News 10/15/08

Reminder: Allscripts CEO Glen Tullman will be live here in an online chat at 7:00 ET Wednesday evening. Several folks have left comments on his article or weighed in on the merger, so why not let Glen answer your questions directly? I’ll be posting the chat thing right here on HIStalk like any other article. You can set up a reminder for yourself right in the chat thing (I don’t know what else to call it, but it will make sense when you see it – picture above). I’ve practiced a little with it and I promise it’s fun and easy to use. Watch for the link or just go to www.histalk.com and you’ll see it.

From AHIMA IS DEAD: "Re: News from AHIMA – Seattle. One word – DEAD. Needs to be merged into HIMSS. No decision makers, no excitement, no pulse, no attendees." I know QuadraMed is there with some of those more modern technologies you’re interested in (HIM and identity management), so drop by their booth, tell them you’re probably the only HIStalk reader in attendance, and ask to be informed and entertained (no promises, but it never hurts to ask, unless you’re a competitor anyway).

From Duffy Dyer: "Re: Medsphere. The company put out a press release that implied that the VueCentric GUI was open source and part of its product, then had to retract it on Hardhats, saying they intended only to say that VueCentric was used in the Indian Health Service facility that just won the Davies." I’d call that press release a total disaster since it was nearly impossible to comprehend even without the gaffe. It must have been a slip because the others are OK and Schwartz PR is among the best that I’ve seen.

From Wilma Flintstone: "Re: Allscripts. Misys was supposed to be the acquirer, but all the top management is from Allscripts, the Allscripts name replaced the tainted Misys one, and it looks like from the site that the old Misys products like Tiger, Vision, Misys EMR, and even MyWay may be available only from resellers. The orange color might be what you get when you mix purple and red and the logo kind of looks like an M and an A (with the M in the shadows), but otherwise it looks like 90% Allscripts."

From Lula: "Re: Ingenix. You might be interested to know (if you don’t already), that Paul Sinclair, ex-senior VP of Cerner, resigned a few weeks ago and is now the COO of Ingenix Consulting. You can validate this via his Linkedin profile." You are correct. I didn’t know that. He had run Cerner’s professional services business for 12 years.

From Fourth Hansen Brother: "Re: shooting victims taken to closed hospital." I couldn’t find the online story to link to, but the text FHB copied says people took shooting victims to a closed Milwaukee hospital twice in a single night. Two men in their 20s were shot in unrelated incidents and in both cases, friends and family drove them to St. Michael Hospital, which has been closed for two years. Police advised everyone to call 911 instead of driving victims to a hospital.

I was Googling former IDXer Jim Crook to see what he’s up to, having forgotten that he’s now on the board of Vitalize Consulting Solutions. If you’re been around awhile (their employees average 12 years with their particular product) you might want to peruse their job listings, of which they have some juicy ones.

A new article by MEDSEEK president Peter Kuhn brings up an interesting statistic: scheduling a patient appointment by telephone takes six minutes (three each for the patient and the scheduler), while doing the same thing via a patient portal takes one minute (just the patient). That’s the same reason I buy online (and schedule appointments online) whenever I can.

This legal mumbo-jumbo, as best I can tell, is some kind of preliminary argument about definitions in McKesson’s lawsuit against Epic that claims MyChart infringes on McKesson patients. In this round, McKesson was the clear winner, it appears.

Online doctor rating service MDX Medical/Vitals.com gets $4 million in VC funding. Inquiries are free, so I looked up John Halamka. The information is basic (specialty, hospital affiliation, medical school, publications) and the results screen includes ads (one for billing software, one a silly game advertising a drug). Why would regular people checking their doctor’s credentials be hot prospects for buying physician billing systems or prescribing Lunesta? The site has all the cute bubble graphics and the Arial Rounded font that embodies 2.0 anything (and that will be as dated as a ’76 Vega in a couple of years), but I’m not seeing $4 million worth of potential with all the similar sites out there.

Hospira acquires the EndoTool blood glucose monitoring system from MD Scientific.

Iron Mountain, apparently tired of making a ridiculously profitable living hauling truckloads of medical records to its old limestone mine for long-term storage, wants to "shift toward a more consultative approach in the healthcare space" by telling hospitals how to handle paper records. The obligatory President Bush/EMR/2014 boilerplate is inserted as a reference to how poorly hospitals are doing with EMRs. I bet they had a big presence at AHIMA.

TeraMedica wins an imaging informatics value award for delivering ROI to its customers, specifically for consolidating disparate PACS through partnerships and in-house engineering.

Carilion’s struggles to convert from a hospital to a clinic are detailed in the local paper. One nugget: they’ve put aside $66 million for a statewide medical information system.

A new Pennsylvania law bans mandatory nurse overtime. It’s too bad a law had to be passed preventing employers from making people work when they don’t want to (or who aren’t at 100%, increasing the chance of error).

HealthBridge, the Cincinnati HIE company, is considering expanding to other cities. It just extended its relationship with Axolotl.

I’m fairly knowledgeable about the use of barcodes, so I found this entry in Loftware’s blog interesting: how about a color-enhanced barcode that can store 1.2 gigabytes of content? As it points out, that could be interesting for easy, cheap storage of medical records, medical images, or even media. If you ask me, healthcare is just beginning to realize the potential of barcodes.

Now you know why subscriptions are free. Modern Healthcare launches its fancily titled "leadership forum," which it says will offer "unparalleled access to highly qualified healthcare decision-makers." Pieces of meat … uhh, provider attendees … can be happy that "educational sessions will not compete with exhibiting, providing maximum sales exposure and sales opportunities for exhibiting companies." Don’t hospital executives have problems to solve at home without attending the equivalent of a timeshare sales pitch? I’m a little hostile, but only because I thought Modern Healthcare was above that level of overt pimping.

The Raleigh paper moans about losing its Misys Healthcare headquarters to Chicago, also claiming without further reference that 44 jobs will be lost as a result. 

Hillcrest Medical Center (OK) will deploy the CareView bedside TV and workflow application. Looks like it includes patient monitoring cameras and recording, online patient viewing for family, Internet access, basic telemedicine, and movies. Tommy Thompson is on the company’s board.

Jobs: Production Control Manager (MA), Regional Sales Director NE (NY), Customer Support Analyst – EMR (PA), Application Manager, Epic Ambulatory (CA).

Dossia joins the Continua Health Alliance (Wal-Mart PHR meets home device monitoring). I thought Continua was going to be hot when it started, but I haven’t heard much.

Microsoft says it will stick with SpeechMagic for Amalga even though Philips sold that division to Nuance.

If you’ve ever been to a seminar talking about the drug supply chain, this is familiar. A former Cardinal employee pocketed $350,000 in kickbacks from a felon in buying drugs of dubious quality on behalf of Cardinal. Cardinal already settled for trading in the so-called secondary drug market. The article cites a case I knew about: a cancer patient died because someone swapped her Procrit labels to sell the lower concentration drug at full price. That drug came from the same guy the Cardinal employee was buying from, who also made $42 million (!) selling phony Lipitor. The program I attended was shocking: totes full of fake Valium coming through the Miami post office, Mexican dealers who buy the same expensive labeling equipment the drug companies use (even holographic label printers) for making convincing fakes, and thieves who had already cracked RFID just in case FDA requires tracking products. Forget Tony Montana’s crack dealing: the real money is in fake drugs for fake Canadian pharmacies and innocent hospitals who don’t know what they’re getting or where it’s been.

Philips misses Q3 estimates, blaming slow US healthcare business.

MedAssurant, a healthcare data analysis company, moves to Bowie, MD. One of the Roche family just invested $175 million in the company, so it must be hot stuff (and has 2,000 employees besides).

A Thai software company called International Medical Software has developed a large-hospital system in J2EE that’s being used in 12 hospitals. An ISP "pay per use" feature is coming.

Oracle CEO Larry Ellison says he’s on the prowl for acquisitions cheapened by the stock sell-off, expecting to continue the company’s one-per-month average.

Odd hospital lawsuit: an overweight 46-year-old woman arrives at the ED complaining of abdominal pain. The nurses and doctors start her workup, but she asks to use the restroom. Staff later find her 6-pound newborn daughter in the toilet. She’s suing the hospital (actually the newborn is suing) for lifelong care of the baby, claiming the medical staff missed obvious labor signs even though the woman herself didn’t know she was pregnant. She had cocaine in her bloodstream. An outside psychiatric expert summarized, "Chutzpah. This is America. You’ve got to love this country. This woman doesn’t know she is pregnant, but somebody else should."

E-mail me.

HERtalk by Inga

From Janeen: “Re: MGMA. Inga, I had to smile when I learned you were going to MGMA. Your friends from RelayHealth will be there. Should we have an Inga lookalike in our booth again?” For those who attended HIMSS earlier this year, RelayHealth did have a lovely Inga stand-in. Too bad Mr. H and I didn’t get our act together in time to provide our unique brand of Fake Ingas, celebrity galas, and giveaways for MGMA, but it was a last minute decision. Anyway, one reason Mr. H is sending me on this field trip is to brush up on the latest in the ambulatory space. We’d like to be better versed in that area to appeal to our readers from that world. Janeen also reminded me that RelayHealth has a PHR offering, with their model connecting to the consumer via their provider. I do plan to stop by to see their plans for working with HealthVault.

I’ve stopped opening my 401K statements recently because all those down arrows make me depressed. On the other hand, I bought gas for $2.69 a gallon this week, so go figure out what it all means. Last week, before the close of the Allscripts-Misys deal, Dr. Borges asked why I thought Allscripts stock was falling if the merger was suppose to be such a great thing. I asked an expert (and HIStalk fan) Sean Wieland, Piper Jaffray analyst and industry mover and shaker, for his impressions since I clearly don’t have the economy figured out. To paraphrase Sean’s comments, this isn’t the time to rationally explain the movement of any stocks because all stocks are trading independent of their fundamentals right now. However, one factor possibly affecting shares of Allscripts was the trade x-dividend. Shareholders through October 10th are scheduled to receive a dividend. The tax treatment of dividends can be a little messy, so some stockholders may have elected to sell their shares in advance to avoid the tax implications. On Monday, Allscripts opened at $4.40 and closed at $5.47; Tuesday it closed at $5.40.

Ingenix announces the winners of its 5th Annual Top 200 coding hospitals. The award recognizes facilities based on the completeness and accuracy of their medical coding practices to bill Medicare for inpatient medical services.

The Health Resources and Services Administration announces plans to hand out $18.9 million to 25 community health organizations for EHR implementation. It seems like a lot until you remember it’s just a drop in the bucket compared to the billions our government is shelling out to our banks and automobile makers. This latest EMR incentive is in addition to the $290,000 per practice that the CMS promised last week to primary care groups with 20 or fewer physicians.

Alegent Health selects LYNX Medical Systems, a Picis company, to provide outpatient facility coding services to its five Omaha metropolitan area hospitals.

I don’t watch a lot of TV, but I do remember that old commercial (for Vicks-44, I think) where the good-looking guy says, “I’m not a doctor, but I play one on TV.” Maybe advertisers will resurrect it from this statistic: 26% of Americans say they get a big part of the health information from TV, particularly TV dramas (not PBS, not even TLC).

Eclipsys announces that the University of Michigan Health System recently deployed Sunrise Acute Care across its 913-bed system and has seen a 29% decrease in medical errors. Additionally, the health system claims a 40% reduction in the time to administer urgent medical orders.

Healthgrades’ 11th Annual Hospital Quality Study concludes that patients have a 70% better survival rate when treated at one of the nation’s top-rated hospitals compared to the lowest-rated ones. Across the board death rates are declining at the 5,000 hospitals studied, but the drop is faster at the top performing hospitals.

E-mail Inga.

Emageon To Be Acquired by Health Systems Solutions, Inc.

 Health Systems Solutions, Inc. of New York, NY announced Monday evening that it will acquire medical imaging vendor Emageon of Birmingham, AL for $2.85 per share or $62 million in cash, a 37% premium to its share price at Monday’s close.

HSS, traded on the OTC bulletin board, has a market cap of $20 million. Chairman and CEO Stanley Vashovsky was quoted as saying, "This transaction will offer us the ability to leverage Emageon’s best-in-market products as well as broaden and strengthen our management team with some of the industry’s most respected leaders. Our ability to bring together innovators in healthcare technology and unleash their entrepreneurial and creative talents will result in cutting-edge solutions that will improve clinical care and significantly improve customer profitability."

The company announced that it will seek Nasdaq listing following closing of the deal, which is subject to shareholder approval.

Emageon settled its proxy fight with Oliver Press Partners LLC in June, giving the investment manager three seats on its board. It announced evaluation of strategic alternatives at that time, including sale of the company. The company’s share price has dropped by 80% in the past year.

An HIT Moment With … Leah Binder

An HIT Moment with ... is a quick interview with someone we find interesting. Leah Binder is CEO of The Leapfrog Group of Washington DC.

Healthcare IT insiders and clinicians often criticize Leapfrog’s choice of CPOE as a technology that benefits patients, given that most medication errors that cause serious patient harm involve drug preparation or administration, not ordering, as in the recent Corpus Christi example with heparin. What overwhelming evidence makes CPOE so compelling to Leapfrog that those critics aren’t seeing?

Our fidelity is not to CPOE per se, but to any and all evidence-based best practices for reducing medication errors and improving patient safety. It happens that CPOE emerges as a clear winner in the evidence. We offer a bibliography on our website.

