Monday Morning Update 5/5/08

From Frazier Thomas: "Re: Misys. I read the the Misys press release about Daughters of Charity. Vern makes a reference, twice in fact, to Daughter’s Of Charity ‘Hospital’. I wonder if he even knows there is no such Daughters Of Charity HOSPITAL? It’s a whole health system, Vern. I guess I should cut him a break. He’s probably got a whole lot on his mind wondering what kind of employee he’ll be for Glen."

From Labrat: "Re: Baylor. The shake-up is true and relates to a conflict of interest issue. The BHCS rumor mill suggests that criminal charges could be pending."

From Up to You: "Re: NAHIT. More info on NAHIT and its stasis following Scott Wallace’s departure at the end of March. Includes some info on the organization’s financials, too." Link (although Modern Healthcare, despite carpet bombing the industry with free paper copies, inexplicably locks its online version behind registration, so you may not be able to read it).

From I-Wish: "Re: paper. Today I visited a new doctor. I downloaded my CCR-compliant medical history from my PHR to an encrypted memory stick. I arrived 10 minutes before my appointment time and handed the memory stick to the receptionist, who uploaded my medical history into the office EMR. I was immediately taken back to the exam room to see the doctor. Then I woke up!! In reality, I arrived 30 minutes before my appointment, filled out 20 pages of  information that required me to put my name, SSN, DOB and insurance number on every page. I then waited an additional 40 minutes to get into the exam room and spent nine minutes with the doctor and was out the door and done! I have been working in Healthcare IT for 15 years now and nothing seems to have changed in the average doctor’s office for the $ billions spent. My dream is to have one doctor visit in my lifetime that does not require a piece of paper! I am a baby-boomer and it doesn’t look good. Maybe for my grandchildren?"

From Terminal Stare: "Re: CIO credentials. Have you noticed how many new CIOs don’t even have a graduate degree these days? No clinical credentials and minimal education – remind me again why they’re paid more than doctors?"

Thanks to HISJunkie, whose HTP/RelayHealth tip gave HIStalk readers the news at least 12 hours ahead of everyone else. Transaction processor HTP and its 65 employees will stay in Columbus under the RelayHealth name.

McKesson will pay $13 million in civil penalties for failing to report suspicious pharmacy sales of controlled substances to the DEA.

University of Michigan Health System finishes its online order entry project, claiming a 29% reduction in medication errors and a 40% drop in turnaround time for urgent meds. None of the press releases mentioned who their vendor is and the intrepid reporters didn’t ask that painfully obvious question, but I believe it’s Eclipsys Sunrise Clinical Manager.

McGill University develops an automated anesthesia system it calls McSleepy that continuously monitors and adjusts anesthesia doses in response to patient conditions. Pretty darned cool.

This ought to get Deb Peel stirred up: UCSF not only inadvertently opens up patient information over the Internet, it does so while sharing patient data with a for-profit company that targets potential hospital donors. UCSF admits turning over information on 31,000 patients over several years to Target America. It paid that company $12,000 a year to match patient names against lists of known donors, board members, and community service supporters (as well as street addresses) so the rich ones could be hit up for donations (what the marketing types call "receiving our messages and ongoing communication"). Information about 6,000 patients was open to Google searches for three months. UCSF didn’t announce its problem until six months after it found out. Too bad Britney wasn’t on their list – they could have scored a nice privacy gaffe trifecta.

Former Deloitte manager Maria Russo will join Jewish Hospital & St. Mary’s HealthCare (KY) as CIO.

Wal-Mart will make some kind of big healthcare announcement Monday morning at 8:30 Eastern. It must be about prescription pricing since the company’s $4 generic guy is on the agenda.

NovaRad signs a RIS/PACS deal with a 1,500-bed hospital in India.

LMS Medical, the Canadian vendor of the CALM patient safety software for OB, will delist its shares from AMEX, but continue trading them on TSX.

Highly annoying: you get a teaser e-mail headline about some "10 Biggest Career Suicide Moves" or "5 Most Important Technologies You’ve Never Heard Of," so you get suckered into clicking the link. When you get there, it’s some idiotic vanity cartoon presentation that you have to click through one page at a time. I don’t have the time or interest in sitting through some crappy video, podcast, or slideshow. I like to skim, not be held captive, even though web guys keep trying to turn the Internet into TV (which I don’t watch for the same reason). There’s no video or audio on HIStalk for a carefully thought out reason: those are for people whose lips move when they read. You’d need at least 60 minutes to get what you could read on HIStalk in five. That extra 55 minutes is my gift to you.

St. Jude Medical signs a deal with Microsoft to work on integrating data from implantable devices with HealthVault.

Strange: a 56-year-old musician in a Steely Dan cover band dies of liver failure after being turned down for a transplant because of marijuana use. His use of it, ironically, was medically approved for his hepatitis pain.

Fresenius Medical Care (Germany) earns CCHIT ambulatory EHR approval of its Acumen EMR software for nephrologists.

Senior citizens are apparently doddering fools who require a SeniorPC, a dumbed down offering from Microsoft. "Think of it as a simplified way to do it all: e-mailing, word processing, plus managing prescriptions, finances, travel planning and photos. There are even word games and number games for keeping the puzzle skills sharp." Yep, Grandpa can just sit back in his drool-covered Barcalounger in his Sansabelt pants and Velcro tennis shoes and punch the optional oversized keys to order prescription refills, do crossword puzzles, and look at pictures of dead relatives, pretty much life’s rich bounty for those in God’s waiting room, at least as Microsoft apparently sees it. Maybe there’s a large print option for games, porn, and celebritard gossip for the more tuned-in geezers. Getting old sucks, but you don’t have to go down without a fight.

Six more organizations get ONCHIT money for NHIN demonstration projects, including the financially strapped Cleveland Clinic and Kaiser Permanente.

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CalRHIO
By Kipp Lassetter MD, Chairman and CEO of Medicity

Regarding the reader comment about CalRHIO, I’d like to set the record straight for HIStalk’s readers. Having won the CalRHIO selection process, I can say that Medicity has never been asked to “pay” CalRHIO anything. What we did offer CalRHIO as part of our RFP response was assistance in building a sustainable model and with network development activities with the expectation that we would be paid back with the success of the network. Their has been ZERO financial exchange between CalRHIO and Medicity or between any of our anticipated subcontractors (Perot, HP, etc.).

We do understand that while we were willing to go “at risk” for our services, other vendors were proposing large fees to cover these activities with no guarantee that the activities would be productive or successful. We feel we prevailed because we were the most qualified to partner with CalRHIO. CalPERS recently has performed extensive due diligence on the CalRHIO business model and value proposition. For those readers that are not familiar with CalPERS, they are the third largest purchaser of health care services in the nation and currently have around $250 billion under management for the benefit of their members.

Both the national healthcare consulting firms of Watson Wyatt, and Mercer were involved in evaluation effort on behalf of CalPERS. The fact that CalPERS came to the decision to “DIRECT” their health plans to participate is far more than CalRHIO “hype”. There is an old country saying that summarizes the comments very well: “the dogs bark, but the caravan moves on".

