consumers have ever had. Endless information is now available in everyone’s home. Society has embraced this new found consumer tool, but comprehensive personal clinical information has not digitally made its way into the consumer’s hands. To some degree it is not readily recommended or available, yet.

How does a consumer get educated about their new role in their own health and their interaction with the healthcare delivery system? Who do they trust to guide them? Consumers trust their physicians far more than any other group in the Healthcare system. They certainly value their doctor’s advice, even if they don’t follow it all of the time.

Today, the consumer is effectively, unwittingly waiting on their physicians to recommend this new medical device for their health. Therefore, engagement of the physician is the key to fostering consumer empowerment.

What is Durable Medical Equipment (DME)?

There is no single authority, such as a federal agency that confers the official status of DME on any device or product. A fairly comprehensive definition of Durable Medical Equipment as contained in a Texas Group Policy is as follows:

Durable Medical Equipment is defined as being equipment that:

• can withstand repeated use; and
• is primarily and customarily used to serve a medical purpose; and
• is generally not useful to a person who is not sick or injured, or used by other family members; and
• is appropriate for home use; and
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition; and
• is prescribed by a physician.

A consumer’s PHR fits the definition as follows:

Durable Medical Equipment means

equipment : Noun. An instrumentality needed for an undertaking or to perform a service.

that:

• can withstand repeated use. A PHR easily withstands repeated use.
• is primarily and customarily used to serve a medical purpose. A PHR contains a consumer’s relevant medical information so many medical decisions can be made based on the contents of the record.
• is generally not useful to a person who is not sick or injured, or used by other family members. A PHR is not useful to anyone in the consumer’s family but the consumer and only the consumer can use it to track and support her health or coordinate her care when she is ill
• is appropriate for home use. A PHR is appropriate for home use or anyplace a consumer has a connection to the Internet.
• improves bodily function caused by sickness or injury, or further prevents deterioration of the medical condition. According to the trade association that represents insurance plans and the executives of most plans, there is consensus among stakeholders that the widespread adoption of health information technology will lead to safer, more effective health care. Experts believe adoption of technology will reduce preventable errors, such as medication errors, increase compliance with recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.

and is prescribed by a Physician; Can physicians professionally make this recommendation to their patients? It depends on whether they can professionally agree with the statement that “a PHR is a medical device that in certain cases can benefit their patient’s ongoing health or illness.”

If physicians prescribe a PHR for their patients, and the Payers collectively agree to pay the costs, the standard of practice in a community will change. Physicians will create a new business model in order to pay for their EMR system, and the power of a new medical device can be leveraged for the benefit of the consumer.

The PHR information must be stored in a secure way with patient privacy a cornerstone of the repository. Physicians must play a role in the central repository of this clinical information in terms of governance and oversight with appropriate financial compensation for their participation.

If every physician in Harris County, Texas prescribes a PHR for every patient that could benefit from such a device, it will be a catalyst for the creation of a clinical information database that would be owned and controlled by doctors and their patients.

The opportunity for today’s leaders is to take steps to enable our community to appropriately leverage the power and value of the data. To be sure, this is not as much a technology problem as it is a sociology issue. The first step is for the Industry is to acknowledge IT for what it is, a medical device.

News 10/22/08

From Elsie EHR: "Re: two I’ve not heard of. While reviewing the new 2008 CCHIT-certified EHRs, I saw two products I hadn’t heard of before … MedLink and SmartClinic. The web site of the latter looks a tad (how to put this delicately?) like it was created by someone whose full time job is not in the field of web design (I like the fact that the title of their home page is ‘home’). Oddly, despite being one of only ten 2008 CCHIT-certified EHRs, SmartClinic’s website doesn’t mention the certification." MedLink is here and VIP Medicine (the SmartClinic people) is here. I’ll refrain from snarky commentary on the latter except to say that you have to see it to believe it. I guarantee I could get an ultra-slick version done for a few hundred dollars (including graphics that are attractive and legible), so it seems like a poor investment to leave it hanging out there like it is.

From Ken Malansky: "Re: the former chairman of that fraudulent vendor you mentioned. He is GUILTY! I spent seven weeks of my life on that jury. The one holdout was star struck by his lawyer’s impersonation of Johnny Cochran." I thought they were going to retry him, but that was probably just prosecutorial chest-puffing after the hung jury in 2006. His attorney also represented Scooter Libby (where he parked his aging mother in her wheelchair where the jury could see him fawning over her), Eliot Spitzer, Exxon, Merck, and Philip Morris.