Among the studies: a study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55% — from 10.7 to 4.9 per 1000 patient-days. Rates of serious medication errors fell by 88% in a subsequent study by the same group. Another study conducted by LDS Hospital in Salt Lake City by David Classen, MD, demonstrated a 70% reduction in antibiotic-related ADEs after implementation of decision support for those drugs.

Recently there were two small studies suggesting CPOE might not be effective, but our expert panel discounts those studies because they took place in hospitals that deployed CPOE in six days — a ridiculously short time period for implementing any kind of complex system change.

Our experts read the peer-reviewed research. If there are better ways to reduce medication errors we welcome the opportunity to consider it.

Would you say that Leapfrog has had the influence on outcomes and healthcare purchasing that were expected when it was formed in 2000?

Leapfrog’s influence has been nothing short of astonishing in light of its short history. The central tenets of Leapfrog’s mission — transparency, good measures of quality, and rewarding good performance — have literally transformed mainstream health policy in the United States. Leapfrog led the way in innovations and policy priorities, among them:

• Leapfrog was the first to issue a never events policy, in 2006; now CMS has begun issuing regulations that Medicare will no longer pay for certain hospital acquired conditions, and all national health plans, and more than 60% of Leapfrog-reporting hospitals have followed suit with never events policies of their own.
• Leapfrog’s focus on paying for value and performance is now a mainstream philosophy. There are over 200 pay for performance programs in the country, including Leapfrog’s own Hospital Rewards Program, which at least one health plan intends to roll out nationally.
• Leapfrog’s commitment to transparency of quality information was one of its most controversial elements in 2000; today there are a plethora of report cards and other public information purporting to reveal comparative information among hospitals. Nonetheless, Leapfrog’s report on hospital performance remains by far the best and most useful: up to date information, evidence-based, and reported in a way that offers a meaningful comparison among institutions.
• Drawing on members’ experience, Leapfrog has influenced the design of CMS’ value-based purchasing initiative as well as HHS Secretary Mike Leavitt’s Executive Order incorporating four “Cornerstones of Value-Driven Health Care.”
• Leapfrog has significant influence in the National Quality Forum, including most recently approval of Leapfrog-sponsored measures on hospital efficiency.

Leapfrog has also seen progress in hospital quality among hundreds of reporting hospitals and raised the bar on patient safety. A recent peer reviewed study from Harvard School of Public Health, consistent with others that have been published on Leapfrog, concluded that hospitals reporting adequate performance on the Leapfrog Hospital Survey have better outcomes than other hospitals in the United States . 

We have not finished our work by any means. Next steps: support and incentivize providers in achieving higher performance, and engage even more employers. Some of our plans: develop best practices for implementing new IT infrastructure that ties to safety, deploy one nationally standardized pay for performance program based on the Leapfrog Survey, support hospitals more in achieving higher Leapfrog standards, and reach out to consumers and employees in new ways to support them in making decisions about providers. 

We are also going to formalize our partnerships with more of the employers now using Leapfrog (the vast majority are not formally members), issue more detailed guidance on implementation of never events, continue our robust partnership with policymakers and like-minded advocates to advance value-driven purchasing, advance a more streamlined and outcome-oriented set of performance measures, and ultimately, of course, improve the quality and safety of care.

All the evidence to date suggests we are on the right track and that we will be very busy in the years to come.

Where does Leapfrog’s mission fit in tough economic times?

There are many questions about who will be in the White House and what will happen to our economy, but one thing can be predicted with near certainty: the Leapfrog vision for health care reform will be a centerpiece. It has to be. Employers and other purchasers of health care will continue to reduce and in some cases eliminate employee health benefits as their profits erode and health costs escalate. In turn, employees will become more price conscious, and shop for the best value. Shopping for value in health care is what Leapfrog is all about.

With all the groups who want to oversee or audit provider performance, why should hospitals participate in Leapfrog’s programs?

Four reasons to start:

1. Because employers and purchasers of health care want them to. Purchasers pay for more than the care of their employees; they also subsidize the care of other patients when reimbursement for their care is inadequate, such as the uninsured.  Over 4,000 employers and counting participate with and use Leapfrog, and there is no other source of hospital data that employers point to as “their” exclusive survey. The least hospitals can do is devote 40-80 hours of staff time to giving employers the information they ask for, and in the process build trust and good relationships with their regional employers and employees.
2. Because it is useful. There is no survey tool that offers a better compendium of the best practices in patient safety, and some of the survey content is like getting high-priced consulting for free. For instance, our evaluation tool for CPOE is unique in the nation and offers invaluable information about the performance of IT systems.
3. Because it is harmonized with others. The measures in the Leapfrog Survey are consistent with NQF-endorsed measures and safe practices, IHI’s 100,000 Lives Campaign, and the Joint Commission.
4. Because you’re going to see market share and financial reimbursement changes tied to performance on Leapfrog. It is happening now. Many hospitals that perform well on Leapfrog feature that performance on their advertising, particularly in competitive markets. Some employers use Leapfrog scores to determine co-pay levels, and this has a very dramatic impact on patient flow. As changes in our economy and health system are emerging, we see these trends accelerating.

What were the surprises, good and bad, since you took the job?

The biggest “good” surprise is the influence of Leapfrog in Washington health policy circles and among hospitals. I was in Washington for one year about 14 years ago, and the change since then is incredible. 

For instance, at that time, the idea of report cards comparing providers was considered fairly radical and opposed by a wide variety of provider stakeholders. Today, everyone seems to agree it’s a good idea, and they just argue over the format (a very big issue, but still, the progress is substantial). Leapfrog is present at every significant stakeholder forum and regularly consulted by leaders in all branches of government. When Leapfrog summons people for a meeting on an issue, the who’s-who of leaders and experts show up. And among hospitals, where Leapfrog has its share of both passionate supporters and harsh critics, our influence is unquestioned. The visibility enables us to get things done in ways that would be impossible otherwise.

The second biggest “good” surprise: there are thousands more employers involved with Leapfrog than our membership roles would suggest.  That’s also the biggest “bad” surprise — we need them to be counted formally among Leapfrog’s membership, which helps assure we can sustain this remarkable visibility at the national level.

Glen Tullman on the Merger of Allscripts and Misys Healthcare

Allscripts CEO Glen Tullman finished this article early Monday morning to share his Day One thoughts on the newly merged Allscripts and Misys Healthcare with the readers of HIStalk. Completion of the merger was announced this morning. Glen will participate in a live chat on HIStalk Wednesday evening at 7:00 Eastern.

Software Silos – The End of the Beginning
By Glen Tullman, Chief Executive Officer, AllscriptsMisys

This morning we announced that the merger of Allscripts and Misys Healthcare has been finalized, creating a new company with a client base of nearly one out of every three physicians and one of every five hospitals, as well as thousands of post-acute organizations. Clearly, this is a great opportunity for the company and for our shareholders.

However, I look at it in a very different way. I see this merger, not only as an opportunity, but as a responsibility as well. We simply must use our new size/scale, our set of solutions and our reach to radically accelerate the movement to create a truly interconnected healthcare system in order to eliminate errors, improve quality and better manage cost.

But we believe this must be a mandate not just for Allscripts, but for all vendors. While Allscripts and others provide applications that help address the issues I outlined above, the core problem is that healthcare is not connected – functionally, financially or technically. That can’t continue and we collectively have the tools to ensure it doesn’t.

Consider this a call to action to eliminate what I call “software silos.” Now is the time to come together as an industry to create standards, to ensure our systems are actual solutions, and that what we provide is the fix, not the problem.

What do I mean by “software silos?” Simply stated, vendors today often provide stand-alone applications. They are not connected to other systems or to information that is vital to our end users – the equivalent of a computer that’s not connected to the Internet.

Yet connecting to information is the very essence of what we are being asked to do, because healthcare is at its roots an “information business.” Without just the right information at the right place and the right time, providers can’t improve the health of their patients or their bottom line.

Today we have taken a significant step in this direction by bringing together two of the major players in the market. In doing so, we have already spurred additional consolidation. And more is coming.

But it will take more than consolidation. As an industry, we have to begin to move with urgency, because this is not a “problem” we are trying to solve – it’s a crisis. The stakes are too great to wait – 98,000 deaths per year from medical errors, clinical outcomes that are given a “D” on every report card relative to other industrialized nations, and $700 billion wasted every year (ironically, the same amount of the recent Wall Street bailout).

Given what’s at stake, it’s disappointing that there are companies in our market who, when it comes to interoperability, can’t spare the time to help find a solution or lend a word of support to the many efforts that are in motion right now between many of us.  In fact, it’s worse than that. For literally everything that is done, they undermine it, preferring to use a “no, because” approach versus a “yes, if.”  Their attitude shows a fundamental lack of leadership.  Simply stated, walls between systems create chaos for patients and providers. We can’t allow this to continue.

A few years ago, I had an experience that I wouldn’t wish on any parent. While I was running another software company, I was in the operating room with my son Sam. As he was being put under, he looked up at a monitor and said “Hey Dad, isn’t that your company?” When I looked up, I saw an older version of our software and knew that we could do, and had done, better.

At that moment I realized that what flows through our systems is not bits and bytes, but human lives. The lives of our families and of our friends.

When Allscripts partnered with Dell, Microsoft, Google, Fujitsu and a number of other organizations to launch the National ePrescribing Patient Safety Initiative to provide electronic prescribing to every physician in the country for free, everyone thought I was a little bit crazy … including our Board of Directors, who reminded me we were in the business of selling software. But I wasn’t crazy (OK, maybe a little bit) – I was actually still, in a sense, in that operating room with Sam with a promise I made that day, which has turned into an obligation to get life saving technology into the hands of healthcare providers.

And that’s exactly why many of us entered healthcare to begin with and why we wake up every day with the passion to make a difference. But we can only deliver on that promise if we connect our efforts.

I am proud of the work both Allscripts and Misys have done through the years to move beyond software silos. We’ve played an active leadership role in developing standards, demonstrating interoperability in live settings with other Electronic Health Records (IHE Connecthathon, HIMSS Interoperability Showcase, etc.) and connecting patients to a variety of personal health record platforms including Microsoft HealthVault, Google Health and Medem. And, on Day One of our merger, our solutions will connect to others in our portfolio, from Emergency Department physicians who can view a patient’s ambulatory health record to hospital care managers who can share records with home care agencies. We’ll focus on leveraging our footprint to drive connectivity across the care continuum from ambulatory to acute and post-acute.

And just as we’re investing our resources in expanding across all settings and enhancing the interoperability of our solutions, it should be the commitment of every CEO in every healthcare IT company to dedicate the time (not just of their people, but their own personal time) and resources necessary to make their solutions fully interoperable.

We all need to recognize that our industry – and the healthcare providers we serve – is at an inflection point. We’ve succeeded in delivering solutions that help hundreds of thousands of providers deliver safer, more effective and more efficient care. But we’ve also helped to perpetuate the information silos that keep our healthcare system from achieving true connectivity and true health.

To paraphrase Winston Churchill, this is ‘the end of the beginning.’ And now the real fun begins …

We can learn from cell phones and computers, two other technology revolutions that changed our lives, and understand that the basic software and technology are a start, but they are just the first step. The real magic comes when you connect – just as cell phones of different manufacturers and carriers are connected. It seems basic, but it’s exactly what we need to do for healthcare. Not at some point in the future, but right now.

When our industry decides to make interoperability a priority, then we can begin to claim that we are truly delivering on the promise of healthcare information technology. With our solutions connected not only across all care settings but across all vendor platforms, we will deliver higher quality, lower cost patient care through an interoperable system that enables all providers everywhere to Connect to Health. The health of patients, of providers and of healthcare is on the line. The beginning has ended and we all now have a responsibility to deliver.

That’s our goal and that’s why Allscripts and Misys came together. Personally, I can’t imagine a better outcome.

Monday Morning Update 10/13/08

From DeEmailWontGoAway: "Re: Cerner. Neal Patterson had an employee town hall on Thursday. In it, he put the infamous e-mail back up on the screen and discussed why he was right then and why it is still right. He also stated emphatically that Cerner WILL lay off people before the end of the year — believe the exact quote was by the end of the year ‘we will need FAR less EMPLOYEES than we currently have on the payroll.’ Could be the right play, but the dude’s style is poor. While he buys a French villa and takes off the whole summer, he needs to forget about the parking lot and pizza guy." I’m on the fence for the first e-mail: it was obviously blurted out without much thought and sounded cold, but it was mostly management that he was ripping and many folks have told me off the record that he was right. Fact is, the economy has taken away whatever upper hand employees believed they had, so he can say whatever he wants, like always. Shareholders (many of them employees) and customers demand high performance, so you won’t hear them complaining about his whip-cracking. The employees who regularly rip the company (sometimes humorously) on JobVent have the same options as employees everywhere – stay or go, thus proving one of you wrong. Complaining is just wasting time instead of making one of those two decisions and moving on.

From Bobby Orr: "Re: Neal Patterson. Nice job, Neal, providing positive leadership comments in a time of crisis – gloom and doom. He mentioned eliminating insurance companies as they exist today, which is interesting because he is now running an alternative one for his employees that does not save the employees any money vs. a traditional HMO."