Bar-Coded Medication Verification
By Laureen O’Brien, CIO, Providence Health & Health Services, Oregon Region

I recently read the Brev-IT commentary about bar-coded medication verification (BMV) systems that claimed they are "generally primitive, hellishly difficult to implement, and badly designed from a nurse workflow perspective".  I can agree with only one of these claims — they are hellishly difficult to implement.

These systems are anything but "primitive," as they integrate information from multiple systems (ADT, pharmacy, nursing) to allow the use of technology (barcode readers) to quickly validate the "5 rights" of medication safety (right patient, drug, dose, route and time) to prevent medication administration errors.

And what is required to gain this safety after BMV is implemented? The nurse must sign on to the system or scan his/her ID badge, scan the patient’s wrist band, and scan the barcode on the medication. Within seconds, the nurse knows the "5 rights" have been verified or knows there is a problem.

When fully implemented and fully utilized, these systems are proven to enhance patient safety and reduce the risk of medication errors. Granted, implementing a new task into the nurse’s work flow adds time to their already busy schedule. But in healthcare, since when is taking more time to do a task safely considered an unacceptable workflow? I would think that doing something unsafe would require workflow adjustments to correct the unsafe practices. 

Try to find a patient who will argue in favor of the nurse not practicing safe medication administration so the nurse had a better "workflow". I’ve scanned the literature and have yet to find that argument. There are lots of articles that speak to nurses getting around the BMV systems and the safety they impart. Why are these discussions so often referenced? We know that use of a BMV system can and does prevent medication errors.

It is 2008. These systems have been available since the late 1980s. There are really no good excuses for not implementing them.

If your hospital is not doing BMV and not planning on doing BMV, shame on you. Your long-term financial status may be in jeopardy, as informed patients start looking to facilities that do use safe medication practices. You know that BMV systems provide enhanced safety, your board knows it, and the public is becoming more educated daily.

Hellishly difficult to implement? You bet, but no more so than implementing any clinical IT system. It is implementing change. Change is difficult. It is also the right thing to do.

CIO Unplugged – 5/1/08

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

Talent Rules!
By Ed Marx

Unlike Hillary, I landed in Kosovo under relative calm. We flew in an unmarked military aircraft that was appointed more as corporate jet than government transport. While there were only Army soldiers awaiting us on the tarmac, we had no fear of danger. Coming off the plane we were greeted by a chiseled young soldier, Army Sergeant Jeff Masters. “Welcome to Kosovo Ma’am/Sir”, which he than punctuated with a crisp salute.

It was near Christmas 2004 and the Army asked me to join a handful of generals, politicians and business leaders to encourage our activated Reservists and Guardsmen stationed in Kosovo. I was honored to be selected. The bonus was that I would be able to visit with my Deputy CIO who had been voluntarily activated to Kosovo a few months earlier for this tour of duty. Most memorable was the don’t ask for permission lights out, fly by terrain Blackhawk excursion we took late one night. What a rush. It felt as if my Deputy pushed the allowable flight envelopes trying to get me sick but surprisingly I did not require my sickness bag. My CFO who accompanied me… well that is another story.

Sgt Masters was assigned as our purser if you will, our guide to make sure we got from point A to point B without getting lost or killed, He went out of his way to make sure our party was comfortable, answered all our questions and pointed us to the mess hall and latrine. He was polished, confident and the passion for service was self evident. In fact, the first evening we sat in on award ceremony where Sgt Masters was being decorated for superior performance. Generals sang his praises. I turned to my CFO and at the same time we said “lets hire this guy”!

Sure enough, Sgt Masters had no technical experience. He was an Army Reserve Combat Medic and was a carpenters apprentice when not on duty for his country. We did not care. He could learn all that but he had one thing that is near impossible to learn, service passion and leadership talent. We observed him closely the entire week and our convictions grew stronger. Once discharged from his activation, we had to bring him to our organization.

I have never been big on resumes. I suspect this was in part because I struggled to land my first “professional” job where recruiters cited either my lack of experience or targeted education. I knew I could do the job but I would never get the chance. I was armed with a Master’s degree, modest experience but moreover, passion to move mountains and a work ethic that was built on huge chore lists growing up and by working my own way through college.

As I finally did enter the workforce, I found little correlation between experience, education and actual performance. Certainly the ideal is to find a high performer with requisite degrees and experience, but by no means is the robust resume a guarantee for success. Time taught me that it was more about talent, the natural reoccurring behaviors and patterns of thought. In fact, while I was slow to land my first professional position, I owe much of my career acceleration to leaders who embraced this philosophy. Each took what traditional managers might have perceived as great risk in offering me opportunities for which I had the talent for, but not necessarily requisite experience and education. I am forever grateful to you Mary, Mike, Jim and Kevin. My own journey brought great clarity and success to my own recruiting and hiring decisions as my career progressed.

Jeff Masters joined us 9 months later. We assigned him to manage a challenging project that was frought with disorganization and poor leadership. A year later the project successfully wrapped up and yielded promised benefits. He worked very closely with our technical division and was learning field engineering skills along the way and took a leadership role. One more year and he moved into the clinical application realm and supported our CPOE system. While there he brought a new level of enthusiasm to the team which was languishing on this legacy application. Jeff brought organization all the while learning the complicated world of supporting clinicians using CPOE. It was such a joy to see him flourish because he was given the opportunity to fully utilize his talents. Today he is a manager coordinating the technology that will be leveraged in a Greenfield hospital at my former employer. I have every expectation that this apprentice carpenter and combat medic will continue his growth and achieve great things for those whom he serves. He has since completed his Bachelors and is now working on his Masters. But that is just window dressing on what already is a talented and highly competent professional who was given the chance to blossom, just like me.

Note. Unlike what is portrayed in the media, the American military is largely embraced by those they are deployed to help. We went on patrols through local villages and little boys and girls would see the soldiers and run to them and hug them. Their parents were warm and welcoming. I never have seen pictures or clips of this in the news.

We stopped in Ireland at 2am to refuel on our way home. We waited in the gate area when another plane pulled in. The soldiers who disembarked were amongst the first rotation of troops returning from Iraq. Once we realized what was transpiring, all of our generals and colonels and accompanied politicians formed a troop line welcoming the soldiers for a job well done. There was not a dry eye. One of my proudest moments as an American.

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.”

News 5/2/08

From Bman: “Re: Baylor. Rumor has it another major shakeup has happened at Baylor in Dallas. Most of technology management up to the VP have been escorted to the door. Does it never stop there?”

From Benny Hinn: “Re: UM. Any fresh insight on the hullabaloo? They were hired to start the new Institute of Health Informatics (IHI) at the U. This isn’t they way I was hoping informatics was going to make headlines, but I guess any press is good press.” Two former Georgia Tech professors, a husband-and-wife team that brought big grants to GT, leave for University of Minnesota. They’re under state investigation for fraud because they paid $80,000 in GT money to the wife’s brother. Tech is also claiming they started full time in Minnesota on October 1 but are still drawing GT checks. Tech paid them a combined $400K per year. Maybe informatics is so hot that profs are being wooed like football coaches.