From Dave Dravecky: "Re: rumor. Heard at MGMA that GE is buying Greenway; can’t verify. Supposedly the VC guys want their money, the market is no good for going public, and GE needs a more up-to-date product."

From Salesgal: "Re: Sage. [name removed] got the axe." Unconfirmed. The person named was sales VP for the northeast, but I didn’t feel right about putting his name up here. If he’s gone (which I assume is the case) it’s embarrassing to him, and if he’s not, it’s embarrassing to me. Those who care will know who it is from the position (and whether it’s true or not).

From TalkoftheTown: "Re: Allscripts. I’m surprised you discount what McConnell says about the Allscripts/Misys headquarters situation. The guy has gotten more then 1.2 billion from the two companies for parts of what is left and it’s now valued at about 600 million. Which raises another issue on my mind – what was Allscripts worth when Tullman took over 11 years ago?" I don’t get the feeling that John is involved at all with the new Allscripts, so while his assessment about Raleigh may be interesting, I don’t know if he’s got any insider information now. I could be wrong. Most of the company is in Raleigh,I think I read somewhere.

From GirlGeek: "Re: Epic. Altru Health Systems, Grand Forks, ND, is switching from QuadraMed’s Affinity software to Epic. Altru is one of QM’s oldest clients dating back to the 1980s (or earlier?). Word is that Altru had to beg Epic to take them on since they don’t meet their bed count criteria."

From Al Borges, MD: "Re: Magellan EMR. Anyone know what has happened to them? Their website is dead. A physician who is still using the Magellan Writer can’t get in touch with them." I snooped around starting with the old domain name, registered by John Curtis of College Station, TX under the company name of BTQnet, a Texas corporation (custom software) with an Austin apartment address (the corporation is not in good standing with the state). He appears to have been at Quotient Integrated Solutions afterward (owned by BTQnet, I suspect) but their PBX doesn’t list him (this writeup says he ways still there in July). He’s on LinkedIn. Magellan was going crazy giving away tablet PCs back in 2005 and that’s all I ever heard of them. OK, can someone take it from there?

Just in: Cerner beats Q3 estimates: revenue up 13%, EPS $0.54 vs. $0.37. The company says it will exceed that in Q4. Well done.

A woman who waited 19 hours in Parkland Hospital’s ED and finally left without having her broken leg treated receives a bill for $162. They probably shouldn’t have let Parkland’s revenue VP go on record because he made it an even worse PR nightmare: "She’s not paying for waiting. She’s paying for the assessment she received." No she’s not, the woman says, who has no insurance and says she will not be sending Parkland a check for having a nurse take her blood pressure and tell her to wait.

McKesson will sell its specialty pharmacy business to Walgreen.

Listening: new AC/DC. It’s no Back in Black, but it’s good, straight ahead rock. I saw them live in the Bon Scott years — the guy in schoolboy knickers (guitarist Angus Young) doesn’t look any older even though he’s now 53.

RAND Corporation is all for NHIN and a unique patient identifier, but then again they’re not the ones who have to pay the hundreds of billions of dollars those would cost. The predict great cost savings and patient safety improvements, but they said the same thing about those EMRS that few doctors are using for various reasons unrelated to the quality of the doctors or the EMRs (poor adoption of which make NHIN and the identifier worthless since they add little value to paper charts).

Kaiser says HealthConnect is now live in 12 Southern California hospitals, bragging that its total of 22 hospitals serving 4.8 million members is the US civilian record.

Dr. Wes says it’s not an "electronic medical record," it’s "a sea of electronic medical servers," observing that every system at his hospital requires its own logon. Sounds like they need a physician portal at NorthShore to run Epic and those other applications mentioned.

Talyst announces its medication system (ordering, pharmacy, automated dispensing) for correctional facilities.

CareTech Solutions migrates the 80-server data center of Port Huron Hospital (MI) to its own Troy, MI headquarters in 36 hours as part of its outsourcing contract. The company has 1,000 employees and is bringing on many more. "Pretty much anything that has an electron running through it we are probably working on it," says Jim Giordano, president and CEO.