From The Alchemist: "Re: Neal Patterson. Folks, I am staunch die-hard metrics man, and although statistics do a great job of lying to support your point of view, I can’t figure out the lie in the World Health Organization’s Report. The United States is the #1 country out of 191 that spends the most money per capita in International Dollars for health expenditures. I can’t figure out where the lie might be in this statistic. The bang U.S. patients are getting for our healthcare bucks ranks the United States in Overall Health System Performance #37 (N + 191) only to redundantly mention that Cuba is Number 39.  The United States is not only ranked #1 for health expenditures, but spends twice as much in International Dollars as Switzerland that ranks #2 for health expenditures and #20 in Overall Health System Performance. If measures applied to our economy in recent days cannot ‘fix’ or ameliorate the situation, then how do we ‘fix’ the United States health system? Throwing money at it doesn’t appear to make things better."

From From Afar: "Re: Misys. Misys and Allscripts have both done layoffs this week. Layoffs at Misys were not mostly management positions. Many positions were project management related positions. There were 11 confirmed casualties from R & D alone, many of which had 10 years or more of service each with the company. There have been announcements about a few executive vice presidents not moving to the new company. Sales did layoffs the week just prior to the big joint sales meeting they had earlier in the week. Management will not release the total number of layoffs."

Listening: brand new Oasis. Melodic Beatles stalkers. I like it. Also: Saviours, angry stoners playing fast guitar.

Yet another business idea I wish I’d thought of: I was buying gas today and saw a pulpy newsletter that featured nothing but local arrest records and mug shots for just $1. The first thing I’d do is raise the price.

HIMSS announces 2008 Davies winners: Eastern Maine Medical Center (a Cerner site), Cardiology Consultants of Philadelphia, Columbia  Basin Health Association, Palm Beach Obstetrics and Gynecology PA (a Greenway site), Oklahoma Arthritis Center, White River Rural Health Center, New York Children’s Health Project, and Community Health Access Network and Member CHCs.

A Louisiana nonprofit isn’t finding many takers for the federal government’s help (financial and otherwise) to implement EMRs. It’s supposed to get 200 volunteer practices, but has only 14 so far.

Sponsor Web cruising: Dewey Howell, MD, PhD of Design Clinicals spoke at a recent medication reconciliation program and the link to his presentation is on the company’s site. 1450 inc. is offering several products of interest to Dragon NaturallySpeaking healthcare users. Healthia Consulting will be at AHIMA and MGMA in the next few days and then AMIA after that, so drop by and thank them for supporting HIStalk. Intellect Resources has a cool newsletter that’s always fun and chatty, so you can read the current and back issues and check out the positions they’re recruiting for. Our consulting friends at Renaissance Resource Associates are looking for some experienced talent in Epic, GE, and other major apps, so have a look. Teramedica, which has several patient-centric software applications, has a couple of job openings and has a signup for its electronic newsletter. The Revere Group will have executives in attendance at Midwest HIMSS later this month, the Blue Cross Blue Shield PMO Summit, and the Jive Software road show on social media. Thanks to all of those companies for sponsoring HIStalk.

Speaking of DNS 10, I’m convinced that voice recognition has finally met those Star Trek expectations. I see it’s available for as low as $70, so I’m thinking about giving it a try.

Norwalk Hospital (CT) honors GE’s Jeff Immelt and heaven’s Paul Newman for giving it money, or so I assume given veiled platitudes referring to "creative, compassionate philanthropy." Newman, for sure. Immelt, I can’t say because I don’t know.

Marvin O’Quinn announces his departure as CEO of Miami’s Jackson Health System, heading out to be COO of Catholic Healthcare West. He mentions Jackson’s Cerner implementation in his short goodbye letter. That’s not why he’s leaving.

Welcome and thanks to new HIStalk Platinum Sponsor Ingenix of Eden Prairie, MN. I usually mention the main offerings of a sponsor company for those who might not be familiar with them, but I’m not sure that’s necessary here since they’re widely known and it’s a long list of products and services they offer to healthcare. Highlights: coding, revenue cycle management, clinical and cost management, demand forecasting, and consulting. White papers and e-newsletter here. Thanks to those folks for helping power the mighty Wurlitzer keyboard that is HIStalk.

You will likely hear much Misys/Allscripts news next week (in fact, you will hear some of it directly and early on Monday morning right here on HIStalk, so look for that). In the meantime, mark this on your calendar: I’ll have Allscripts Chairman and CEO Glen Tullman in a live chat Wednesday, October 15 at 7:00 PM Eastern time (it’s the first time we’re trying this – sample of what it will look like here). Glen will answer questions directly from HIStalk readers. I have to confess: Allscripts was one of those companies that I griped a little about recently because they lumped HIStalk and other blogs as some kind of wacky sub-journalism instead of industry pros who happen to write online, but they’ve done a 180. Anyway, more from them on Monday morning and in the Wednesday chat. If you have questions and won’t be able to join us online, you can e-mail me your questions for Glen.

The special dividend for Allscripts shareholders when the Misys merger is completed will be paid on October 17 for $5.23 per share, with a record date of October 9.

The CoaguTrak Web-based anticoagulation management system ($65 per provider per month) includes native Google Chrome support for its AJAX-powered technology.

One of the two Harvard grad students who just won Siebel Scholar awards is working on disease management software for doctors and patients.

California, that big state whose movie star governor is demanding federal dollars because the state (like the country) can’t live within its means, could have saved money had it not passed a law allowing resigned state employees to get cash for unused vacation and work credits. One prison doctor got four years’ pay when he quit after 10 years, $815,000 for unused vacation and on-call pay, with no records to back it up. Private companies don’t allow accruing that kind of amount, of course, and especially under California’s policy of paying at the most current (usually highest) pay rate. Also mentioned is a minimum security prison nurse who earned over $200,000 in overtime in one year, bringing her one-year pay to $321K.

GE’s Q3 earnings dropped 22%, surprising no one since suckitude of that magnitude had been pre-announced. GE Capital, which the company kept saying was doing great while every other industry player self-destructed, is finally blamed. One funds manager said GE has a lot of good businesses and one underperformer – GE Healthcare, about which even usually cheery Jeff Immelt acknowledged as "a challenging quarter at Healthcare." Time to break GE into far more valuable and nimble individual pieces if you ask me, especially if its other businesses are as hamstrung by corporate bureaucracy as healthcare, which as I always say is the elephant’s graveyard for once-decent products (the first-to-worst KLAS phenomenon that’s unique to GE).

UTMB’s hit from Hurricane Ike: $710 million, of which insurance covers $100 million.

Those little fellows who whip horses for a living now have a PHR. I’m pretty sure they don’t shoot them if they break a leg.

Teleradiology and PACS vendor Medweb sends employees to Pakistan on a humanitarian telemedicine mission as part of the US government’s Digital Freedom technology sharing initiative.

It’s HIT’s version of Fisher vs. Spassky: Dolbey is sponsoring The Coding Game at AHIMA, pitting coders against computers. Too bad it’s not in Las Vegas – the bookmakers would be all over it.

MD Anderson, trying to forestall a senator’s demand that it account for its charity care practices in his investigation of hospital tax exemptions, sends Sen. Charles Grassley at least some of what he asked for. He is considering requiring tax-exempt hospitals to provide at least 5% of revenue on charity care (MDA spends 7.6%, but I’m guessing that includes unreimbursed care at ridiculously inflated "list prices" that don’t reflect cost). MDA got fingered in a Wall Street Journal article called "Cash Before Chemo" that detailed a patient’s plight when MD Anderson refused to take her insurance and demanded $105,000 in cash before it would admit her. Everybody wants hospitals to run like a business, except when they want them not to, a situation I ineloquently described in my recent Inside Healthcare Computing guest editorial called Every Time I Say It’s About Patient Care, You Tell Me It’s a Business: Healthcare IT Lessons Learned from North Dallas Forty. I bet Mack Davis never expected anything from his otherwise anemic film career to be used to make a healthcare policy point.

Odd hospital lawsuit: a 77-year-old woman hits the gas instead of the brakes in a hospital parking lot, crashing into the radiation department and killing the hospital’s radiation chief and a secretary. The radiation chief’s widow already sued the driver, who settled without paying anything, but she’s now going after the elderly woman’s doctor, three of his partners, and the practice they work for, claiming they didn’t tell the woman to avoid driving while on medications. Her lawyer says he’s optimistic that he can get more than $10 million.

Also odd: a Yale-graduated surgeon who failed his board exams for five consecutive years and who lost his surgical privileges and medical license after three months of practice at Meadowview Regional Medical Center (KY)  is arrested for the armed robbery of an Austin, TX bank, while wearing a gas mask as a disguise (picture above). Among his medical adventures: leaving a patient under anesthesia for 1.5 hours while arguing with a colleague, clipping the bile duct on two patients, and severing a patient’s carotid artery. Looks like he had filed for bankruptcy as well.

Vendor Deals and Announcements

• The 25-physician Premier Surgical Associates (TN) selects Intergy EHR by Sage for its EMR/PM solution.
• Software provider Cielo MedSolutions and consulting company TransforMED will market one another’s products and services to clinics adopting the “medical home” model.
• Tableau Software will provide its visual data analysis solution for AHIMA’s e-HIM® Virtual Lab program. The Tableau Desktop will be available in the Virtual Lab to help HIM students gain hands-on experience with data visualization, analytics, and business intelligence software.
• The Orthopedic Specialty Clinic selects SRS’s EMR for its providers based at Salt Lake City’s Orthopedic Specialty Hospital.
• The University of Miami Miller School and Medicine and the College of Engineering are partnering with GenerationOne to leverage mobile healthcare technologies and telemedicine to contribute to the care of chronic disease patients.
• Alpha Systems is selected as the vendor of choice for Winthrop-University Hospital. Alpha will provide the 591-bed facility with enterprise EDM software and day-after-discharge document scanning services.
• Consulting firm Physician’s Trust is now an approved eClinicalWorks vendor and will be providing eCW’s EMR/PM solution to physicians affiliated with Hoag Memorial Hospital Presbyterian.
• Zotec Partners announces a couple of new clients for its Electronic Bill Center PM/billing suite. The nine providers at Yakima Valley Radiology (WA) and 32-provider Atlantic Medical Imaging (NJ) are transitioning to the Zotec’s solution.
• The Duke University Health System deploys the Velos eResearch system to automate management of clinical trials.
• Physician services organization Medical Network One (MI) will utilize registry technology from Wellcentive to track patients with chronic conditions.
• Community Health Systems Professional Services Corporation (TN) signs a three-year outsourcing transcription service contract with Spheris for its 118 owned and operated hospitals. As part of the deal, Community has made a minority equity investment in Spheris and will have two seats on its board.
• Texas Children’s Cancer Center announces a new Web-based health history developed with Baylor College of Medicine. The Passport for Care application can be accessed by childhood cancer survivors throughout their lifetime.
• Orthocrat announces that The George Washington University Hospital has purchased TraumaCad, its Web-based pre-op planning and digital templating software solution.
• McKesson is deploying BIO-key International’s WEB-key biometric ID technology to enhance the security and convenience of their medication dispensing cabinets.
• The Christ Hospital (OH) is implementing the eICU Program by VISICU for its 44-bed ICU. eICU combines early warning software and remote monitoring capabilities.
• Park Nicollet Health Services (MN) is implementing Premier healthcare alliances’ SafetySurveillor to prevent healthcare-associated infections.
• A study by Research & Markets finds that the US PACS market is about 90% penetrated.
• Rhea Medical Center (TN) receives $256,500 in funding from the Appalachian Regional Commission (ARC). The money will be used towards the purchase of EMR equipment, training, installation, and licensing for the 25-bed facility.

E-mail me.

News 10/10/08

From The PACS Designer: "Re: Rich Internet Applications (RIA). The next wave of improvements for the web includes RIA. Microsoft Silverlight is a cross-browser, cross-platform, and cross-device plug-in for delivering the next generation of media experiences and rich interactive applications for the Web. Click on the video screen for each of the presented videos to see where RIAs are going to enhance the viewing experience." Link.

From Charles Chipps: "Re: Modern Healthcare’s Best Places to Work. I got a e-mail invitation that looked like a big deal, listing cocktails and dinner and asking for an RSVP. I clicked through and finally got to the RSVP screen and tickets cost $175!" Maybe they should have sent an invoice instead of an RSVP. It’s kind of tacky not to mention in the original e-mail that you’re just being solicited to buy a ticket, not come on over for free.

From Bailey Quarters: "Re: Misys. The Raleigh layoffs have begun, mostly in management." The Raleigh paper quotes a Glen Tullman statement that says an unspecified number of duplicate positions are being eliminated, but that hiring goes on in Raleigh. From Afar report 9 people in R&D were cut loose Wednesday.

From Tucker Garvey: "Re: Misys. Being one of the people that got laid off today due to the merger of Misys/Allscripts, many people were affected, just as John McConnell and others knew they would be. The salespeople were let go prior to their joint sales meeting on Sunday and the others occurred Thursday."

From Skip Battin: "Re: Streamline Health. Heard they’ve had a considerable cut in their workforce, up to 25%." A couple of folks told us that some salespeople who weren’t making their numbers were replaced, but that’s not surprising these days.

From UNoMe: "Re: IBM. As a former IBM’er and a reader of your informative site, I’m curious as to why we don’t see more news about/from them in healthcare IT. Have they become insignificant?" I’ve never followed them, to be honest, so I can’t say that I know what they’re up to. All I could drag up from memory was their big data warehousing project with Geisinger and whatever they’re doing with UPMC.