From Larry Finkelstein: “Re: WHCC. I went to the World Health Care Congress conference in DC recently and was very impressed as to the depth of breakout small group discussions. Most of the 1,300 (so we are told) attendees were CEOs, COOs, CIOs and the spin level was at a fairly tolerable level. My favorite session was a couple hours with Denise Cortese of Mayo fame in an intimate open discussion with maybe 30 people talking about how to fix healthcare.”

From unionjack: “Re: UPMC in the UK. It all sounds very mysterious. Surely Epic won’t allow a third party to implement their apps. It must be Cerner and the others then. Why all the hush-hush? And what is UPMC up to?” They’ve installed more stuff in their own place than most vendors, so they’re qualified. The article strongly hinted that they’re looking for financial growth outside the US, something the average hospital isn’t thinking about. It does kind of stretch the definition of a non-profit whose mission is improve health since it’s local taxes they aren’t paying.

From Will Weider: “Re: my picture in USA Today. All I could think was that this has to improve my chances of winning a HISsie next year.” Will is still bummed that he lost the Best CIO HISsies award. He goes on record saying what Microsoft hates to hear (but should get used to hearing): “I wouldn’t put on Vista if it was free,” referring to Ministry Health Care’s 14,000 desktops. John Halamka is quoted too, saying BIDMC will skip Vista because XP’s running fine.

From Amy: “Re: RHIOs. I’m not sure how much better a chance at success CalRHIO actually has. They wanted one big integrator to pay ~$2m to play in their sandbox, ditto for another vendor. How sustainable will that be over time? Tons of good hype though – they are great at that.”

From HISJunkie: “Re: HTP. Just heard that RelayHealth (McKesson) bought HTP, the revenue cycle/claims scrubbing firm out of Ohio.” Listening: The Apples in stereo. Sunny Denver pop. Like crossing the Beatles with ELO.

Sign up for e-mail updates and the weekly Brev+IT newsletter to your right, if you’re so inclined. If you’re new, that Google search box over there digs through five years’ worth of HIStalk (well, it will be five years next month, anyway). The obnoxiously green Rumor Report button will take you to a secure, anonymous reporting form that will even accept attachments if you have juicy stuff to send my way (no dirty pics, please – I meant rumors and secrets). And as always, thank you for reading and recommending HIStalk. I’m always buried in work, but feel free to e-mail me – I guarantee I’ll read it and I’ll try to reply.

John Glaser touts linking genetic information to EMRs. I like the idea, although there’s still a ton of work to do in just linking EMR information to EMR information.

Jobs: Sales Executive – Workflow Solutions, Regional Sales Manager SE, Epic Pharmacy Consultant, Credentialing Verification Specialist. Sign up for the weekly job blast here.

New poll to your right: are you seeing the negative effects of business conditions at work? I’m not in my hospital (yet), but lots of businesses have shut down not far from my house (including two fast food restaurants, which is unusual). The good news is that the world’s appetite is insatiable and we farm like nobody’s business in the good old USA, so unless they’re planning to eat their highly valued currencies, they’ll need to send some of it our way. Money talks, but so does wheat (as the former Soviet Union found out).

Thanks to new HIStalk Gold Sponsor Virtual Radiologic. The Minneapolis company provides around-the-clock radiology interpretation services. Here‘s a story about them. More related to HIT, they offer vRad Enterprise Connect, a fully hosted RIS/PACS solution for big rad groups interesting in rolling out teleradiology. Former Misys Healthcare guy Rob Kill is the company’s president and COO and most of the management team is physicians. I appreciate Virtual Radiologic’s support of HIStalk and its readers.

Community Hospital of Los Gatos (CA, 143 beds)  is testing a PDA system for physicians from Validus Medical Systems. Never heard of the company, but its board looks strong. Here‘s a newspaper story about the CEO’s interest in technology.

Allscripts misses estimates yet again: revenue up 11%, EPS $0.09 after special items vs. $.08, but analysts expected $0.11. Share price didn’t change much, probably because software sales weren’t too bad despite the company’s problems with TouchWorks. Apparently it was announced during the call that the Misys merger might close this summer (which is soon, just in case May slipped up on you).

The iPhone in Healthcare: hot.

Perot Systems announces Q1 numbers: revenue up 15%, EPS $0.23 vs. $0.19, beating estimates of $0.22.

Cardinal Health announced today: revenue up 5%, EPS $1.02 vs. -$.01, exceeding analyst expectations of $1.00. Shares are up 6%.

A former Johns Hopkins professor and physician files suit against the university and hospital for sexual harassment and gender discrimination, claiming that a male colleague had what he called his “T&A display” for a screensaver, that another had “wall to wall” provocative photos, and that inflated condoms were left on her chair. She also claims that her female boss screamed at her and asked why she wouldn’t cry “like a normal woman.” Her bio and picture are still up on the Hopkins site, but I’m not saying a word.

UnitedHealthCare gives El Rio Community Health Center (AZ) $200,000 for a connectivity project.

The CEO of Siemens says the US healthcare market will improve next year. Guess that means he’s hoping the government’s cost containment efforts on imaging will go away. Good for Siemens and GE, bad for everybody else who’s paying.

The Fort Worth paper goes after tax-supported JPS Health Network’s charity claims. The system claimed to have seen 850,000 patients, but it was actually just 157,000 unique patients. It claimed it spent $75 million more for charity care than it was given, but that didn’t include “tens of millions” of extra taxpayer dollars it received for it. The health system claimed to have provided $439 million in charity care in one year, but based its numbers on charges, not cost (which the paper claims was less than $25 million). The health system bragged on 15,000 trauma admissions, but when challenged, said a computer glitch caused an error — the actual number was 1/10 that figure. Doh!

Hospital lawsuit: a New York doctor was hired as a top administrator at Atlanta’s Grady Memorial Hospital, so he quit his job and moved at Grady’s expense in October. The hospital called the night before his first day and said he didn’t have a job after all. The money-losing hospital’s former CEO (later fired) had hired him without board approval, offering him “excessive” compensation of $800K and a 15-month severance package. The doctor wants over $1 million in severance and damages. His fired almost-boss is suing for $2 million in severance himself.

E-mail me.

Inga’s Update

As if we needed more proof that healthcare is in a mess, the AHA notes that uncompensated care nationwide has increased by 44% to $31.2 billion in 2006 since 2000. Not surprisingly, bad debt is rising as well, so more hospitals are requiring upfront payment before performing care. I actually agree with the up-front approach in theory, but not sure where that leaves the masses of under- or uninsured. And, sadly, I don’t think the next White House occupant will be able to fix the system any time soon. For some reason, the whole issue is making me particularly gloomy today. How many more jobs will be outsourced and/or hospitals closed before things get better? Oh well, guess I will go back to worrying about more mundane concerns, like the $80 it just cost me to fill up my SUV.

Besides, how can I fret over such things when I could be rejoicing that David Blaine held his breath for over 17 minutes on Oprah, David Cook is poised to win American Idol, and Tony Romo and Jessica Simpson are in love? I guess I really am happy to see that celebrity-snooping hospital employee from UCLA is being indicted for supplying us with the inside information we all wanted to know.