Arthur Clark is named VP/CIO of Haven Hospital (FL), coming over from John Sealy Hospital (TX).

A survey reinforces what everybody knows already: order sets improve processes and patient safety. The best time hospitals can spend in a clinical systems implementation or improvement is to develop an effective order set review process, starting with automatic inclusion and working toward evidence-based consensus.

Winchester District Memorial Hospital of Ontario, Canada signs for QuadraMed QCPR, document imaging, and enterprise scheduling.

ClearCount Medical Solutions, a Pittsburgh vendor of RFID surgical sponge counting technology, raises $4.1 million in Series A financing.

Daniel A. Krause, formerly of SciHealth, is named head of US business development for Satyam Healthcare.

Millin Associates announces a new practice management billing system for certain clinic types.

A new project named Wareed will electronically  link all hospitals in United Arab Emirates. Cerner is a participant.

A mob with iron rods storms and vandalizes a hospital in India, claiming that a patient’s lab tests were sent to an outside organization because the hospital’s doctors get a cut of the cost. The hospital says techs work only normal office hours and after hours work is always referred.

A man registering his pregnant wife online at Mary Washington Hospital (VA) finds that he can see the files of 803 patients on the site. The hospital said it was "an anomaly." The man got an invalid security certificate warning, then tried to delete some of the URL, which then took him to other pages that showed him the records of every patient who had registered online since December 2007.

Jack McCloskey joins Magruder Hospital (OH) as IT director, leaving a similar role at Floyd Memorial Hospital (IN).

NextGen Healthcare is named as one of the best places to work in the Philadelphia area.

Jobs: Epic Consultant, SIS Project Manager, Cerner PharmNet Consultant.

About 88% of American adults can’t make good health care decisions given the right information, an AHRQ study reports.

HLTH and WebMD cancel their $2.31 billion merger. I can never figure out that corporate mess where one owns most of the other and Marty Wygod is chairman of both companies. Conveniently, I have zero interest in both.

E-mail me.

Inga Live from MGMA

From Nasty Parts: "Re: political correctness. Did not realize the whole Obama thing was a done deal!” A couple of weeks ago I made one remark about Sarah Palin’s bangs and suddenly started getting hate mail from folks who treated that as a political endorsement. Yesterday I quoted someone else who mentioned “a possible role in an Obama administration” and suddenly I have written off McCain. I think everyone needs to take a deep breath and settle down. It will all be over in two weeks.

From Inga Wannabe: “Hi Inga. I am at MGMA and for some reason, several friends insist that I am Inga. I finally gave up and let them call me Inga. And, I actually decided it might be fun to be you.” Yea! We had a fake Inga at MGMA after all! By the way, it is pretty fun to be me. You are welcome to be Tina Fey to my Sarah Palin anytime (note to the crazy politicos: the previous sentence was not meant to be political).

From oneHITwonder: “Re: annoying texting. Man, I am so bummed out that I did not identify Inga in the relatively small CCHIT crowd. I will have to keep looking … hope she was not the annoying lady who was texting behind me during the entire session.” Likely not me since I sat up pretty close and (just like in third grade) would have been embarrassed if the speaker caught me not paying attention. As for the texting people, you have to remember that there are a lot of busy people in this world who believe the world may fall to pieces if they were unavailable to their underlings for an hour.

I got my first LinkedIn recommendation! “Not only does she give us great information, she also gives us humor, fun, and something to look forward to reading every day.” Thank you, Christianne for making my day. Mr. H and I, by the way, love to accept all LinkedIn requests.

It’s Tuesday afternoon in lovely San Diego. There is a reception tonight, but I don’t think my feet can handle any more standing or walking. I think I’ll go for dinner, a glass of wine, and an early night before I head for home in the morning.

Last night was a not an early night. I scored an invite to the Allscripts party, which was in a beautiful outside patio on top of the Hard Rock Café. It was pretty packed. Everyone seemed to be upbeat about the Allscripts/Misys thing, though it’s easier to be happy when you’re being provided all the free drinks you want. The only thing I heard anyone complaining about was the lack of food. Perhaps Allscripts decided to eliminate consumption synergies.

In a session yesterday, the speaker asked who had a hospital-provided EMR. Only about 10% of the hands went up, which surprised me a bit. I wish he had also asked if anyone’s practice had been offered the financial assistance from the hospital but turned it down. That’s the question I want answered.