From Heather McNamara: "Re: CNN. Mr. HIStalk, I forgot to send you this link that was on CNN this weekend. I saw your complaint about CNN and then thought, ‘Shoot, where else could I get a story like this?’ LOL." Link. It’s a story and huge disgusting picture of a guy’s root-like warts that earned him the nickname Treeman. Check these current headlines that CNN’s hard-working journalists have crafted: 7-foot snake found under hood of car, Man paddles giant pumpkin 150 miles, Leaping dolphin lands on boaters, and Brinkley’s ex tells why he slept with teen. Any resemblance to actual news is purely coincidental. Right about the time I think that maybe we can pull ourselves out of our current economic mess, I think about those large numbers of Americans who can’t be bothered to read about it because the paddling pumpkin story has worn out their moving lips.

From MSC: "Re: Medsphere. There’s some confusion regarding the recent VueCentric press release. There is no relationship between the company called VueCentric and Medsphere’s product with the same name — it is simply a case of confused identity." Having the exact same name as another software company’s product that’s #1 in Google PageRank is indeed confusing. I found the press release hard to follow, I admit, like it had been hacked on by committee until the very soul was sucked from it (if I get time, I’ll write it my way for comparison). Still, sounds like a good development for anyone who can figure it out.

Cerner CEO Neal Patterson says that healthcare will need a bailout that will dwarf what the financial industry is getting unless reform is undertaken. "The Wall Street bailout is a one-time number. To bail out health care, it is not a one-time fix. When the bailout comes … it’s going to be a very gloomy day." We’re good on those already, but thanks anyway. He said in a user group speech that the company will allow customers to participate in software development, which one write-up called "open source" but that doesn’t sound exactly like it, even though customers can share stuff they’ve built.

Canadian EMR vendors Healthscreen and Wolf Medical will jointly offer their uninsured services and EMR applications, respectively.

Several readers e-mailed me to say that the Fox Meadows EMR vendor I mentioned is actually just a MediNotes reseller, not an EMR developer. That brought back the creepy, powerless feeling of trying to deal with our local Medical Manager dealer back in the day, an unresponsive, unethical, and incompetent bunch that turned us against Medical Manager even though the product was fine. So, we did the only thing we could: dumped it and bought Medic (now Misys, soon to be Allscripts). That was the first I’d heard of buying software from a dealer since hospitals don’t otherwise do that.

Adena Health System (OH) gets $278K in USDA grants to connect its sites for distance learning and telemedicine.

If you think about it, click on that "E-mail This to a Friend" button at the top right of the page and tell a few folks you like about HIStalk. I don’t advertise, so you’re my only hope.

Jobs: Nursing Informaticist – Meditech, Project Manager – EDIS, Director of Clinical Informatics, User Interface Designer. Gwen will send you a weekly job blast if you sign up.

Prison HIT systems are getting better, even though they’re 10 years behind healthcare, which is 20 years behind everybody else. Howard Salmon of Phase 2 Consulting, who I know from another life, said that. I thought Phase 2 was folded into Rehabcare when John Short took that company over. In fact, I checked and it’s a wholly owned subsidiary. Now I’ve achieved closure.

A family practice group in Minnesota launches a CHF management program after the local hospital shuts theirs down because of budget cuts. Family Practice Medical Center credits its EMR with allowing it to identify and monitor target populations.

SCI Solutions announces a new version of its Schedule Maximizer rules-based enterprise scheduling application. Enhancements are included for large facilities and for the new advance beneficiary notice forms.

A software company’s CIO survey didn’t quite work out as planned, judging from the company’s rather testy announcement of its results. Only 40% of CIOs said that software quality is important (or so the software company claims without showing the actual survey instrument), leading the company to editorialize about "corporate apathy," "disregard," and "high-profile horror stories." As I always say, "Don’t ask a question if you don’t want to know the answer." And, don’t use a press release to slam your respondents/prospects.

Andy sent this odd hospital lawsuit: a man brings his wife to Beebe Medical Center (DE) for indigestion, but ED doctors somberly tell the man an hour later that his wife has died of a heart attack. An hour after that, a nurse notices that the woman is breathing in the morgue, even with an endotracheal tube in place. The woman is healthy enough now to join her husband in suing Beebe. The hospital claims "Lazarus syndrome," a documented condition in which clinically dead patients spontaneously regain heartbeat and breathing, possibly due to delayed delivery of administered epinephrine to the heart or reduction of intrathoracic pressure after ventilation and compressions are stopped. The irony, of course, is that they’re being sued by a live patient for mistaking her for dead, a condition that most of us would be pretty happy about considering the alternative.

Baptist Health System (KY) goes with ADC Telecommunications for an antenna system to improve in-building cellular coverage for McKesson’s Horizon MobileCare Rounding and other applications that run on smartphones and PDAs. Interesting: they bought Nextel phones originally because docs wanted push-to-talk, but passed on Nextel’s repeater because it worked only for Nextel, it was expensive, and the doctors weren’t really using Nextel anyway.

CMS says faxed prescriptions don’t count toward the 2% eRX bonus.

Covisint signs a deal to create an HIE for three big Michigan physician groups.

Cardinal Health will pay $34 million to settle Justice Department charges that it didn’t report suspicious narcotics orders to the DEA.

When questioned by the local paper about who won the Obama-McCain debate, a Florida woman said, "McCain sounded like a socialist on health care with sponsorship of electronic medical records and community health clinics." Seems like kind of an odd thing to say.

UPMC is trimming the management ranks at some of its hospitals.

The former chairman of Staten Island University Hospital’s (NY) pathology and laboratory medicine is charged with tampering with the hospital’s billing system to steal $19,000 in insurance payments.

Healthcare Growth Partners gets a mention for being retained by clinical trials software vendor Datatrak of Mayfield, OH as its advisor.

E-mail me.

HERtalk by Inga

From Sam Matalone: “Re: politician initiative. I have been trying nearly every day contacting the political camps and no traction. The last time I heard the word ‘unavailable’ so much was when I was asking my friends to help me move. Either way, I will keep on keeping on.” Sam is referring to his attempt to get our presidential candidates to provide some specifics on their proposed healthcare IT programs. I have gone through the same exercise a couple of times in last few months and the most I have gotten is daily spam from the Obama campaign (and nothing from McCain’s). Sam also notes that he has been “spammed like you wouldn’t believe” from the Obama camp.

From Missouri: “Re: Cerner. FYI, Cerner is in Missouri, not Kansas!” My apologies. I knew that, now that I think about it. The Missouri connection reminded me of some mindless trivia I learned a few years back. Who knew that the Missouri’s state animal was the mule?

From Travelin’ Man: “Re: healthcare spending. A WSJ article from 9/22 might be of interest in discussions with your readers. Rising out-of-pocket expense is having an impact. CitiGroup says the hospital market will be flat for the next couple of years." The article says that Americans are cutting back on healthcare spending, with examples: first drop in filled prescriptions in decades; physician office visits are down 1.2% year over year; 22% of people say they’re going to the doctor less often because of the economy; areas hit include hip and knee replacements, mammograms, and ED visits. On the other hand, more than 3/4 of people say that economic conditions are stressing them out, leading to other medical problems.

From Man Connoisseur: “Re: Peter Pronovost. I can’t be the only one who thinks he gives Prince William a run for his money in the perfect man department, can I be? Damn.” Agreed. He’s quite the package.

From IT Writer: “Re: ultraportable laptops. Looking for those who are either using or managing the use of them, such as the Asus Eee PC. What are the special security considerations? This article is scheduled to appear in Computerworld. Drop me a line at ekeiser@john-edwards.com. Eve Keiser." This note came my way via Gwen Darling of HeathcareITJobs.com. If you can help, you might earn 15 minutes of fame.

I’ve been checking out MGMA sessions and exhibitors and was surprised by the absence of PHR-related ones. I realize many physicians question the value and validity of a patient-maintained record and perhaps see PHRs as one more administrative task. And, for the most part, patients aren’t rushing to get their PHRs updated. But for exactly those reasons, why wouldn’t Microsoft, Google, etc. want to jump on the chance to educate a captive audience of thousands on the virtues of PHRs? It seems odd that they don’t find the MGMA crowd important enough for a bit of self-promotion.

Speaking of the economy’s effect on healthcare, a Hewitt Associates study estimates that in 2009, overall employees’ healthcare costs – including employee contributions and out of pocket costs – will increase 8.9%, from $3,513 in 2008 to $3,836 in 2009. Who’s getting that additional money? Not the providers, I bet.

Good news for the Drink and Download e-mail crowd. Gmail has a new feature called “Mail Goggles” (cute name) that will prevent you committing e-mail faux pas, like sending nasty-grams to co-workers or whiny notes to your ex after a night of drinking. The system can be set up to make you answer five simple math problems when sending e-mail at odd hours. If you can’t get them right within 60 seconds, you will have to wait until you sober up the next day.

HIMSS Analytics and the American College of Clinical Engineering are jointly conducting a research study of medical devices in American hospitals. The goal is to evaluate patient safety and quality care benefits of medical devices that share data.

athenahealth COO James M. MacDonald resigns as the company’s COO and EVP due to health concerns.

DR Systems announces four new contracts for its Unity RIS/PACS totally about $2.19 million.

StatCom announces survey results showing that 89% of healthcare execs believe their facility has poor patient flow. The root causes: poor communication (67%), ineffective scheduling of activities and resources (36%), lack of beds (36%), lack of staff to help facilitate patient flow (34%), and poor centralized knowledge about the location and status of each patient (32%).

Merge Healthcare releases preliminary 3Q financial results through the end of September. Expected net income is $.01/share. Considering their long string of losses, even that small profit is good news.

Not so good news for the folks at UTMB Galveston. Following $709 million of hurricane damage last month, officials are contemplating layoffs for up to 4,000 of its 12,000 employees. State lawmakers are looking at ways to avert the workforce reduction to Galveston Islands’ largest employer.

E-mail Inga.

News 10/8/08

From Pharmacy IT Goddess: "Re: layoffs. Layoffs coming at the University of MN Medical Center-Fairview. Sounds like multiple departments." Fairview announced Monday it will cut 150-200 jobs this month, caught in a bind of declining investment value, increasing interest rates, lower Medicaid reimbursement, and unpaid patient bills. The first of many hospitals that will have the same unfortunate problem and solution, no doubt.

From Pedro Guerrero: "Re: Picis departures. Nivaldo Diaz, Chief Technology Officer, and Scott Lentz, Sr. VP of Business Development, have resigned." We asked Picis. "We can confirm the recent departure of Nivaldo Diaz from Picis. Nivaldo was a long-time member of the Picis team and we will miss him. Scott Lentz, on the other hand, is still with us in a consulting capacity. It’s not unusual for talented technology executives to choose to make a change periodically. Each made his recent career decisions for his own set of personal and professional reasons. We owe much to both of them for the success the company has experienced."

From Pitt News: "Re: big changes at West Penn Allegheny Health System. The latest is the CIO position." Pitt News forwarded the internal e-mail announcing the departure of CIO Nick Valadja, effective October 6. John Foley, new in the CTO job, is named CIO. He doesn’t appear to have a healthcare background. West Penn found a $73 million revenue overstatement in July that got the SEC’s attention, but it’s not clear whether that’s related. According to the Pittsburgh business paper, West Penn hasn’t released fiscal year results that were due June 31 ("30 days hath …")  Maybe it’s like those leap year babies that have a birthday only one year in four.

From Kelly Tarr: "Re: HIMSS 2008. I’m trying to find an electronic version of the exhibitor list. Does anyone have one to share?" If anybody does, e-mail it my way and I’ll pass it along.

From Nancy Greenly: "Re: HIT adoption panel next week." Link. The panel discussion will be next Thursday, 10/16, in Chicago, with Steve Lieber of HIMSS, Jane Horowitz of NAHIT, Dan Michelson of Allscripts, and Ralph Fargnoli of Beacon Partners. The topic is rather veiled, referred to only as "the pending healthcare IT bill," surely meaning Pete Stark’s bill (warning: PDF) that HIMSS doesn’t like (may we assume that the invited co-panelists aren’t fans either?) Another clue: HIMSS dearly loves every other HIT bill because they all call for more government spending, but the blurb says this: "some think that its official passage is inevitable," like they are referring to global warming or prostatitis. What HIMSS doesn’t like about it: it calls for open source solutions, it does not pay specific homage to CCHIT for certification, and it stiffens HIPAA penalties and allows patients to request audit trails. The party is at the Sheraton Chicago if you’d like to crash (well, register first, anyway) and argue the other side.

Trivia: we stayed at the Sheraton Chicago once and while Mrs. HIStalk was watching While You Were Sleeping on TV in the room, we recognized that several scenes in it were shot right outside the hotel, on the river. Mrs. H can’t get enough of Sandra Bullock’s mindless chick flicks (she’s a big Miss Congeniality fan).

From Frank Pulver: "Re: HIStalk. I have not only enjoyed, but have also benefited greatly from your breaking news and insights. Not a lot of industry rags that I choose to keep up with – issue of effort versus value. You are very much appreciated!" That e-mail made me feel so good I anonymized it and put it up here like a proud mom sticking pictures of the kids on the refrigerator. "Frank" is a quite high-ranking vendor guy and I’ll leave it at that. I sure do appreciate everyone who reads here.

Speaking of Picis, Christine Cournoyer takes over one of three titles held by Todd Cozzens, being named president in addition to her current COO title. Todd is still CEO and vice-chairman of the company. Lourdes Engel, as mentioned above, also gets an expanded role as SVP of product development and CTO.