Sentillion’s context management solution technology is now patented.

Heritage Ministries Management Company (NY) is deploying Vocollect’s AccuNurse voice-assisted technology across its three skilled nursing facilities.

A study of 100 minimally invasive coronary bypass surgery patients indicates that robots provide better care than surgeons. Researchers at The University of Maryland Medical Center determined that the use of a DaVinci robot resulted in shorter hospital stays and faster recovery for patients, as well as fewer complications and a better chance that the new bypass vessels will stay open. Plus it is apparently cheaper. No mention of who writes the better chart note.

Aloha means goodbye for 89 employees at Hawaii Medical Center. Perot has been contracted to handle the hospital’s business office, call center, health information management, and admissions departments beginning June 28th.

Hospira acquires Sculptor Development Technologies, developers of the bar code med administration system VeriScan Rx.

The Daughters of Charity Health Systems will offer Misys MyWay to its physician practices. For the next three months, apparently (why only three, I wonder?), interested physicians can contract for the hosted solution at a “subsidized rate.” Daughters has also been offering a hosted version of Misys Vision/EMR product for the last couple of years.

ThedaCare (WI) is spending $90 million over the next three years upgrading technology, re-designing patient rooms, and eliminating nursing stations in its two hospitals. Officials predict the changes will reduce patients’ length of stay by 21% and overall cost of care by one-third.

Sharp Healthcare is selling its Sharp Mission Park Medical Center to Scripps Health. The combined group of Sharp Mission Park and Scripps Mercy Medical will form a new 100-physician entity specializing in FP, peds, and internal medicine.

From California Dreaming: “Great blog. I just wanted to send a quick note to say that I have really enjoyed reading your blog. The HIS field is somewhat new to me (I came from the higher education sector). Over the past few weeks I have been trying to immerse myself into as much information and knowledge as I can, and your blog has definitely helped. I’m not sure if anyone sends a ‘Thank You’ to blogs… but I felt the need to show my appreciation.” I am not clear on blog etiquette either (though I see a potential opportunity there.) In any case, we are glad you are reading. Tell your friends.

E-mail Inga.

2006 is Year of the RHIO, but Now-Gauche Technologies Can Help Patients Today

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in February 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Every HIMSS Annual Conference is the “Year of the Something.” CPOE, PDAs, networks, wireless, or CHINs. Newly minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.

Sometimes the Something booms, although often only after several years. Sometimes it disappears without a whimper. Neither outcome dampens the enthusiasm of HIMSS, consultants, and vendors to push a new, carefully orchestrated Something each year, likely because fewer people would attend conferences, hire consultants, and buy new products otherwise. Maybe they learned that from the car makers.

This is the Year of the RHIO. I’m not against that, but it would be nice if organizations finished implementing yesterday’s fads first, like CPOE and electronic medical records. Those are still a hopeful dream for the vast majority of hospitals. And, we know they can deliver value today.

At least some of the RHIO hype appears to be genuine (unlike the Year of the PDA, which everyone knew was a joke.) It seems that technologies developed by Connecting for Health and IHE will allow RHIOs to interconnect, at least according to groups chewing through government grant money. The enthusiasm is palpable, although those with functional memories will recall that technology problems weren’t what ended the Year of the CHIN in the first place.

Eventually, RHIOs will provide patient benefit (at least 3-5 years from now, I expect.) In the meantime, they could become CPOE redux: encouraging premature interest in immature products by unprepared organizations, consuming resources and organizational energies that could have been spent on more worthwhile projects.

Most hospitals still haven’t implemented bedside barcoding, smart IV pumps, electronic MARs, and clinical decision support, all comparatively inexpensive slam dunks compared to CPOE. But, we convinced ourselves to lead with CPOE through some bizarre logic and we’re still trying to get physicians to use it years later, passing up some great patient safety opportunities along the way.

In any case, RHIOs are about to morph from a science fair project run by grant-fueled big contractors to the mainstream. Uncle Sam is sending just one receiver downfield and it’s RHIOs. Whether you’re ready doesn’t matter. That virtually no doctors have EMRs that can contribute or use clinical data doesn’t matter. That hospital clinical systems still capture only a small percentage of electronic data doesn’t matter. What does matter is that RHIOs are hot and hospital executives will be encouraged to hop on the bandwagon.

I think many RHIOs will go right down the toilet through lack of a sustainable financing model, poor governance, or a general lack of interest in cooperating with barely tolerated competitors. Those that are successful will at least spur demand for better clinical systems in all settings. That’s good: according to several HIMSS speakers this week, we’re turning our backs on those systems just as they are becoming good enough to use.

Let’s celebrate the shockingly fast progress that’s been made on RHIOs. Clearly lots of good work has been done. But, remember that your first obligation is to ensure good outcomes for patients under your facility’s care right now. We need to finish implementing all those now-gauche technologies that didn’t make the HIMSS hot list this year.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

News 4/30/08

From Kinky Friedman: “Re: Misys. Misys announced this weekend that Vern is staying on board after the merger in a yet-undefined role. Mike Etue and Glen are thrilled.”

From CaryObserver: “Re: Allscripts. It will be interesting to see Allscripts Q1 results and the market reaction. My guess is deals stalled due to the announcement and things will get blamed on timing issues rather than execution issues. How many quarters will they miss before management is held accountable?” Well, a bad quarter now could jeopardize the deal, anyway. The Brits were already whining that MDRX was being overvalued, so that would be ammo.

From Delores del Rio: “Re: RHIOs. Not that another RHIO going under is news, but it’s (just) slightly more interesting when it’s out of Silicon Valley. I don’t feel the need to comment much myself since it’ll be easy for others to do so.” Link. California’s Smart Health is worm food after two uninspiring years. Board member Richard Levy (also chairman of the board of Varian Medical Systems) is quoted as saying that breathy estimates of RHIO cost savings will never happen, especially with the big California acute care players like Sutter and Kaiser building their own interconnected systems. Even Daughters of Charity CIO Richard Hutsell took a kick at the still-warm corpse: “There was no economic model that said this makes sense. Who is going to be the one in charge, to manage it and iron out all those millions of details?” CalRHIO’s got a much better chance because it reaches beyond areas of local competition and may have learned from the funding mistakes of its predecessors.

From The PACS Designer: “Re: Web 2.0 magazine. TPD thought HIStalk readers might want to brag to their peers about seeing one of the first of a string of new ways to read magazines and books online. Cardiovascular Business Magazine is one of the first to employ reading their magazine as it would look in your hands. To go to a featured article on the front page, click on it and you’ll be brought to the article’s first page. To proceed to the next page, move your cursor to the lower right hand corner and drag the page to your left. Have some fun exploring and reading online!” Link. There’s probably a medical records analogy in there — the paper metaphor was so strong that somebody took the latest, sexiest technologies just to emulate it on-screen. Can I get a chisel and stone tablet plug-in for Word? 

Listening: The Czars. Big, haunting vocals over lush melodies. If a guy could sing Paint the Moon like John Grant, he’d need one of those deli ticket dispensers to make the smitten ladies wait their turn to idolize him.