I touched on this yesterday, but my impression is that the top concern for attendees is improving the bottom line. Hence, vendors are promoting many tools for increasing revenues and/or cutting costs. Even solutions like EMR are being discussed in terms of how it will help with pay-for-performance objectives. When I thought more about it, I remembered that the administrator is the one charged with taking care of the bottom line, so it shouldn’t really surprise me that they are less concerned with finding tools to make life better for physicians, etc.

A cool tool I checked out was from a company named Phytel. As I understand it, their Proactive Patient Outreach program works with any PM/EMR. It scrubs the offices’ data and finds all the patients meeting a particular set of criteria, such as all diabetic patients who have not had an office visit in over a year. Then it will call those patients, thus increasing revenue. Really simple concept, the technology works, and it produces results.

A couple of companies were promoting standalone products that calculate the patient-responsible monies at checkout and then place a hold on the patient’s card for that amount. Thus the patient has no surprises about the costs, does not have to worry about later paying a bill, and the practice is paid faster. Preferred Health Technology and mPay Gateway were the two I saw offering slightly different flavors of this concept. Both claim the PM vendors are lining up to partner with them.

One of the most entertaining moments of my day was a meeting with athenahealth’s Jonathan Bush, who gets excited about everything. He was clearly still pumped by a dawn surfboarding expedition. He’s about 100 IQ points higher than the rest of us, reflecting on recent industry consolidations and Marxist capitalism (consolidation is a predictable result of capitalism). We quickly jumped to his theory on software licensing versus software as a service, which is where he obviously believes the industry is heading. Finally, JB was gracious enough to say that HIStalk is about the only industry publication he reads (the always skeptical Mr. H says he probably says that to all the journalists).

A few other quick tidbits:

• I tried a couple of times to ask someone at the busy NextGen booth to explain more about their recent RCM acquisition. I never got a chance to talk to anyone in the know, but I did get a free t-shirt and a cool little flashlight.
• I spent a bit of time in Greenway’s booth and got the scoop on their new PrimeResearch product (they are excited about it) and quickly met EHRA chair Justin Barnes.
• Tried to check out PatientKeeper a few times, but every time I walked over there were busy, busy, busy.
• I met Sage VP Sharon Howard, who commented they were happy to be done with the turmoil a few months ago when her comments about some layoffs were misinterpreted. She thinks they did the right thing trying to be as forthright with the press as possible.
• I asked several attendees if they had an EMR and if they were on their first one, second, etc. Almost all claimed to still be on the first. Several vendors claimed they had replaced one competitor or another, but admitted that most buyers are on their first install.

Enough on my impressions! My wine is waiting. If you were at MGMA, please send us your thoughts!

E-mail Inga.

Inga Live from MGMA 10/20/08

Greetings from San Diego! It’s been years since I’ve been here and I had forgotten how absolutely perfect the weather is. Although, aside from the short walk from my hotel to the convention center, I haven’t had much fresh air!

I spent Sunday afternoon checking out the exhibit hall. Apparently there are over 350 vendors here to promote their wares to the 2,800 attendees. The traffic seemed pretty slow to me, and actually several vendors agreed. It’s Sunday as I write this, though, so it will pick up Monday.

None of the booths were over the top like you see at HIMSS. Cerner, McKesson, Sage, and Allscripts had some of the bigger booths, but there were plenty of small booths throughout. I also noticed what appeared to be 2-3 vendor no-shows.

One of my first visits was to Med3000/InteGreat, which was handing out cute little teddy bears. It probably would have been Mr. H’s favorite booth because two booth babes in black boots and white shorts were flagging those attendees who didn’t find the teddy bear to be an adequate draw.

Another memorable booth was Health Business Navigators. Everyone was wearing these silly white sailor hats, but they were being good sports about it and people were stopping. Plus if you sat through a five-minute overview of their ad hoc reporting tools, they gave you your own hat plus a $5 Starbucks gift card.

It’s been a few years since I had been to an MGMA meeting, but I seem to recall EMR being the buzz at that time. This year EMR is still hot, but revenue cycle billing services seem to be this year’s "it" product. Sage, for example, had a presentation by RCM expert Pam Moore, who is editorial director for Physician Advisor. I sat through her spiel, which was pleasantly generic and not a straight pitch for Sage. They also had really comfy chairs to sit in, and if you participated, you got your name in the hat for a $500 cash drawing (which, sadly, I didn’t win).