ValueAct Capital is down $35 million on its Misys investment that hasn’t even closed yet, raising its estimated losses in the company to nearly $160 million overall.

If you work with databases of any kind, you’ll thank me later for telling you to download and try this $150 query tool.

Just in case watching the world economy implode isn’t depressing enough, here’s a year-old tome (warning: PDF) that predicted it all. There’s some great stuff in there about the mysterious Federal Reserve, the certain failure of policy efforts to create prosperity, and the postulation that we’re now entering Kondratieff Winter (15 years of hard times that will be needed to correct the previous 45 of prosperity). I hope it’s wrong since I’d rather not work until I drop, at least at jobs other than HIStalk, anyway.

I’ve temporarily overcome my frugal tendencies and am sending Inga to MGMA in San Diego, so she’ll be reporting from there starting next weekend. We like meetings and it’s fun to write live from them, but it’s hard to get away.

MedAptus announces its charge capture solution for physicians who bill for providing hospital services, such as hospitalists, intensivists, and anesthesiologists.

It’s a pleasure to introduce you to new HIStalk Platinum sponsor Informatics Corporation of America (ICA) of Nashville, TN (that might be my favorite company name – it says what they do and it’s unapologetically old school). ICA’s solution offers an aggregation platform (patient lists, filtering, alerts and reminder), workflow tools (messaging, patient portal, forms, eRx, chart deficiencies, and outpatient orders), and population management (dashboards for wellness, disease, and clinical metrics). Vanderbilt created the technology to address inefficiencies among its organizations that allow process improvement without ripping and replacing; ICA is commercializing it. Bassett Healthcare (NY) had 90% physician utilization in a month. Thanks to ICA for supporting HIStalk and the people who read it.

ScriptRX says it hopes to earn 35% of the urgent care eRX market. The Florida company‘s system costs $7,000 per year.

Board members at Regional Medical Center (SC) are still fighting over the hospital’s proposed Cerner contract and the bidding process that preceded it. The topic morphed into heated discussion about procurement policies and parliamentary procedure.

Medsphere adds the VueCentric GUI to its commercialized VistA product. VueCentric apparently changed its company name to that of its main product, MortgageDashboard, so I don’t really know what that’s all about, but the press release says it has unspecified roots in the VA. Medsphere is odd; they blast press releases, but then don’t get them up on their own site quickly, so you won’t find it there.

The Department of Justice joins a whistle-blower lawsuit against McKesson and other companies for Medicare fraud. The complaint says McKesson paid kickbacks to nursing home operator Beverly Enterprises in return for earning its durable medical equipment business.

A guest blog post by US Senator Sheldon Whitehouse (D-RI) pitches billions in savings from "a national health information technology system," which he says is like the interstate highway system (no, not too expensive to afford – "a national solution proportionate to the problem"). Here’s his bill. He wants money, of course, and makes this argument: "The financial market knows how to capitalize a revenue stream, and the market discipline on the revenues and capital will be beneficial." I think we’ve seen some good examples of how the financial market capitalizes a revenue stream ("irresponsibly" comes to mind). Still, given specifics, he might have some good ideas.

"The MRI machine has finally arrived," the headline says, referring to the MRI machine Lockport Memorial Hospital (NY) won in the Siemens contest early this year. I had visions of them excitedly flinging packing material everywhere while standing in the box like in A Christmas Story, when the Old Man gets his leg lamp delivery, announces "It has arrived," and then ponders over the wording stenciled onto the box ("ruh JEE lay … that must be Italian") until Ralphie’s mom points out that it actually says Fragile since the F is off the edge.

RelayHealth gets a mention (even if its name is misspelled) in a story on patient satisfaction in Most Wired hospitals. Memorial Savannah cites patient-physician e-mail capabilities, appointments, prescriptions, pre-registration, and bill-paying as RelayHealth services that patients like.

While I’m thinking about that, I had a great ED experience recently that made me appreciate IT from the patient’s viewpoint. I drove to the ED in the middle of the night (nothing serious, just worrisome), gave only my name and address, and the ED person pulled up all my records from the hospital’s affiliated practice where my PCP works. No further questions, no discussion of insurance, no handing over an insurance card for photocopying, etc. The wrist band printed from existing information, the nurses and doctors worked from swing-arm EMR monitors and had everything right there: allergies, meds, history, etc. I’ve never been to the ED as a patient and expected the worst, but it was an utterly satisfying, compassionate, and efficient experience. IT is ugly from the trenches, but as a patient, it was just damned cool. I should pimp myself out as a spokesperson for the vendor.

Speaking of EDs, Parkland Memorial Hospital (TX) is on the hot seat after a patient waits 19 hours for treatment in the ED and finally collapses in an exam room, dying of a heart attack. He had checked in on the ED’s fancy kiosk, but that wasn’t much consolation since he was 165th in line among a logjam of accident victims and non-emergent patients. A study last year found that patients waited nearly 13 hours to be admitted to a bed there. The bad thing is that it’s not just them – that kind of situation is common. Hospitals just haven’t been able to use available tools and technologies to unclog the ED, which is mostly not the fault of the tools and technologies.

Greenway Medical announces that its PrimeSuite EHR meets 2009 requirements for earning the 2% increase in Medicare reimbursement for e-prescribing.

Baton Rouge General (LA) outsources IT staffing and services to PHNS.

Southern University (LA) is live on an EMR system in its student health center after Hurricane Katrina convinced it to move from paper. They chose a system from South Carolina-based Fox Meadows, which says it’s the leader in EMRs, but I don’t think I’ve heard of it. The site features many happy-looking stock photo people.

E-mail me.

HERtalk by Inga

I will be checking out all the latest in the medical practice news and trends at MGMA in San Diego starting next weekend, and of course, visiting the exhibit hall. My plan is to collect lots of trinkets and also check out a few EMRs, PMs, and assorted other technology. I’ll be sending reports back to Mr. H at headquarters to keep all informed of my findings. Just thinking about it makes me want to go buy some new shoes!

The Bronx RHIO is the first NYC RHIO to begin exchanging data. Since July, the RHIO has received consent forms for over 4,000 patients of the borough’s 1.36 million residents. dbMotion has provided the RHIO’s technology platform with additional services and applications provided by Emerging Health Information Technology, Initiate Systems, and RxHUB.

John C. Lincoln Hospital (AZ) and a hospital in Vietnam sign a joint venture agreement to provide American healthcare expertise and technology to Vietnamese patients.

Former Healtheon/WebMD COO Steve Curd is taking over as PracticeOne’s new CEO. Curd was also CEO of VantageMed until its acquisition by Nightingale.

SAP appoints John Papandrea senior VP of its healthcare industry business unit. He comes from Deloitte Consulting, where he advised healthcare organizations on IT strategy.

The Cerner user conference is not the only big HIT event in Kansas this week. Mercy Health Center, located about an hour and a half south of Kansas City, happened to go live on Epic the same day the Cerner event commenced.

Lenox Hill Radiology (NY) claims it reduced A/R 40% since integrating ZirMed and MedInformatix’s RIS. Since going paperless, Lenox has also grown the practice 200% without hiring more staff and has reduced check-in times from six minutes to one.

Here’s a creative strategy for raising revenue by the end of the year to offset ongoing losses: Merge Healthcare announces an amnesty program to address unauthorized use of its software. Users can pay up by the end of the year or the company will seek damages starting in January.

Emdeon announces the appointment of Frank J. Manzella as the company’s senior VP of corporate development.

Eclipsys is hosting its user conference this week in Atlanta. About 1100 clients from 250 sites are participating in the 2008 Eclipsys User Network Outcomes Conference.

This news may be a bit troubling to parents. A survey finds that nearly half of pediatricians would not disclose a medical error to the parents or patient. However, if the error were obvious, they were more likely to admit it.

Public Hospitals Authority in the Bahamas purchases Sunquest’s LIS, along with some other Sunqest solutions, for $1.5M.

If you are in the ambulatory care world, particularly if you have an interest in EMRs, Jewson Enterprises’ new POMIS Report is a must read. You can download (for free!) the 135-page document to learn all you need to know about vendor market share, delivery models, marketing spend, practice demographics, and more. Jewel and Vinson Hudson have spent 35 years studying healthcare IT for physicians and they clearly understand the market. Did I mention it was free?

Mr. H is always coming up with creative ideas to keep me from going back to a real job. To that end, I need a few reader volunteers to assist on two different projects. If you are either a physician or a CIO (or a high level hospital IT exec), drop me an e-mail saying you’d be willing to participate in a 10-minute survey (either via e-mail or phone.) In return, I will fill you in a bit on our secret plans.

E-mail Inga.

An HIT Moment with … Peter Pronovost

An HIT Moment with ... is a quick interview with someone we find interesting. Peter J. Pronovost, MD, PhD is Professor, Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management; Medical Director Center for Innovations in Quality Patient Care; and Director, Quality and Safety Research Group, The Johns Hopkins University School of Medicine, Baltimore, MD.

On September 23, Peter was announced as a 2008 Fellow of the John D. and Catherine T. MacArthur Foundation, recipient of a so-called "genius grant" that will pay him $500,000 over the next five years, no strings attached. The fellowships are awarded to "talented individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction" to "encourage people of outstanding talent to pursue their own creative, intellectual, and professional inclinations."

What was it like hearing that you had been named a 2008 MacArthur Fellow? 

Amazing. I do not consider that I fit the bill of genius. What I do is try to make complex ideas simple and use them to improve patient outcomes.

What will you do with the grant?

I’m not sure. I have been toying with trying to make a checklist maker, an IT tool to tap the wisdom of crowds and make a more efficient knowledge market. I believe certain markets are so fundamental to society, like buying a home, healthcare, and retirement, that we need to guarantee that they are efficient.

What is the status of your "List" projects and have you had any interaction with IT vendors?

Still working on it and not working with vendors. I am trying to work out the "plumbing" first and see what product we can create.

What are your big projects going forward?

We are developing programs for MRSA and decubitus ulcers, evidence-based checklists and measures.

Are you a star back at Hopkins now?

I am not a star. I am very much a doc in the trenches doing patient care. That is what keeps me grounded and provides ideas of what we can fix.

I am delighted that patient safety was recognized. It has been very hard to get this field accepted as a legitimate science or as important in healthcare. Though we have a ways to go, we are making progress, and the MacArthur certainly helps.

Misys Says Allscripts, Misys Shareholders Have Approved Merger

Misys announced this afternoon that shareholders of Allscripts Healthcare Solutions have approved its merger with Misys, with Misys shareholders also approving the transaction in a separate vote. Misys says the closing will occur by Friday.

Monday Morning Update 10/6/08

From Lisa LaPorta: "Re: practitioner certification exams. EMR vendors with an enterprise content management solution already pull all the information together to allow the physician to make a final diagnosis. The only piece that’s missing is test delivery and psychometrics. Any of the big players could create something that would have a larger market space than just certifying boards (universities, teaching hospitals, and residency programs)." Seems like a natural for McKesson, if indeed there is a market, since its May acquisition of Vivalog (now called Horizon Study Share) put it into the radiology teaching and reference case business.

From Louie Dampier: "Re: Misys/Allscripts. The first joint sales meeting starts Sunday. I’d like to be a fly on that wall." I admit that I’m not a fan of the deal because it came in a moment of Allscripts weakness (Touchworks v11 and erratic revenues) and I wouldn’t want Misys involved. Once it happens, though, I hope it works out since it affects the livelihood of a big bunch of people doing good work who can’t be blamed for iffy Misys leadership.

From The PACS Designer: "Re: CUI. Microsoft has rolled out its Common User Interface with the hope that we healthcare professionals will be willing to contribute help then improve patient safety and lower the number of medical errors. TPD has been experimenting with the Microsoft CUI and will try to enlighten HIStalkers in future posts." Link. That’s actually pretty cool, although showing its UK origins (paediatric, nil by mouth). I need to study it a little since I was surprised at its depth and detail for specific clinical situations. It would be nice to have good human factors design principles and consistency in healthcare apps. As always, though, standards=commodity to vendors, so it’s a hard sell.

Speaking of Microsoft’s CUI and not to steal TPD’s impending thunder, but their Patient Journey Demonstrator is just about the coolest thing I’ve seen in awhile. I was also impressed that, even though it requires a Silverlight download, it seemed to work in FireFox. Click on the pic for a better look. Some of the stuff’s actually live and working, while other parts are mocked up. CUI also has an online community. I have no idea who’s actually doing anything with this. 

Lisa LaPorta’s comment reminds me that this is a good forum for vetting potential HIT-related business ideas. I say that self-servingly since I’m intensely interested, but I think everybody likes brainstorming. I’m a great idea man, but my value drops off quickly after that. I’m damned annoying when someone innocently says, "What do you think of this idea?" and I start speaking in tongues with about all the stuff racing at hyperdrive through my head. Inga gets all kinds of odd-hours e-mails full of stuff like, "What if we started a ‘systems we’re using’ site for CIOs? Should we do another electronic newsletter? What kind of fun can we create at HIMSS? Can you get that celebrity psychologist Dr. V to do some fun stuff with us?" Loyal co-conspirator that she is, she always tries to sound slightly supportive while hoping I’ll forget about it.