Epic launches its next big construction project in Verona, getting Campus 2 underway. The local paper says the company is up to 3,000 employees (tripled in five years) and over $500 million in annual revenue. The article took some nice shots at Epic’s competitors, noting Epic’s KLAS ratings, its disdain for publicly traded companies, its six sales reps, its unwillingness to negotiate prices, and its resistance to selling out or going public. The new digs will add 1,700 offices to the 1,500 built in Campus 1 in 2006. Here’s a story about the Epic treehouse (the picture below is from the Wisconsin State Journal). Thanks to the reader who sent the links over – cool stuff.

Daughters of Charity chooses SIS’s perioperative solution.

Vendors and consultants, meet your newest competitor: University of Pittsburgh Medical Center. UPMC will install five clinical applications in 14 months in three UK hospitals under the banner of a for-profit company it formed last year. UPMC and the hospitals have also formed a joint venture to sell IT services to other UK hospitals. Per CIO Dan Drawbaugh: “The Newcastle contract is the first of what we hope will be many international agreements for our information technology services.” They have an unfair advantage in that they run every information system known to mankind, so they’re certainly living the vendor-agnostic creed.

Presidential candidate (and my choice, not that it matters) Ron Paul endorses B.J. Lawson for a North Carolina House seat. Both men are physicians and graduates of Duke University School of Medicine. Lawson was a founder of mobile computing vendor MercuryMD, sold to Thomson in June 2006.

Industry long-timer Dale Chernich is named CIO of WestCare Health System in Sylva, NC. I know he used to be with Dynamic Control and I think he was somewhere in PA for awhile (Hershey, maybe?) and most recently at Medical College of Georgia.

Picis will have a May 14 webinar on its Perioperative Dashboard. A customer will be presenting. Since they e-mailed me a press release, I felt empowered to conveniently ignored the copyright warnings at the beginning of their online demo and take a screen shot because I though it looked cool. You can click to enlarge, at least until they tell me to yank it down.

May is “Legacy Free” Day, according to a New York medical society. CMS and HIMSS want clearinghouses to send NPI in the provider identifier field of claims. CMS information is here. NPI is required starting May 23.

Penn White is named medical director of WiFiMed Holdings.

My editorial this week at the newsletter: “The First Lesson I Learned Working for a Vendor: Products Don’t Need to Be Great, Just Good Enough.” I’m obviously still holding some grudges toward the crappy vendor I worked for years ago.

BidShift apparently felt its conjoined name was too descriptive of what it offers, so, like every other company before it, it dug out a Latin dictionary and came up with Concerro. That will no doubt strengthen its brand recognition among people who have been dead for centuries.

Community Hospital of Bremen (IN) gets $500K of someone else’s money (yours, specifically, if you pay federal taxes) to buy more Meditech stuff.

Wall Street Journal has an article on healthcare security lapses. Not much new, but it does mention that HHS has yet to levy even one HIPAA fine, although some incidents have resulted in criminal prosecution.

A survey of second-year medical residents in Canada says that 75% of them want to use EMRs.

Here’s a fun piece about medical tourism from the perspective of several patients who not only used it, but enjoyed it. Mentioned: grocery chain Hannaford Bros.. which offers overseas procedures for which it pays the employee’s share of the bill, flies the employee and a companion to Singapore, and pays for two weeks in a hotel for recovery. “He was blown away by how patients were treated – each are picked up at the airport by limousine and get to stay in hospital suites complete with mini-fridges. Physicians are always prompt; their bonuses are tied to how long they keep patients waiting.”

E-mail me.

Inga’s Update

Quest Communications CEO Edward A. Mueller is named to McKesson’s board of directors. He was formerly CEO of Williams-Sonoma, which sounds like a much more fun gig. McKesson also announces that more than 10 community hospitals have signed on for its Paragon HIS solution and Practice Partner EMR/PM during the past year.

Qatar University pharmacy students will use Cerner’s Academic Education Solutions for EMR practice.

A survey of European general practitioners finds that 87% use a computer, 70% the Internet, and 66% for consultations.

David Brailer and his Health Evolution Partners firm announce their first investment. Evolution is providing an eight-figure financing commitment to e-Rx company Prematics. Brailer will join the company’s board.

Misys partners with Wolters Kluwer Health to enhance the clinical content of MyWay.

Sunquest opens a new London office as its international headquarters. The company has 17 UK hospitals using its systems.

The Indiana HIE is considering taking its expertise outside of the state to share with other markets. Leaders would like to see its model become the national norm. It may not be a bad idea given its success financially (self-sustaining without grants and donations; the 39 participating hospitals pay service fees, but not the 8,500 physicians).

Premier will promote Eclipsys solutions to its 1700 hospital members.

The 18-doctor Florida Cardiology group is implementing Sage’s Intergy EHR and PM. The software will be web-based and available across the group’s eight locations.

E-mail Inga.

Monday Morning Update 4/28/08

From Hates to Lose Things: "Re: stolen medical records. Sounds like the records that were stolen were encrypted. At least they are using their EMR if they already have 2 M records backed up!" Link. Thieves break into an archive company’s truck and steal backup tapes containing two million medical records from the University of Miami. It took the company two days to tell the university and another month for UM’s School of Medicine to post a public alert. At least backups are hard to do anything with. UM has stopped transporting tapes offsite, great unless they get nailed with a hurricane again or have some other local catastrophe.

From Orlando Portale: "Re: Second Life. Important to remember that Second Life (SL) is a rich 3D development platform, some what analgous to Java or C++. So, one’s impression of Second Life really comes down to the quality of the design and user experience of the particular property you are experiencing. Currently there are a limited number of Second Life healthcare examples — check out the UK. NHS Poly Clinic or Virtual Palomar West (disclaimer: that’s ours)." The problem is that you (apparently) have to register first, choose a name and avatar, and do all that geeky stuff before you can ever get to somebody’s site. Nobody’s going to do that. It needs to be as simple and fast as getting on a webinar to attract that same executive level user. I’m sure it’s fine once you get there.

From MilitaryMD: "Re: CliniComp. FACT: Haudenschild is definitely back as CEO, having gone through four management teams in four years. He has reconstituted the same team that delivered buggy code and poor customer service in the 2001 era. Severe morale problems among the staff, expect those with alternatives to bail. OPINION: Most likely, he just gave up on selling the company and will try to squeeze whatever profit he can out of the existing and  contractually committed customer base by trimming staff and under-delivering on service and new releases." Inga spoke to a colleague who officially confirmed through the company that he’s CEO again.

From Pippi Longstocking: "Re: Cerner. I hear that Cerner has been sniffing around HIMSS trying to re-engage with sponsorships, ads, off-site events, etc., but that HIMSS has rebuffed them, saying no exhibit, no opportunities."

Listening: Ours. Depending on the tune, sounds like U2, The Doors, or Radiohead. Impress your friends with music they’ll like by someone they’ve never heard of.

McKesson will lay off 114 employees on July 11 at its Gilbert, AZ office. I think that’s where some of the former Per-Se transaction processing people work.