And speaking of comfy chairs, the Panasonic folks had this awesome massage chair. Full body massage. I want to marry the massage chair.

Anyway, my favorite booth pitch was Gateway EDI. If you gave them your card to swipe, they would donate $5 to Susan G. Komen for the Cure. Good stuff.

According to the exhibit information, Misys and Allscripts were each scheduled to have a booth. However, they used the original Allscripts space for all the demos (complete with the new orange, new logos, etc.) and turned the other into private meeting rooms. It’s actually pretty impressive that they had all the new branding in place a mere one week after the merger closed. I am sure the marketing guys were breathing a sigh of relief that there were no more delays in the merger.

Towards the end of my booth trekking, I stepped into the Workforce.com/OnBase booth. Tiki torches, thatch huts, and an open bar made it seem like a good stop (I actually did hang out at one of their tables for a bit, but drank only water). Unlike every other booth I popped into, no one really chatted with me for some reason. I kind of wanted to hear their story, but everyone seemed to be busy putting collateral up or conversing among themselves.

After a short break in my hotel room, I went over to the opening reception. Lots of folks there were using up their free drink tickets (I used mine up, too). They had an assortment of entertainment in place (my favorite was the lady making ice sculptures with a chain saw). I had fun chatting with a few administrators who were trading EMR implementation horror stories. I actually slipped out early lest I be tempted to find some after-party!

On Monday, I sat in on a CCHIT session. Not surprisingly, most of the attendees were looking for EMRs. Besides learning more about the certification process, there was some discussion on what other criteria CCHIT should consider. The audience recommended CCHIT consider adding more more portability requirements to make it easier to move from one EMR to another (when you dump the first vendor). Another couple of suggestions that I am sure would make vendors quiver: coming up with a certification process for physician PM systems and making EMRs more seamlessly integrate with PMs at a nominal cost. 

One session I missed: The Office: Manners Matter and Courtesy Counts.

I also  had a chance to hear Glen Tullman speak this a.m. The conversation was brief, but I heard enough to leave me convinced he really is passionate about this whole connecting healthcare thing. I’m sure he has shared his "connecting the community" vision hundreds of times, but  he still managed to sound genuinely fresh and passionate about advancing interoperability (between Allscripts products as well as other products). Someone asked him if he was making any plans for a possible role in an Obama administration or possibly as a senator. He stressed that he had signed a three-year agreement and wouldn’t have done that if he hadn’t thought long and hard about those options. He also said he has been vocal in his opinion that the HHS leader should be a physician and since he lacked that credential, it sort of hurt his chances. Of course, if that phone does ring, I imagine he’ll at least take Obama’s call. However, my impression is that he believes he has a chance to make a bigger impact in HIT staying in his current role.

I’m sitting in a session but I can’t absorb another fact about the benefits of interoperability. So, a few more notes:

• If you sit through a Navicure demo, you can get into a drawing for an Audi convertible. I am hoping to drive home.
• Magician fans could get their fill at the Greenway and McKesson booths.
• If advertising in the restrooms is appealing to you, you’d best stick to HIMSS. At least the ladies’ rooms were signage-free.
• Even though Medinotes is now part of Eclipsys, you’d hardly know it. Not only did they have separate booths, there was very little signage promoting the marriage.
• I prefer suits over those homogenous golf shirts. Don’t know if it is a trend, but a good number of the vendors wore "real" clothes and not those shirts that never fit the women well and in colors that real men would never wear. 

An HIT Moment With … Justen Deal

An HIT Moment with ... is a quick interview with someone we find interesting. Justen Deal was the Kaiser Permanente employee made famous when his November 2006 internal e-mail criticizing the organization’s HealthConnect EMR project was leaked out to the press. The CIO left, the CEO was publicly and somewhat arrogantly defensive, and HIStalk’s readers voted Justen Deal Industry Figure of the Year in the HISsies that year.

What has your post-Kaiser Permanente life been like?

In one word, interesting. Challenging at times, as well. It helps to have the perspective afforded by two years, though. Challenging in that the first few days, weeks, and months took a lot of patience, quite a bit of deliberation, a fair amount of persistence, and a ton of coffee.