MediNotes CEO Don Schoen says sales leads tripled the first day after its acquisition by Eclipsys, speculating that doctors are familiar with the Eclipsys name from their hospital work. Don will stay on, the company won’t move from Des Moines, and the MediNotes name will apparently live on as a wholly owned subsidiary.

Bad times are good for entrepreneurs, attendees of a Massachusetts Technology Leadership Council "un-conference" were told this week. Reasons: laid off people think more creatively, operating guys regain control over the finance guys, and companies often gain competitive position during slowdowns. That’s a stretch, but you play the cards you’re dealt.

New poll to your right: do you agree with the HIMSS decision to not support Pete Stark’s HIT bill because it advocates open source software?

Kaiser Permanente Southern California has the highest rate of breast cancer screening in the country according to an NCQA analysis, crediting KP HealthConnect’s record flagging that allows any KP employee to remind the patient that they can get a no-appointment mammogram or make an immediate appointment. Criticisms aside (cost), it appears that Kaiser is really using its EMR to do some darned interesting things that benefit patients. Once you get the application up to a critical mass of usage, you can put all kinds of value-added functions on top of its data and real-time patient encounters.

Fulton County Hospital (AR) and CIO Phillip Hughes get mentioned in a local newspaper’s story about the hospital’s PACS.

Jobs: Director of Clinical Informatics (AZ),  Senior Software Engineer (IN), Senior Systems Analyst – SoftLab (FL).

Turnaround consultants from Wellspring Management want to extend their contract at Natividad Medical Center (CA), raising their CIO rate to $44,000 a month ($275 an hour) plus expenses. $528K a year to run the MEDITECH shop of a 172-bed county-owned hospital? Seems a bit rich. The company’s CIO has been there since January 2007, starting at $374K a year as an interim "until a permanent chief information officer could be hired." How hard could they be looking?

If you’re at Cerner’s shindig, how about a live report? I thought having clients blog live from it was fun a couple of years ago, but I haven’t heard anything about it since.

Listening: Big Star, a power pop cult band that should have been huge, but instead broke up in 1975. Also: new and excellent prog from Half Past Four.

It’s been a long time since I did this, but about a revival of Companies Invoking HIPAA’s Name to Sell Stuff But Misspelling It: Incentive Logic, Emtec, and Frost & Sullivan, not to mention dozens of newspapers. It’s amazing how many newspapers run the full name, but still put HIPPA in parentheses after it like they didn’t even notice what they just wrote. And as a reader wrote me, "Another healthcare acronym that’s sure to ratchet up the HIPPA not HIPAA misspellings … The Medicare Improvements for Patients and Providers Act (MIPPA)." That’s one thing that annoys me about healthcare – we make up long, cutesy names for stuff, then have to derive contrived acronyms because we’re too lazy to pronounce the long, cutesy names we made up in the first place. My blood pressure goes up every time I read a medical journal, especially when it’s obvious that an author has taken the opportunity to add to the acronymical abyss (AA) by making up his or her OWN acronym. You just know they’re also using some eye-rolling pronunciation to go with it. People saying "Jayco" for JCAHO used to drive me up a wall. Years ago, the HIMSS people were coached to say it out (H-I-M-S-S) but nobody picked up on their lead, so it died fast.

I was accepting some LinkedIn connection requests and Dann’s HIStalk Fan Club group popped up, so I took an unplanned look and was amazed to see 281 big-name members. It’s a fine networking list, that’s for sure. Maybe I should send the next ultra-hot insider rumor just to that list. LinkedIn has grown and improved unbelievably over the last few months, so it’s cool to see everybody on there and especially to see their pictures.

$175 million to support eight Cerner sites for two years? That’s what BT wants to charge NPfIT to replace Fujitsu.

University of Illinois at Chicago is offering a fully online MS in Health Informatics. I would think that would interest clinicians who want to add formal credentials or maybe CIOs coming from other industries. I snooped around a little more and it appears to be 45 credit hours at $675 per hour, or about $30K for the program. That’s pretty reasonable for that kind of school and program. They’re running a text ad to your right, which is how I found them, although I think they’ve had a HIMSS booth in the past. They also offer post-Master’s and post-Bachelor’s certificates in health informatics. All of us industry long-timers used OJT to get where we are today (sorry about that!) so it’s exciting to see folks with formal education coming in, even though they’ll probably take our jobs.

Hawaii’s Big Island is losing three of its five orthopedic surgeons, including the president-elect of the state medical association. The problem: low reimbursement and high malpractice costs. Interesting fact: malpractice plaintiffs get no award 85% of the time, but the doctor pays an average of $150K per case to defend themselves.

1450 brings up a free online tool that helps physicians choose the most appropriate version of Dragon Medical for their practices.

Allina is eliminating 300 positions, among them that of former Fairview CIO Gary Strong, promoted to chief administrative officer in July 2007 and now headed for unemployment.

I hate CNN’s web site with its junk entertainment headlines, endless videos instead of stories, and so-called iReporters ("user-generated news") . One iReporter posted a message Friday morning falsely claiming that Steve Jobs had been taken to the hospital with chest pains, sending Apple stock down 9% and triggering an SEC investigation into whether the poster was shorting shares. Some of the hard-hitting investigative stories on CNN now: Howard Stern’s wedding, a Texas man is building a house of mud, somebody’s selling surfboards featuring naked women, why men cheat, and the world’s fattest man gets married. No wonder everybody else in the world thinks Americans are stupid – we get our news from the Enquirer.

The Illinois attorney general steps in when Cook County Hospitals and Health Systems refuses to release its budget after it was approved, claiming it’s a draft until Cook County Board President Todd Stroger makes any changes he feels like before submitting it to the county board. Apparently the budget calls for big increases in budget and headcount.

Health Information Exchange of New York will start moving data on Halloween.

BIDMC rolls out its self-labeled Web 2.0 site.

Northampton General Hospital in the UK bans staff use of Facebook after finding a cell phone picture of a topless night shift nurse on duty and in uniform on the site, with recognizable patients in the background.

Vendor Deals and Announcements

• Dell, Intel, and Motion Computing are teaming up to offer a new wireless assessment service that provides comprehensive wired and wired network analysis, design and validation.
• Quantros announces its acquisition of Medcast Health Analysts. The companies’ combined solutions will provide clinical, financial, and operational data assessment tools within a single platform.
• The first 10 products receiving CCHIT ’08 EHR certification include MEDENT 18, eClinicalWorks 8.0, Epicare Amulatory EMR, PrimeSuite 2008, Practice Partner 9.3, MedLink TotalOffice 3.1, MedPlexus EHR 9.2.0.0, NextGen EMR 5.5.28, Pulse Patient Relationship Management 4.1, and SmartClinic 16.
• ConnectivHealth names Steve NeSmith to the newly creative role of vice president of interactive. (huh?)
• St. Luke’s Episcopal Hospital IPA (TX) selects Valence Health to help them become a clinically integrated provider organization.
• ZLB Plasma is now a licensed user of Mediware’s RecruitTrak software.
• Steve Case’s Revolution Health is merging with Waterfront Media in a $300 million deal. The combined entity will be known as Waterfront Media.
• Garden City Hospital (MI) has implemented three Web-based scheduling software modules from Concerro, formerly known as BidShift.
• Seattle Children’s Hospital and the University of Washington will implement Microsoft’s Amalga technology.
• Cerner expects 7,000 people to descend on Kansas City on Sunday for its 2008 Cerner Health Conference. The city is hoping for a $4.5 million economic boost.
• Zynx Healthcare announces that in Q3 it added more than 1,755 evidence-related charges to order sets and plans of care in its clinical decision support products.

E-mail me.

News 10/3/08

From The PACS Designer: "Re: Microsoft going virtual? Amazon has announced that they are testing Windows Server on their Elastic Compute Cloud (EC2) platform. We could be seeing Windows Server (for virtualization)  as a monthly service soon!" Link.

From Tippy Martinez: "Re: Pfizer. So much for the expensive advertising of drug companies about how they’re out there searching for cures and helping people. Between the lines: ‘Since we lost our two big cash cows (Lipitor & Norvasc) and can’t make any more obscene profits on heart drugs, we’re quitting. We’ll go after other cash cow drug with patents. Oh, we have other heart drugs in the pipeline, but there’s no profit in pursuing them" Link.

From Otis Sistrunk: "Re: Siemens. The corruption situation is about to get messy. Some believe they’ve been getting information from subcontractors on what competitors are developing." Philips files suit against Siemens Medical Solutions for patent infringement.  

From Nick Carlton: "Re: I’ve said before, but just can’t stop myself from saying it one more time – damn, you’re good …" Please, if it makes you feel better, keep saying it. You’re too kind, or at least I think you are since I’m not sure what I did to elicit such a nice comment.

From SPEECHtoTEXT: "Re: speech recognition. What does this mean now for partners of Philips SpeechMagic that were/are competitors of Nuance (Dictaphone/eScription)? This includes Dolbey (uses SpeechMagic as speech engine), Medquist (used to be owned by Philips and uses SpeechMagic), 3M (former SoftMed). Nuance will own the market in 24-36 months and you will pay four times more than you do now."

From Elvira Hancock: "Re: more graphics instructions for the world. Before holding down the shift key so as to not distort the image, please make sure the 10-megapixel, 35-megabyte image file has been reduced to a manageable (under 100 KB) file size. If you don’t know what this means, please don’t add pictures to your Word document and if you do, please don’t email it to me." Yessir. I remember a previous employer’s HR department, which constructed highly elaborate Excel pivot tables for even the simplest information (like which three of your employees had missed their TB check). They put the whole hospital’s employee database into one worksheet and e-mailed all 25 megabytes to every manager and supervisor in the organization.

From Adam: "Re: GE. The troubles at GE indicate to me that we may see GE HC exist at some point in the next year or so as a separate company. This could then trigger similar moves at Siemens and Philips. We may soon be witness to a dramatic restructuring of HCIT on a global basis." GE shares fell another 10% today, even as the company offered $12 billion in new shares that were discounted to the price Warren Buffet paid. Like everybody else in the financial business, GE claims its GE Capital lending division isn’t all that exposed. Nobody believes that.

Lawson Software’s Q1 numbers: revenue up 2%, EPS -$0.01 vs. $0.03.

Some of the reader comments about financial issues were justifiably gloomy, but here’s a thought for both providers and vendors. The risk of pulling out of the stock market in times like these is that you lose money going down, but miss the chance to make it back going up (and the market is notoriously impossible to time). From a business perspective, your competitors could leap ahead while you’re dusting the cobwebs off sales, R&D, etc.

Two Partners Healthcare IT employees and an IT consultant are charged with bribery for allegedly steering business to Future Technologies in return for kickbacks.

If you’re registering for HIStalk Discussion using a non-work e-mail address, please let me know ahead of time so I can activate your pending request. The Russian spammers are sending through dozens of automated signups each day from Gmail and other free accounts, so I’m just deleting those that look fishy.

CMS says (warning: PDF) providers can no longer sent orders with stamped signatures, but electronic signatures are allowed. I know SCI’s Order Facilitator can send electronically signed orders from community hospitals to physicians. What that means for hospitals: a marketing advantage to docs (meaning: $$$).

Virginia HIMSS will feature a healthcare debate between the presidential campaigns at its conference in a couple of weeks, with Rep. Michael Burgess, MD (R-Tex) taking McCain position and Blackford Middleton, MD (Partners Healthcare) speaking on behalf of Obama. I see that Blackford is pictured on Obama’s site, saying "This country may suffer in fail in significant ways unless we fix healthcare." Healthcare’s now a tiny bump in the road compared to the obstacles in front of us, unfortunately.

Charles Colander is named CIO of Elmhurst Memorial Healthcare (IL), moving from Northwestern Memorial Hospital.

A software company’s "fake snow" mail promotion shuts down Gunnison Valley Hospital (CO) when the leaking white powder is noticed by a hospital mail clerk and emergency authorities evacuate part of the building, fearing anthrax. Before the contents were verified, 40 people had to strip naked and shower in an inflatable decontamination tent in the hospital’s parking lot. Says the hospital’s culinary director, "We got to take a shower, that was nice. It was a different day altogether, that’s for sure." The vendor makes help desk software (notice the Instant Snow promotion – that was the stuff) so the package was probably headed to the IT department. SnoWonder is the snow and it’s cool (no pun intended). I’m thinking of getting some and burying someone’s office at work. The picture above is of the Gunnison stuff, but a fake snow competitor (who knew?) has a video.

John at Chilmark Research is offering a free download of the executive summary of its May PHR market study.

ZocDoc, a service that lets patients schedule doctor appointments over the Web, gets a few million from Amazon’s Jeff Bezos. It also includes patient ratings of providers, I noticed.  One big gripe: they aren’t national, so if you search for an area they’re not in, you get a "Notify Me" signup box that can’t be closed. Nothing like annoying people first thing.

Think about it: CPOE for the Wii. CPO-Wii. Just sayin’.

For hospitals roll out consumer portals from MEDSEEK.

Palm Drive Hospital (CA), withdrawing its plan to exit bankruptcy, says it will use open source computing to save money and operate more efficiently. Guess they didn’t listen to HIMSS.

HP is pulling the plug on its Identify Center security applications, so IBM wants them to think Tivoli. It’s been awhile since I looked at it, but it was highly complex and expensive back then.

E-mail me.