Sharon Pfaff is named CIO of Cancer Care Ontario (Canada).

The Leapfrog Group (remember them?) announces its CPOE Evaluation Tool.

Steve Lieber of HIMSS says doctors won’t trust PHRs. I’ve been saying that all along, but he’s got more vested interest since EMR vendors pay HIMSS while PHR vendors probably won’t. He’s right, though: duplicated tests don’t cost a doctor or patient anything, so why should the doc put themselves at risk by trusting someone else’s information, no matter what the source? I bet they redo a lot of tests even when the paper records are right there in front of them. That’s how defensive medicine works.

E-mail me

Art Vandelay on Yet Another Reason to Use What We Have

Not to be doom and gloom, but there is a major storm on the horizon. A number of organizations have gone on a capital spending binge. Interest rates are adjusting up. This is just like over-buying a house with an adjustable rate mortgage. For health care organizations, the binge usually involves major new facilities and major information systems. Large depreciation expenses are (or will be) coming our way. This will impact the bottom-line financials that lenders review.

Interest rates will adjust in a troubling way if the binge did not result in a return on investment that matches the depreciation and overhead of the investment. Consider that Park Nicollette is paying an extra $5-6M on its debt a year due to a recent rate adjustment. I believe we will see some de-installs of EMRs given the lack of tangible returns to offset the ongoing costs.

If the scenario above sounds like your organization, it is a good time to develop your budget contingency plans beyond the typical 1-3% cut. The finance department will be knocking on your door soon. When I develop my lists, I categorize the opportunities into cuts, consolidations, efficiencies, and growth opportunities. The last three areas usually take money to make or save money. Remember, "No company ever shrank to greatness". 

The PACS Designer on Open Source Software

OpenEMR is a software platform in the SourceForge.net community.  Contributors give their time to enhancing software solutions by continually updating performance issues, which is good in one sense, but may be less good for the end user. If your office has an experienced geek who is willing to submit change proposals regularly to the OpenEMR community, then it may be a solution to consider for your staff.

As with anything that is free, there are some negatives, so tread gingerly when considering OpenEMR.  Also, OpenEMR shouldn’t be confused with OpenEHR which is from "The openEHR Foundation", a not-for-profit company, with its founding shareholders being the University College London, UK and Ocean Informatics pty, Australia.

The OpenEMR consists of appointment scheduling; patient registration; payment and insurance tracking, processing, and collecting; charting and record keeping; prescription writing; laboratory tracking; patient check-in/check-out, tracking and handling.

Installing OpenEMR on a Windows 2003 server can be challenging for the less experienced installer.  Hiring the services of a professional in this area of software development is highly recommended.

In conclusion, you have to be extremely cautious when a free solution has had only had minimal usage in the last few years. Also, bugs found several years ago still have no responses with fixes, so you would be wise not to extend an effort to use OpenEMR without help from outside service providers.

TPD Usefulness Rating: 3.

openEMR site.

Inga’s Update

The 265 bed Washington Hospital (PA) implements MobileMD’s HIE and EA solutions to connect to its physician community. The 33 participating practices can receive a variety of reports real time even if they don’t have an EMR.

A couple of weeks ago I mentioned the closure of an Ohio mental health facility because they owed McKesson $13,500 for some medication. Fortunately the police took off the padlocks at least temporarily while they negotiate with McKesson. While I am all for everyone paying their bills, why is McKesson going to such extremes to collect an amount equal to two days of John Hammergren’s compensation?

VC firm Psilos Group commits a $13 million investment in HealthEdge.

I am on a little weekend vacation and my Internet connection is weak, so I’ve told Mr. H I have to cut my post short. I also happen to be at one of those spots that requires you to start happy hour early , so there is that issue, too.

E-mail Inga.

News 4/25/08

From Sharp-End: "Re: bedside barcoding. I’m interested in talking to people from hospitals who have purchased BPOC systems or are looking. Questions: how important is system price vs. total cost? Is your implementation queued behind that of other clinical applications from the same vendor? Have you assessed total costs?" If you’re willing to swap e-mails or chat with Sharp-End (who’s an independent consultant), e-mail me and I’ll connect you.

From Little Enos: "Re: CliniComp. Rumor has it that owner Chris Haudenschild is back on top as CEO. They have acquired some great deals without him running the mother ship. Can you confirm? Why now? They’ve turned over several CEOs." We’ll try to confirm. I used to mention it when they changed CEOs, but it got old.

From The PACS Designer: "Re: Web 2.0. The mainstream media are starting to pickup on the Web 2.0 theme due to the Web 2.0 Conference being held in San Francisco. The BBC reports that ‘Web 2.0 is set to be embraced by Enterprise 2.0 as businesses prepare to spend nearly $5 billion by 2013 on social networking tools and over half of the companies in North America and Europe see Web 2.0 as a priority for next year’.  TPD has posted numerous comments about Web 2.0 in the past and is happy to see the concept gaining some traction with financial backing from the C-level types." Link.

From Bird Fidrych: "Re: Cerner. I was telling a friend what a great read HIStalk is and how much I enjoy it. She sniffed that you’re a paid shill of Cerner’s and have no credibility. Say it ain’t so, Joe!" It ain’t. The only vendor money I get comes from those companies whose ads are staring at you on the left. I’m surprised someone would even make that claim given the ripping Cerner often takes here (not to mention the pretty good record of accuracy I have, which would seem to squash the "no credibility" theory). She’s sniffing, all right.

Listening: Sinch, thinking man’s metal/prog/alt from Philly.

CalPERS, the retiree system for 1.2 million retired California public employees, announces that it will support CalRHIO’s statewide RHIO. Medicity is involved, I assume, since CalRHIO uses its technology.

AHA’s for-profit subsidiary endorses Vocera badge communicators (in return for? …) That got me interested in digging: the "non-profit" parent AHA took in $102 million in one year, according to its most recent federal records, enjoyed an $18 million annual profit, has $126 million in assets, and paid its CEO $1.9 million. That CEO was previously a member of Healthcare Research Development Institute, an "exclusive club" that got the attention of state attorneys general (here’s the story from The New York Times and here’s the list of the pocket-liners who couldn’t eke out a living on their massive non-profit hospital salaries alone). Gary Mecklenburg was its CEO; he was also the CEO of Northwestern Memorial who earned $16.4 million as a parting gift (the hospital’s CIO got $665K in comp that same year, close to a record). We’re not exactly talking vows-of-poverty nuns selflessly taking care of the sick, are we?

Speaking of salaries, NHS’s Richard Granger was so good that it will take two civil servants to replace him (his was the highest-paying job in British government). They’re adding a CIO position in addition to the Director slot, each advertised at an annual salary of $400,000 (at current exchange rates, which values US dollars at slightly less than Confederate ones).

Cerner’s shares get a nice pop after the earnings announcement, going from the high 30s to today’s close at $46.49. Now if Neal will just send over my check for shilling, we’ll be all set.

Medsphere announces an OpenVista go-live at Lakin Hospital (WV).