Interesting in that I came to see healthcare information technology from a different angle. I saw the provider side, the needs, the costs. I saw the vendor side, the challenges, the risks. If you got past the headlines, I always defended Kaiser Permanente and the importance of the HealthConnect project, and on more than one occasion, I pointed out the strengths and advantages of Epic.

I eventually began working on Vieue, which has given me the opportunity to put some of that perspective to use. I know that no one company or person can solve every healthcare information technology problem, but there are a few we’re working on.

What good and bad effects resulted from your famous e-mail?

We’re just shy of about two years out, so, as I said, the time allows a bit more perspective.

The negative was that I ended up leaving Kaiser Permanente, which is an organization I believed in and still very much care about.

On the positive side, speaking about healthcare in general, I think there has been a small, but real shift in how electronic health record projects are assessed, in terms of their costs and successes. I think there still is a lack of thorough, public, critical analysis of the efficiency and effectiveness of electronic health record projects, but it has definitely improved, and I hope my e-mail played some small part in that.

HealthConnect is getting good press about improving patient outcomes. Are you buying it?

I think we all agree that smart, interconnected electronic health record systems can have an enormously positive impact on patient outcomes. The recent report that Kaiser Permanente is leading the nation in terms of breast cancer screening rates is great news, and it comes after more than a decade of work at KP specifically geared towards increasing detection. For 2005, the Southern California region achieved a mammography screening rate of 84%, which, as you’ve mentioned, has reached 87% according to the most recent data. By comparison, the current national average is 72%. 

Other regions have seen success, as well. In 1996, the Georgia region had a screening rate of 74%. In 1997, they implemented their Breast Health and Cancer Detection Program, and by 1999, they had significantly increased their rate to over 84%. The combination of building smart reminders into healthcare information systems and relevant patient workflows can obviously go a long way to improving patient outcomes.

Broadening your question just a little bit, I think the question for healthcare has to be whether we’re actually taking meaningful steps towards taking breast cancer screening rates up nationally, towards catching the hundreds of thousands of deaths every year caused by preventable medical errors, towards tracking and ensuring better compliance and follow-up on chronic conditions. I just don’t think we’re seeing the sizable shift we should be seeing there across the country, and I think that’s because the software isn’t as "smart" as it needs to be to catch, track, and prevent.

The other issue, I think, is cost. Across healthcare, we’re spending tens of billions of dollars on healthcare information technology, and the return on investment just isn’t there yet, until we are indeed meaningfully and quantifiably improving outcomes and reducing the cost of care. I worry about whether we’re wearing out our welcome with providers and insurers alike when we over promise, under deliver, over budget.

Lots of folks said you were highly analytical and well spoken in your HIStalk interview, but said they would never hire you because of the risk of a similar situation down the road. Has that been the case?

I decided fairly early on that I wanted to focus on Vieue, so I was thankfully spared any awkward interview moments. For any companies that might care about my particular perspective, though, I will say that I think it is critical to have a thorough, sincere, and independent compliance process, which can go a long way towards catching and addressing concerns proactively. I think it is a mistake to view compliance as a public relations apparatus, but the reality is a competent compliance process can often help prevent internal problems from becoming public problems, not through suppression but through correction.

Kaiser chairman George Halvorson is speaking at the HIMSS conference in Chicago next year.  If you were in the audience, what questions would you ask him?

I honestly can’t think of a single question.

Monday Morning Update 10/20/08

From Hoyce: "Re: inkjets. I wonder what these cartridges will cost?" Link. HP licenses its inkjet fluid technology to Home Dialysis Plus for mixing of dialysate and water for in-home treatment of kidney failure, saving the patients trips to the dialysis center. HP had already licensed the technology for administration of vaccines.

From The Blogfather: "Re: Cerner. Never let it be said that Neal Patterson makes idle threats. After bringing up the famous e-mail at the company meeting, he followed through and cut Cerner’s healthcare benefits in the middle of open enrollment. Cerner’s only contribution is $400 to an HRA account, leaving associates to fund the remainder of their care through old school FSA accounts." Unverified.