HERtalk by Inga

From Elsie EHR: “Re: Bizarre skin disease. MSNBC reports on a peculiar skin disease called Morgellons which is being studied by the CDC. Page 3 of the article says: ‘The study is a joint project with the northern California research division of the giant HMO Kaiser Permanente. California seems to be a Morgellons hot spot, and Kaiser uses electronic medical records — which allows investigators to search among 3.5 million patients for complaints of fibers and either skin lesions and/or itching or crawling sensations.’” Link. It’s encouraging to see that EMRs really are helping in disease detection and healthcare studies. The report also indicates that roughly one new disease is identified every year. As EMR use becomes more widespread, the data mining potential becomes invaluable.

MidSouth eHealth Alliance (TN) is transitioning to Informatics Corporation of America’s (ICA) patient exchange technology. MidSouth has been using Vanderbilt’s version of the same product. The ICA technology was developed based on a platform developed originally by Vanderbilt Medical Center.

Wal-Mart associates are now able to take advantage of Dossia’s personally-controlled health record technology.

Stephanie Alexander has apparently resigned her senior VP post at Premier Healthcare Informatics.

I love the name of EnovateIT’s new articulating wall-mounted arm. The Fluid makes me think of some hunky WWE superstar. Actually, the Fluid is designed to serve clinicians in confined work space or can be configured as a wall-mounted computer station (if you visit the EnovateIT web site, you can see a fun little clip of the arm in motion). For an arm, it’s actually kinda sexy.

Former Misys exec Andrew Lawson is now president of MedAvant Healthcare Solutions. MedAvant had filed for bankruptcy protection back in July, then PE firm Marlin Equity acquired the company for about $300 million.

Perot Systems names Harry Greenspun, MD its new executive VP and CMO for the healthcare industry group.

If you’re a Texas Medical Association member, you can now get DocSite PQRI tools as a membership benefit. The solution provides physicians with tools satisfy PQRI requirements and qualify for incentive payments.

CHIME and the AHA name University Health Systems (TX) winner of their annual Transformational Leadership award. UHS was recognized based on their investments in health care technology, including the development of EMR, CPOE, and PACS systems.

In yesterday’s Readers’ Write, a top prediction for vendors was an increase in consolidation. Here are a three more small deals, in addition to this week’s Nuance/Philips deal and GE’s Agility Healthcare acquisition:

• Amcom Software has acquired Commtech Wireless. Amcom makes call center and paging technology while Commtech provides technology to connect nurse call alarms, patient monitors and similar technology to healthcare providers.
• IdentiSys acquires CardSmart Systems. Identisys sells and integrates ID and access control products. CardSmart specializes in ID and card issuance products.
• Quantros, a provider of safety, quality, and compliance software data infrastructure solutions for the healthcare industry, acquires Medcast Health Analytics a provider of web-based clinical utilization and financial analytic solutions.

There is also the ongoing Allscripts/Misys saga and Eclipsys’ purchase of Medinotes. Definitely sounds like a consolidation trend to me.

E-mail Inga.

CIO Unplugged – 10/1/08

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

Brigades, Battalions, and Budgets
By Ed Marx

Ah Fall. The crisp air. A scenic array of dancing leaves. Squirrels foraging for groceries. And of course, football.

Oh yes, and budgets!

Each year at this time, corporate America undergoes a fandango abounding in ritual. We perform the dance of sworn improvements, promising to enhance processes and reduce pain. But at the end of the day, or should I say months, little has changed. The mist of illusion dissipates, and we find ourselves reinstating the customs of familiarity and comfort. Insanity, as some describe it—expecting change while doing things the same way.

Part of the corporate America ritual goes something like this. Create and submit a pork-filled budget. Mandates go out to make across-the-board cuts. We make the cuts, and inflated budgets become more realistic. Additional mandates call for further reductions and managers dutifully wince and deal. Dependent upon the financial outlook, the budgets find acceptance; nevertheless, the call goes out for another round of cuts. This forces managers to sub-optimize valuable programs and services, targeting areas that, as a rule, should remain untouched. Without counting the cost, they sacrifice so-called discretionary spending: travel, training, education, and entertainment.

Here’s my take on the ultimate solution. Avoid across-the-board budget reduction mandates altogether. Instead, target programs and services that have a wide swath across the organization’s traditional budget silos. Eliminate or delay a planned integrated initiative before you reduce associated expenses and end up with a sub-optimal outcome. “You can’t cut your way to prosperity,” as I learned from a former mentor, Tom Zenty (CEO, University Hospitals, Cleveland). Choose to heavily invest dollars in areas that will push top line revenue growth so as to create more opportunity for clinical advancement.

The unfortunate reality? This rarely happens in corporate America.

As an Army Combat Engineer Officer (Reserves), I lived out a similar budget cycle. We platoon leaders had to decide what to cut and how to avoid sub-optimizing services and product. While in this environment, I adopted an approach that I use today when confronting across-the-board-mandates. I’ll sum it up with a question: Would you rather carry 40 average soldiers into battle or lead 35 of the best trained, equipped, skilled, and talented?

As a junior officer preparing for a major military exercise, I tackled the following dilemma. Assessing my platoon of forty untrained soldiers, I looked for the champions: those with the solid attitude of a soldier; any man or woman who displayed leadership talent; and the ones eager to learn and improve. After sifting the wheat from the chaff, I invested in the promising soldiers, training and equipping each one. Judgment day arrived. During the exercise, we surpassed all production expectations. My 35 soldiers outperformed peer platoons that operated with full numbers but lacked the advantage of an empowering investment.

Although it may appear counterintuitive to some, I have since applied this principle throughout my healthcare career. The effort is worth it, and the end product speaks for itself. Leaders reap what they sow, as do corporations. When the budget reduction mandates come, and they invariably will, I’ll pursue the 35 trained, equipped, skilled, and talented.

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.”

Readers Write 10/1/08

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.

A Summary of Reader Predictions of How Economic Issues Will Affect Healthcare

Employment

• White collar markets (including healthcare) will be flooded with hard working but ethically questionable employees displaced by the dismantling of the financial industry
• HIT employment will drop slightly, but will increase in 2010-11
• A big jump in unemployment will occur if the credit market seizes up
• Consultants will do well because big system vendors will minimize headcount to keep P/E ratio looking good
• Process redesign work increases as hospitals have to live off their own revenues instead of bond money
• Sales reps will turn over because it will be hard to make the numbers and sales costs are easy to cut fast
• Hospitals will reduce headcount before they reduce payments to vendors
• Vendors will cut projects that haven’t gained market traction and those teams will be cut

Hospital Spending

• No change
• Slowdown in big capital projects due to funding problems
• Ambulatory surgery center niche market dries up
• Projects will shift from clinical improvements to operational improvements
• Emphasis will be on throughput, staffing ratios, and cash flow
• Projects that result in more referrals, lab orders, and radiology orders in the IDN’s big hospital will get focus

Physician EMRs

• Physicians will buy only when affiliated hospitals insist
• Downward pricing pressure
• More interest in e-prescribing and disease registries, which cost little and provide benefits like CMS incentives
• Less interest in EMR adoption because primary care providers will be squeezed even more
• Physicians and physician groups will face tight credit and postpone big outlays

Healthcare Reform

• Consumer-driven healthcare dies when consumers lose what little clout they had
• Healthcare reform is moved back at least five years
• High deductible health plans will increase, forcing employees to shop on price or defer treatment
• Population health will decline as patients can’t afford chronic care
• Employees will underfund health savings accounts
• Emergent care will increase
• Providers able to communicate value and patient relationships will compete for the fewer patients with enough healthcare savings account funds to afford care
• Uninsured patients will rise in number
• Only private pay will flourish
• Patients will go overseas because of bad press about US healthcare
• Providers will need to collect for the care they deliver since self-pay will increase due to uninsured patients and higher deductibles
• Hospitals will struggle with how aggressive they should be in collecting payment and will be challenged on pricing

Provider IT Investments

• A shift to those providing quick financial wins, probably at the expense of clinical and patient-centered systems
• HIT will be pressed to prove the value of technology
• Hospital EMR projects will be scaled back or not purchased because of long-term expense
• No change in the short term because budget cycle is already underway
• IT departments need to educate the executive team about their focus and value
• Hospitals will scrutinize capital outlays more carefully since some will face liquidity crises because of their investments are in securities
• Solutions with quick ROI and a cost that is not prohibitive will get purchased

Vendors

• Consolidation due to credit constriction
• Niche startups encouraged, other new entrants discouraged
• R&D will be hard to fund for new companies trying to develop products with long cycles
• Sales will keep dipping
• Reductions in training and travel budgets, hiring freezes, salary freezes
• Less presence at conferences
• Foreign investment increases
• Non-real estate investment companies will still look for companies at $20 million, but smaller will be too risky and not worth the trouble
• Companies themselves will postpone IPOs, but mergers and acquisitions will pick up in hopes of finding synergies and cost savings
• Increased push to outsource
• Healthcare won’t be recession-proof this time
• Small companies with an undifferentiated product will die more quickly
• If the economic crisis lasts 2-3 years, mid-tier companies will be squeezed for operating capital and will be acquired
• Large vendors will weather the storm if they monitor expenses
• Middle tier companies will suffer, but more innovative companies will appear in 2-5 years
• Lag of new technology development will create cheaper and better solutions in 4-10 years
• Sales cycles will extend and some purchase decisions that are close to signing will be cancelled or postponed indefinitely
• Small vendors will face more financial scrutiny from customers who fear being left holding the bag
• Well capitalized vendors may use the uncertainty to push clients into term licenses or subscription models, which are less attractive than license payments, but require less cash and provide more flexibility
• Minimal change in M&A activity because vendors will seek exits, but downward valuations will convince them to wait out the storm

Nuance Acquires Philips Speech Recognition Systems

Nuance announced this morning that it has acquired Philips Speech Recognition Systems of Vienna, Austria, a European leader in healthcare in speech recognition, for $96.1 million in upfront and deferred cash.

“Nuance has been disciplined and focused in our pursuit of the healthcare opportunity in North America, a strategy that has paid dividends both in our rapid growth and the broad adoption of our solutions,” said Paul Ricci, chairman and CEO at Nuance. “PSRS provides a solid foundation of customers, partners and European language-solutions as we expand our business in Europe and enable broader geographical leverage for Nuance’s portfolio of healthcare products and services.”

HIStalk reader EMR Wannabe predicted the sale last week, saying, "Within the next ten days, Philips will announce divestiture of its SpeechMagic division. Conjecture is that SpeechMagic is getting resistance from large inpatient vendors because Philips competes in areas where GE, Siemens, and others make big money (radiology and PACS systems). SpeechMagic is about to take another run into the U.S. market, starting in 2009, but it does not fit into the Philips technology portfolio." 

News 10/1/08

From oneHITwonder: "Re: a low-tech PHR. Pros: providers might actually look a a piece of paper vs. a flash drive or log onto the Internet. Cons: storage space limited for anyone with a chronic condition." Link. Great idea. It’s the one platform that’s compatible with what 99% of doctors use.

From Spart: "Re: private enterprise. You obviously have a very right-leaning and libertarian slant on things, with one exception. You deride HIMSS for being pro-industry and private enterprise." I’m right-leaning and libertarian on fiscal and government role issues, liberal on social issues (don’t you get my grassroots populism and anti-establishment tone?) HIMSS is a nonprofit member organization and I pay dues, so it’s a little different. Like RSNA, AMA, ASHP, etc., they need to work harder to keep the commercial side away from the supposedly scientific side if you ask me. Like they used to, in other words. I wouldn’t enjoy the conference nearly as much if vendors weren’t involved, but I might like it a little more if I didn’t feel constantly manipulated by HIMSS to consort with them. It’s like having the junior high school dance chaperone pushing you publicly toward the wall-hugging row of girls before either of you have worked up the nerve to talk. In my generation, anyway.

From OB1: "Re: HIStalk. I just don’t know how you do it. You have a full time day job and yet you are able to post regularly and troll to find relevant and interesting information. Have you managed to slow time in your universe?" Apparently not because it’s flying by on this end. I can’t wait to get home from the day job to do HIStalk stuff, although it takes many of my waking hours (counting all the e-mail and web maintenance stuff I do that I don’t mention). You know I enjoy it when a cynic like me blathers on about how much fun it is, as though I had Kim Kardashian’s hand in my back pocket or something. As I write this, I’ve been at it for 3.5 hours without even getting out of the chair and another hour to go and I’d swear it was only 15 minutes. The saddest sound of the day is when XP shuts down. What a nerd.

You may have noticed that Leah Binder, CEO of Leapfrog Group, added a comment to Monday’s posting. I’ve invited her to me one of our "An HIT Moment With …" guests and sent her five questions, so she’s got the floor if she wants it.

Listening: King’s X, hard rock/prog/semi-Christian from some mighty talented guys from Katy, TX. And speaking of Texas (maybe my favorite state), I had barbeque at the epicenter of brisket above on a recent trip. Name the place and you get … well, satisfaction.

GE Healthcare acquires Agility Healthcare Solutions of Glen Allen, VA. The privately held company uses a Real Time Locating System for enterprise visibility and patient flow management. I knew CEO Fran Dirksmeier in a previous life.

University of Washington’s Institute of Translational Health Sciences and Seattle Children’s Hospital sign for Microsoft Amalga (just the Azyxxi part, apparently, since they’re a little sloppy with that name).

Jobs: Soft (SCC) Implementation Manager, Developer, Customer Support Representative, Solutions Executive. Employers who ask Gwen nicely will get her Halloween gift – a free introductory job posting in October.