CPSI’s just-announced Q1 numbers: revenue up 13.8%, EPS $0.33 vs. $0.24. Sweet.

Jerome Grossman, whose long list of civic and educational accomplishments includes co-founding Meditech, has died of cancer at 68. I wrote about his lawsuit against the company in 2004.

Transaction processor MedAvant (aka ProxyMed) gets a nastygram from its auditors: they think the company’s about to go belly-up. Market cap is below $14 million. The CFO just quit, revenue is down, losses are up. Other than that, it’s going great.

GE’s Jeff Immelt makes excuses about the company’s performance, ending with a tag line of "building the best products." Ironic in healthcare IT, of course, since its products are at or near the bottom in most of the important KLAS categories (well, technically speaking, it bought them instead of built them, so maybe that’s his out).

Microsoft’s Q3 numbers: revenue flat, EPS $0.47 vs. $0.50.

The CEO of the healthcare business of  Siemens quits after an investigation finds new evidence of corruption in the former Siemens Medical Solutions Group. At least 10 countries are investigating the company for bribery.

Varian Medical Systems’ Q2 numbers: revenue up 19%, EPS $0.56 vs. $0.46.

FDA problems didn’t help GE’s financial performance. Now, the agency has warned Philips Medical Systems about manufacturing practices in an Ohio plant.

Shares of WebMD Health tank after the company warns of weak advertising demand. The stock was down 12.2% Wednesday. Earnings will be announced on May 6.

E-mail me.

Art Vandelay on VistA Outages

The VA’s recent experiences with server consolidation are not surprising. The root cause for one of the incidents is no different than the Parkland experience with their Epic outage (operator error). The VA’s other major incident was caused by a hardware failure.

In my experience, the two other common causes of outages are human failure to execute some manual task during an upgrade or poorly written software (ex: memory leak, runaway process). When consolidating servers, testing is a must. Back-up/restores, fail-over, and monitoring must all be tested in the backroom. User downtime processes and the communication plan should also be tested.

With M platforms, the monitoring and automation tools are rarely present. Epic has actually put a significant amount of effort into building the "RedAlert" Toolkit to assist its users. I am not sure if the VA has done the same development. I have also found the attention and rigor behind smaller and distributed environments is usually lacking.

In the non-M world, the architectures are usually already integrated with monitoring tools at various layers. This includes the OS, app. server and database layers. These vendors have also matured enough to provide the basic SNMP traps. Those of us from the early mainframe era were in a similar position and "rolled our own" utilities. Now these utilities can be purchased at exorbitant prices from IBM and CA.

To compound the problem of a lack of tools for M platforms, I rarely see the mainframe rigor in the client-server and web environments. The rigor comes with documentation, change control procedures, well-understood dependencies, defined testing plans and separate environments. It is a must to test these plans in the real world.

News 4/23/08

From SurprisewithSmile: "Re: NHS. It looks like a side effect of the ‘credit crunch’ is the UK Government doesn’t want to spend any more money on IT for its nationalised healthcare system. So the NHS and its suppliers are going to be locked into their obsolete contracts until this recession ends or they lose patience. The rumour at the UK Healthcare IT conference (HC2008) is that the NHS will reduce the scale of the national programme by allowing healthcare organisations to choose systems from the new framework contract rather than having to take the integrated systems that have had delivery problems and delays for the last four years." Link.

From Serrenity: "Re: SecondLife. I found your comment on SecondLife to be a little bit disparaging and a little offensive. I think that your characterization of SecondLife as pertaining only to Internet hermits and those desperate for phony friendships and cybersex. Wow, talk about a low-ball punch. I mean, I would have expected such luddite thinking and stereotyping for some other blogs, but from a technology forum? No." I know it has many fans, but I just don’t see casual business users doing anything than ordering the hip young techies to stick a site out there. I gave it a couple of hours, during which time I loaded a 35 meg client that ran like molasses on my PC, tried to get my headset to work in it (I’m not picturing CEOs in headsets), and went halfway through a tutorial and tried to figure out the mass of messages and controls required to perform even the simplest tasks (flying was cool). Pretty much like The Sims to this untrained eye, which is why I stopped playing around with that after about the same two hours (I admit that I have a short attention span, but I have do more computer geekiness than the average businessperson).

From The PACS Designer: "Re: CCR. The Continuity of Care Record or CCR will start to be employed going forward as sort of a passport of your health symptoms. Since it is carried or transmitted from one provider to another, you can help improve care if the new provider has as much detail as possible about your health history and the prior health experiences of your family."

From Marty Puccio: "Re: comments. Is there a way to access the site other than histalk2.com that automatically loads all of the comments?" Not that I know of, although that would be nice. The best way to see them is to click the e-mail update link. You can also click the article’s title to open a new page with comments displayed. Speaking of which, if you don’t get the updates, stick your e-mail and name in the "Subscribe to Updates" box to your upper right (and the Brev-IT e-mail newsletter signup box right below it if you’re so inclined – here’s the latest issue).

From Larry Zito: "Re: name that hospital. Looks like Winnie Palmer Hospital (Orlando Regional Medical Center). It’s a little less ominous in the daylight." Right you are, according to the reader who sent in the pic.

From Dr. Dobbs: "Re: AJAX frameworks. Here are some links to show how far they’ve come." Links: Screencast, sample Javascript widgets, desktop emulation, comparison of AJAX frameworks.

Listening: The Frost, late 60s Detroit psychedelia. Kind of Grand Funkish.

We did a fun interview with Rob Seliger, CEO of Sentillion, over on HIStech Report.

Jobs: Marketing Director (any location), Account Manager (UT), IT Director (NC).

Picis announces ED PulseCheck 4.0.

Great Q1 numbers for Cerner: revenue up 5%, EPS $0.44 vs. $0.34, beating estimates by 3 cents. I’m delighted to have been wrong — I thought sure they would turn in a bad quarter and, as the industry’s bellwether, foretell bad times coming for all. Congratulations to everyone there. CERN shares are up over 7.5% in after-hours trading. We’ll see shortly if its competitors fared equally well.

A bad Wall Street day for Omnicell, whose announced lower expectations led to a 30% haircut in the share price. Market cap’s down to $417 million with a PE of 16 even at the lowered earnings estimate. I don’t buy individual stocks, but this one looks like a deal (either as a shareholder or an acquirer).

Here’s an interesting story on the virtual physician visits offered by RelayHealth.

GE’s Jeff Immelt is taking big heat (some of it from predecessor Jack Welch) for the company’s recent and surprising downturn. Conde’ Nast Portfolio has an interesting recap of GE’s problems (too big and conglomeratized for investors to reward with anything but a pitiful PE) and suggestions to streamline the structure. "Nobody really understands your Healthcare business, so you can get rid of it however Wanchoo sees fit."

Sumter Regional CEO David Seagraves provides a somber update to the destroyed hospital’s financial situation.

Sad: a patient in a mental hospital for the elderly hangs herself by stringing a computer cord around her neck and raising it with an overhead motorized bed lift.

Australia’s Queensland Health is suing TrakHealth and its new owner InterSystems for misrepresentation. That follows TrakHealth’s earlier lawsuit against Queensland Health for cancelling its contract.