From The PACS Designer: "Re: Virtual Desktop Infrastructure. With the increased focus on virtualization, a term invented by VMware in 2006 is starting to gain some traction. Virtual Desktop Infrastructure (VDI) will be seen in the news more often now due to the virtualization efforts of VMware, Amazon, and now Microsoft with its soon to be introduced virtual desktop that runs in cache memory as a thin client. As more organizations look to reduce operating costs and simplify desktop application management, you will see more movement toward this thin client concept. The possibility of thin client PACS running on a virtual server that downloads the application to your cache memory could be a new trend in the years to come and would be a good cost saving application for smaller providers." Link.

From Fourth Hansen Brother: "Re: non-competes. They just got killed in California. Are people getting out of those that Epic writes?" Link. The California Supreme Court rules that employers can’t stop former employees from starting businesses or working for a competitor. Let’s face it: no court will stop you from making a living just because your former employer made you sign some questionably binding document as a condition of employment. Your problem isn’t the courts, though – it’s the new employer who doesn’t need the legal headache (or to make Epic mad if they depend on them). They’ll just hire someone else. If a former employee had the time and money to fight the non-compete, they would probably win and potentially set a precedent for everyone. I haven’t heard of Epic’s in particular, but I’ve heard that some Wisconsin attorneys were taking cases awhile back.  

From Lucy Ewing: "Re: physician contracts. Will doctors sign anything someone puts in front of them? A friend mentioned that a practice was getting terrible service from their billing service and planned to change. The billing service’s CEO freaked out and threatened to sue, pointing out that the contract they signed legally obligates them to send all billing through that company." I know doctors hate lawyers, but so does everyone else … until you need one. Like when signing a contract. 

The Raleigh paper just can’t accept the fact that Allscripts has moved the former Misys Healthcare’s headquarters to Chicago. The reporter pestered Glen to the point he finally said, "I wouldn’t rule out the fact that the headquarters may be here at some point in the future," surely just to get the reporter off his back. For some reason, the reporter then checked with John McConnell, who’s not part of the deal, and he fanned the dying HQ embers by saying Glen works for Misys and they’ve always liked Raleigh. My opinion: the important products going forward are Enterprise, Professional, Payerpath, and Connect. Everything else in Raleigh other than product maintenance (sales, administration, non-HealthMatics R&D) is way overstaffed under the new model. As tough as it is to hear, Misys brought little to the table except lots of indifferent customers, so it’s certainly not going to business as usual in Raleigh since Allscripts really needs to put up good numbers right away. I hate that "trim a tree to make it grow" stuff too, but that’s reality.

PatientKeeper’s Suzanne Cogan will speak Monday and Tuesday at MGMA (at Sage’s Booth 615) on "The Physician on the Go: Improving Revenue and Practice Operations with Mobile Applications."

I never heard of company Conceptual Mindworks of San Antonio, TX or its EHR product Sevocity (I must not pay enough attention to CCHIT certification since it earned Ambulatory 2007 in May). The name’s a stretch ("a combination of two words: seven, which signifies good luck or prosperity and velocity, which means speed or journey") but it looks of cool and is cheap ($800 startup per provider, then around $500 a month for EHR; another $200 for PM) with 24×7 support. They seem to have made their money from Air Force contracts.

Here’s a bit of McKesson history that I hadn’t heard. In 1938, its predecessor, drug wholesaler McKesson & Robbins Inc., faced bankruptcy after it was discovered that the CEO had cooked the books (he was actually an ex-con and swindler who used a fake name and medical background to buy the company). At an emergency company board meeting, word got back that the CEO had committed suicide. Said a Goldman Sachs partner who sat on the company’s board: "Let’s fire him for his sins anyway." The same thing happened with the HBOC acquisition, announced October 26, 1998 (maybe McKesson will be providing cake and punch for the tenth anniversary) except that McKesson’s executives didn’t kill themselves (only their careers – they were all canned after the fact) and the numbers were a lot bigger ($14.5 billion). The happy union was frenetically consummated on January 13, 1999 and the cooked books were discovered only three months later, sending $9 billion of McKesson market value up in smoke in a single day, leading to an entirely new meaning for Pathways Accounting. Everyone I knew saw it coming, so either I had smart friends or McKesson had dumb executives. Believe it or not, the adjusted share price still hasn’t recovered from that self-inflicted disaster: shares were around $82 in the fall of 1998 and are a little more than half that now. Cerner shares have tripled since then.