A Cisco survey says outsourcers in China, Brazil, and (to a lesser extent) India are unsure how their employees handle sensitive data or already suspect they’re sending it outside the company. Employees there are more likely to tamper with the security settings on their PCs, use P2P networks on work devices, and install unauthorized software than in the US. The Grady transcription breach is mentioned.

Exempla Healthcare (CO) signs a deal with Novo Innovations to deliver data directly to practice EMRs, moving up from Novo’s drop box data exchange.

Since I’ve never had anything to do with Virtual HIMSS, I didn’t realize that the signup page requires answering questions similar to those asked by the "never had a paid subscriber" rags before sending you the subscription you don’t really want, leading you to just randomly check blocks here and there to be done with it. The footnote suggests that if you aren’t a hot vendor prospect, you’ll pay $79 instead of getting in free like everybody else, a reader tells me.

FDA will spend $2.5 billion on new IT systems over the next ten years as part of what’s called a bioinformatics initiative, but it mostly sounds like infrastructure and data center relocation.

Victoria, Australia is going back to the drawing board on its ambitious HealthSmart project after falling two years’ behind schedule and failing to bring up even one site on Cerner Millennium. "A $79 million deal with Cerner was signed in March 2006, but costs had risen by $17 million to $96 million in 2006 – the biggest price blowout so far, the audit office found."

Speaking of Millennium, a key Connecting for Health doctor thinks iSoft’s Lorenzo will be used more than Millennium because Lorenzo is newer and better suited for web deployment.

Yet another medical helicopter crash: four die in Maryland when a helicopter goes down taking a patient to Prince George’s Hospital. One of the two teen patients being transported was the only survivor. Condolences to those affected.

Doctors in Iraq will be allowed to carry guns to encourage them not to leave the country in fear. Over 2,200 doctors and nurses have been killed since the 2003 US invasion. The article says at least 20,000 of the 34,000 are already gone and healthcare is worse than it was pre-invasion. Bet they’re really glad we John Wayned right in there.

HIMSS backtracks on its curt statement that it won’t support Pete Stark’s HIT bill because it calls for making open source systems available. HIMSS says "there has been some confusion" and claims "with some modifications to the legislation, common ground can be made to meet stakeholders’ goals." You know they’re sweating when a fact sheet (warning: PDF) is produced. It says, "This would be like the Department of Defense developing a new automobile to compete against Ford and Chrysler." First, we’re already bailing Ford and Chrysler out of their own stupidity with taxpayer billions, so that’s not much of a free market example. Second, much of healthcare is non-profit and we all pay for it without having a choice like we do with cars. Third, the bill doesn’t require developing new systems; VistA is the obvious incumbent and nobody seems too threatened by it other than HIMSS. Last, why does HIMSS even need to weigh in on whether the government builds an IT system? And while I’m at it, maybe HIMSS should have polled use dues-payers before presuming to make snide statements on our behalf. This might be the second case in a couple of days where an out-of-touch administration misrepresented its constituency and was shocked at the backlash.

Speaking of HIMSS, open source advocate Ignacio Valdes, MD, MS leads off his editorial with, "HIMSS response, while predictable, is misguided on so many levels that it is difficult to know where to begin." But he does.

A Florida newspaper article covers a local women who, faced with an estimated $4,000 to $5,000 worth of diagnostic tests in multiple locations even after her insurance paid its part, heads off to India and gets it all done in six hours in one place for $350. Unlike HIMSS and its anti-open source stance, AMA’s board chair actually sees it the patient’s way: "We are not opposed to the idea, especially when institutions are accredited properly. Some of these institutions overseas are wonderful, and many of their physicians have trained in the United States." In another example, a woman went to Mexico for two root canals, two extractions, airfare, and three nights in a hotel in a mini-vacation with her daughter for $1,600.

QuadraMed will offer real-time BI tools from InterSystems in its revenue cycle applications, providing dashboards and key performance indicator monitoring.

Moses Cone (NC) will spend $2 million to put Centricity in its 29 clinics and physician offices.

In the UK, Ascribe Group acquires the healthcare division of WCI Consulting.

A Florida ambulance service gets a local paper mention for its unnamed technology that sends a patient’s EKG results to the hospital ED, reducing the door-to-balloon time for a heart attack patient to just 12 minutes vs. the national average of 112. Now that’s cool.

A note to the entire world: please hold down the Shift key when you resize PowerPoint or Word images so they don’t get distorted. Thank you.

Greenville Memorial Hospital (SC) will require ED and night visitors to wear electronic security badges linked to their driver’s license and destination.

Ontario restructures its eHealth programs under one organization.

A Massachusetts company’s technology allows filtering text messages and BlackBerry e-mails, using the example of a hospital’s blocking all outbound messages containing the name of a VIP. From the website, the product also allows setting white/blacklists for user smartphones, archiving messages, and maintaining BlackBerry PIN addresses even when devices change. Sounds like a big brother’s delight. I just wish restaurants and other public places would install that technology that blocks all cell phone use.

Lawson’s CEO obviously has vested interests, but his quote is still fun: "Getting signed up as a SaaS customer is fast, but getting out is just as fast, whereas traditional software is like cocaine — you’re hooked. It’s too difficult and expensive to switch providers once you’ve invested in one. If it were easier to jump ship, a lot of people would’ve hit the eject button on SAP a long time ago."

I wish I hadn’t found this page because I screwed around with it for most of Sunday afternoon: a complete list of Web 2.0 applications and descriptions. Some I liked and may use, most I laughed at, especially the dumb "you can’t sue us because it’s not a real word" names.

E-mail me. I read every one and always reply to the nice ones. I thank you – seriously – for reading and contributing. Over 61,000 visits and 94,000 page views in September … I’m honored and pleased. Thanks, too, to BFF and co-conspirator Inga.

Misys announces its Q1 earnings. The healthcare division’s revenue was flat compared to last year, with ILF revenue falling seven percent. Not too surprising given the uncertainty associated with the Allscripts acquisition and iMedica lawsuit.

I wonder if this is a sign of the times? Virtual Radiologic’s stock fell 34% Monday after the company announced weak September sales. The company continues to sign new customers but the number of procedures performed dropped. The company speculates that higher gas prices have resulted in fewer motor vehicle accidents and thus fewer radiology tests. Or perhaps people are avoiding medical treatment all together to avoid co-pays. Is it a start of a trend?

CCHIT announces the first 10 products to receive ’08 Ambulatory EHR Certification.

Cardinal Health is spinning off its clinical and medical products business as a separate company. Current Cardinal vice chairman David L. Schlotterbeck will lead the group. When the spin-off is completed in 2009, current Cardinal Chair and CEO Kerry Clark will retire. His replacement is George Barrett, who has served as vice chair and CEO of the Healthcare Supply Chain Services group.

Baptist Healthcare Services (KY) is rolling out in-building cellular infrastructure across its five acute-care hospitals.

In case you missed it, we debuted last night our latest HIStalk feature, “An HIT Moment With…” We will run these periodically and will include just five questions. Thanks go to Matt Grob for agreeing to be our guinea pig. Check out Matt’s comments about the state of the economy and the effect on HIT budgets. Here’s something to add to your stress level if you are a techie type: “Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like.” Anyway, if you would like to participate in our HIT Moment (or nominate an interesting person) let us know.

MediConnect Global announces it will provide at no charge digital backup copies of archived medical records to any patient or organization losing medical records during one of the recent hurricanes.

Stratus Technologies and Orion Health are teaming up to offer continuous availability of patient health portal data running on Stratus servers.

Emdeon acquires GE Healthcare Technology’s patient statement business.

Several readers have mentioned they’d like to hear where our presidential candidates stand on healthcare IT policy. Here is a bit of information courtesy of Health08.org:

McCain

• Supports the rapid deployment of 21st century information systems and technology that will allow doctors to practice across state lines.
• Believes if the system demands information on outcomes, then the market will respond to provide the HIT infrastructure.

Obama

• Believes the use of HIT should be a requirement for participating in government health programs.
• Supports a government investment of $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
• Would phase-in requirements for full implementation of HIT and ensure that patients’ privacy is protected.

Innovative Consulting Group, a healthcare IT support services provider and HIStalk sponsor, sent over a link to their latest newsletter (warning: PDF). In addition to some tech tips and client profile, they feature an interesting by a Cerner practice director about maximizing EMR for quality initiatives.

One of my official HIStalk duties has become tracking the HIStalk Web traffic. I am pleased to report that September has been our biggest month ever in terms of number of visitors. So, thanks, readers, for allowing us to keep you current and/or entertained!

E-mail Inga.

An HIT Moment with … Matt Grob

An HIT Moment with ... is a quick interview with someone we find interesting. Matthew Grob is Director, Health Care Consulting with RSM McGladrey, Inc.

Of all the ways you could have gotten involved with HIMSS, why did you choose CPHIMS?

I had been an annual conference reviewer for a few years and then served for three years on the HIMSS Foundation Scholarship Committee. I was looking for something a little more involved and the CPHIMS program had always interested me.

I sat for the exam at its inaugural offering at HIMSS 2002 in Atlanta and truly saw the value in the credential – what it means to clients, colleagues and employers as well as the personal satisfaction in having it confirmed objectively that I actually know something about what I do for living.

In 2005, I applied and was accepted for a two-year term on the CPHIMS Technical Committee. At the end of that term I was asked to chair the committee for the next year. I must have done something right because they asked me to chair for a second year, which is where I am now.

It has been an exciting time because aside from having the opportunity to work with some really smart and dedicated people who really know their stuff, we recently revised the exam content to reflect both current practice as well as the fact that it is quickly becoming a global credential – I will be presenting on it at the World of Health IT in November in Copenhagen.

For next year, I will be on the ballot for the HIMSS Nominating Committee and urge all your ultra-hip and sophisticated readers to vote for me!

What hospital trends are you seeing in your consulting work?

My practice also deals a lot with the ambulatory and primary care side of the business. We are seeing a shift in hospital environments to tying the two sides of the house together.

There are so many good reasons to do so. The benefits on the clinical side are clear for safety and continuity of care, but we are also seeing it come together on the patient accounting/practice management side as well. Layering business intelligence tools on top of all of those systems are also on the uptick as organizations want a better way to monitor and manage the health of their patients, populations, and their organizations utilizing the wealth of data that is collected throughout the continuum of care and the organization.

How do you think the economy will impact IT budgets in hospitals?

Wow, what a timely question. I see it as a chicken-and-egg scenario. It is clear that the way to better manage the health of our population is through IT and that will, in turn, result in reduced healthcare costs. Payors already recognize that through pay-for-performance initiatives. But to get the benefits, it all takes investment and I suspect that access to capital will be that much harder as we enter this uncertain time in our country’s economic history.

Interestingly, here in the New York market where some of our clients are hiring for technical positions (i.e. those that do not require specific healthcare knowledge or expertise), the candidate pool just got a bit more sophisticated and bigger with jobs lost at Lehman Brothers and the like. I suspect that will be happening elsewhere as well.

You spent a lot of years as an analyst at NYU Medical Center. If you had to take a hospital job again, which one would you want to work for, what job would you want, and why?

I don’t see myself leaving New York in the near future. Given that, I would want to go back to NYU. They were the gold standard when I was there and continue to be leaders in the industry.

Paul Conocenti, the CIO, came from banking but managed to understand pretty quickly how to run IT in a large medical center that has a history of innovation and success. Pravene Nath, the CMIO, is also visionary and understands how to do things right the first time. I would want to use my leadership skills and abilities to improve workflow and operations using technology as an enabler, with a focus on clinical systems. I’ve worked on the revenue cycle side of the house, but my first and true passion is the clinical.

If I were to leave New York, I would love to work with John Glaser up at Partners, Edward Marx at Texas Health Resources, or Buddy Hickman at Albany Medical Center as they are all great leaders and thinkers and they just plain get it. When I started in consulting at Ernst & Young back in the mid-90s, Buddy was one of my team leaders. I often point out that we share not only that history, but a hairline (or lack thereof) as well.

What do you like about living in New York?

I think the question with the shorter answer would be what I do not like about living in New York.

My wife and I were both born and bred on the Upper West Side where we live now. We live a block and a half from Lincoln Center, steps from both Central Park and newly developed waterfront along the Hudson River, and walking distance to most museums. It’s about a 30-minute walk to my office, so I actually get to see my kids most nights when I’m in town rather than sitting in traffic or on a train or bus.

But I’m also spoiled. I am used to being able to find pretty much anything I want 24/7 and within walking distance. The city has a rhythm and vibe that is very hard to find elsewhere and diversity in all aspects is what keeps it interesting. Growing up in apartments, we never had a lot of space and the city and Central Park were our backyards so while yes, it would be nice to have some more room, we’re pretty well adjusted to the confines of a Manhattan apartment. I’m just happy we bought ours 11 years ago. We’d never be able to afford one today!

Misys Gets Allscripts Merger Funding

Misys PLC announced this morning that it has signed agreements to obtain the $325 million it needs to fund its proposed merger with Allscripts. A group consisting of HSBC Bank, Bank of Ireland, and Royal Bank of Scotland will provide $150 million as a revolving credit facility over 18 months, while ValueAct Capital will provide $175 million under a subordinated credit facility over 20 months.

A revolving credit facility provides funds that the borrow can draw down and pay at its discretion over the specified time period. A subordinated loan is repayable after all other debt has been satisfied and is therefore riskier to the lender.