Jim Riley, formerly of Payerpath, joins MedAvant as sales VP, reconnecting with his former Misys boss Andrew Lawson, now MedAvant president.

Picis will be at CHIME’s Fall CIO Forum next week in Lost Wages, so if you’re going, drop by and tell them you appreciate their support of HIStalk.

While I’m on that particular soapbox, show a little sponsor love all around when you get the chance: click their ads to see what’s up with them and tell their executives that you saw the company mentioned on HIStalk. I’m a foot soldier working a hospital job by day, so I need some allies in proving the sponsorship value here. Thanks.

Sisters of St. Francis Health System threatens to cancel its WellPoint contracts because the Indianapolis insurance company isn’t paying on time. The insurance company blames its BlueCard claims payment software. WellPoint has been sued by investors who claim the company knew about the problem but didn’t disclose it. A representative of the company’s Anthem subsidiary says the problems won’t be fixed until February. WellPoint’s former CEO walked away with $23.9 million last year and the current one is getting $9 million a year. Why deliver actual care when pushing the paper it generates pays so much better? Adding value is so 1970s.

Gartner places Sentillion in its Challengers quadrant for Enterprise Single Sign-On.

Alberta, Canada (always reminds me of "Prince Albert in a can") will make health information available online to its residents.

Healthcare IT consulting firm Global Works Systems opens its new corporate office in Colchester, VT, which it points out is near its partners Allscripts and GE Healthcare.

I hadn’t snooped around MEDITECH’s site lately, so here’s your info tidbit: the cafe lunch in Westwood Monday will be grilled steak tips with sweet potatoes and Brussels sprouts. I bring that up because I’m one of the approximately five Americans who will eat Brussels sprouts (as long as they’re fresh and not frozen). I see they’ve posted all new (to me, anyway) color photos of the executives and they look like the kind of people I like (few ties, some are kind of nerdy looking, and everybody looks happy, maybe because they’re wealthy). It’s the most successful company in the history of the industry (which it happened to create – look it up) so I like to pay appropriate homage. The only blot on their otherwise perfect HIStalk record is that I can’t convince Neil Pappalardo to let me interview him even though he’s a rock star to me, but Howard Messing did an inarguably fine interview back in the early days of HIStalk that I really enjoyed.

A huge federal raid in the Cleveland area involves MetroHealth Medical Center. Several companies were searched, among them a local division of Siemens, which got contracts for both public housing and hospital work. FBI agents told the Siemens employees to clear out while they hauled out boxes. "He is an employee at Siemens, which handled a $33 million energy conservation contract with CMHA that Phillips helped shepherd through. McMichael is named in a federal subpoena involving Carroll and Greco. The subpoena indicates that agents are looking into whether contractors, including Siemens, had any financial relationship with the hospital administrators or whether any contractor did work at the men’s homes." Bribery (several billions of dollars’ worth) appears to have been woven into the corporate culture, according to former executives. Somehow they’re still in business.

The preview looks wickedly funny: Children’s Hospital, an Web series on the WB. Doctor in clown makeup: "I’m challenging you to a healing-power-of-laughter-off."

Vendor Deals and Announcements

• InteGreat and Nuance extend their partnership, giving InteGreat the ability to provide its clients with Dragon Medical 10.
• eHealth Global Technologies announces the release of the Image Exchange Service for RHIOs and HIEs. The product facilitates the exchange of medical images utilizing a DICOM-compliant viewer.
• Ingenix acquires business intelligence company Bull Services/Integris. Bull Services also offers consulting services, systems integration solutions, and outsourcing.
• QuadraMed’s former VP of strategic services Vicki Wheatley is now VP of consulting services for HIT consulting firm Just Associates.
• North Hawaii Community Hospital contracts with Phoenix Health Systems to provide IT management and infrastructure services.
• Physician-owned MSO Premiere Medical Resources (Ohio) selects Noteworthy’s NetPracticePM and NetPracticeEHR for its 92 members.
• iMedica signs a sales and marketing agreement with CySolutions, a provider of community health center solutions.
• Munson Healthcare (MI) selects Lawson Human Resource Management Suite and Lawson Business Intelligence to consolidate its administrative processes and support its HR and payroll functions.
• MedAssets announces the release of its Medicare Recovery Audit Contract solution that helps healthcare providers throughout the recovery audit process.

E- mail me.