E-mail me.

Computer Sciences Corporation establishes a dedicated healthcare sector, leveraging its 2007 First Consulting Group acquisition. CSC veteran Deward Watts will lead the new business unit.

McKesson announces the availability of its integrated workforce management suite. Regular HIStalk readers know all about it since we did an HIStech Report on the suite right before HIMSS.

Since I am plugging HIStalk productions, I encourage you read the LingoLogix review posted Monday. We are starting a new series called HIStalk 911 to provide high level observations and recommendations for newer, emerging and/or smaller companies (at no charge and not available to sponsors just so everybody knows there’s no mutual back-scratching or anything). Since it was our first one, we are dying to know readers’ opinions, both in response to our comments and to the company itself. Thanks to LingoLogix, by the way, who asked us to take this peek under the hood.

Michael B. Kaufman, former Eclipsys executive VP, is named to the board of Premise Corporation. I was impressed to read in their press release that Premise grew revenue a whopping 260% in 2007 and 2265% over five years.

Unity Health Care in Washington DC selects eCW for EMR/PM. Unity has over 100 providers across 31 locations.

Seems the Seppos are not the only ones with HIT implementation issues. The Aussie’s HealthSmart project is at least two years behind schedule with more than half the budget spent and only 24% of the planned installations complete. The “cornerstone” of the project is implementation of Cerner’s Millennium clinical suite, which is not yet operational at any of the participating hospitals.

Connecticut IPA Fairfield (CT) County Physician Management Corporation and Norwalk Hospital select NextGen’s EMR/PM for its 200 member physicians.

MediCorp Health Systems (VA) purchases Sunquest’s LIS for a new Stafford hospital next year. MediCorp already uses Sunquest products at its Fredericksburg facility.

MEDecision names Tim Wallace as interim president and COO. Former president John Capobianco resigned last year. The company also named a former Horizon BCBS executive medical director as executive VP and CMO.

I looked over the newly announced Fortune 500 list, scanning for healthcare-related companies, and found a few familiar names. GE ranked as the country’s third largest publicly traded company, HCA was 31st, and EDS came in 43rd. GE was also the second most profitable. Cardinal Health was named the 19th fastest growing and McKesson is considered the 13th best bang for the buck (based on revenues per dollar assets.)

E-mail Inga.

HIStalk 911: LingoLogix

Company
LingoLogix
25 Highland Park Village #100 509
Dallas, TX 75205
214.252.9522
www.lingologix.com

Product
GoCode computer assisted coding for ambulatory encounter notes.

The Elevator Pitch (provided by the company)
"Improved compliance, revenue, and speed to billing – automatically for ambulatory patient encounter notes, with our Natural Language Processing (NLP) solution, GoCode from LingoLogix.  Physicians do their documentation while GoCode works in the background, without requiring providers to change the way they work.  New intelligence, reporting, knowledge extraction from narrative, free-text digital medical content.  We can work with an EMR or without one, real-time or batch mode, ASP or behind the firewall – no problem. And, the Chief Compliance Officer will be impressed with our consistent coding accuracy that has been demonstrated against audit to exceed 90% accuracy in automatic E&M, ICD9, and CPT coding extraction."

First Impressions
We went right to the the company’s web site, of course. It’s very serious and low key. Can we figure out what the company does and why customers and prospects should care? Let’s jump in.

The good news about all the smarmy criticism that follows: we think GoCode is pretty cool, at least judging from our CIO-level, first-pass review. It passes the first-sniff test. The customer we talked to raves about its ability to bill fairly and consistently (which usually means increased revenue) for its target customer, large organizations that do outpatient billing. Compliance is important, but nobody likes buying compliance solutions, so let’s go with Get the revenue you’re entitled to through accurate, defensible billing advertising approach. Is that the message being sent? Let’s take a look.

The most important web real estate (top left of the home page) has some stock art and a tagline, "The Science of Specialized Languages." That’s not much of a come-on, at least until the company gets huge and has offerings in many industries. It’s true, it’s bold, and it’s broad, but it’s not the best use of the 30 seconds of a casual reader’s attention that you’re apt to get. Redesign the front page with a clearer call to action and a single, constantly repeated message.

We’re serious about the 30 seconds rule. It’s like a date – the evening’s outcome is usually decided in that same 30 seconds. Spend more time creating a shorter message. 

Under The Company, it says, "“LingoLogix was formed in 2002 for the purpose of taking core technology developed at The Mayo Clinic to market.” Nobody’s going to buy just because Mayo wanted to make money. Isn’t your purpose to assure doctors they are coding accurately for maximize reimbursement? Prospects like customers whose very specific mission aligns with theirs. Name-dropping Mayo is fine, but not here. Would you go to a doctor who says, "I went into medicine because I wanted to drive a Porsche?"

Neither is the unremarkable history of the company and the year-old press releases in the News section of the front page. What are you selling? Am I a prospect? Has nothing happened in the year since the last press release went out? What do you want me to do next?

We would write sexier press releases. The news isn’t that the customer signed the agreement to use the product, but that they state that it’s "more accurate than human coders." This is a great story badly told. Don’t be afraid to market yourself – tune the message, focus on what’s newsworthy, and give the press ideas for stories that will generate free PR. 99% of press releases are terribly written, guaranteeing that no reporter in their right mind will do anything except move on quickly.

Since we’re lost at this point, we’ll click on Products. That’s a misnomer – there’s only one (and there’s nothing wrong with that – it shows focus). If I do enough clicking, I can find more specific information. The downloadable brochure is good, but it’s hidden away and is in the PDF form that clickers often avoid. It also doesn’t match what’s on the site – it’s better in identifying benefits, though it stops short of saying it helps you get your money. The testimonials are good and should be on the main site.

It’s better to repeat one focused message than to spray out several of them. Tell me (again) what problem I have and how you’ll solve it. Give me a bullet list of key features (reduces the need for coding specialists, works with free-text dictation without templates, etc.)

There’s a link for Demos. Oops – it’s just a signup form, free of the immediate gratification I’m seeking. Few people will do that. I’m doing you a favor looking for information – why stick a salesperson in between me and what I want to see? Is it top secret? Why can’t I just look at a video or PowerPoint on my own? The product section actually has a link in microscopic letters that links to a screen shot, but there needs to be more of that and it should be easier to find.

Surely something here is innovative (what was that "science of specialized languages" bit?) so where are the white papers, testimonials, architecture descriptions, etc.?

There’s no mention of a sales and marketing executive or of any strategic partners who will resell the product. Prospects might not care, but investors might, so we would talk a little about the distribution channel.

If you redesign the web site, go Web 2.0 and hire a pro. Simplify the message. Make it appealing. Strip away everything that doesn’t add value. Put your best foot forward in 30 seconds or less.

Identify the Problem, The Audience, and Their Fears
The first question we ask a company that’s looking for marketing help: who’s your target decision-maker? What pushes their button? How do you find them and get your message in front of them?

It’s not clear from the LingoLogix site, but its customer tells us the company has three influencers to reach: the CIO, the outpatient manager, and the compliance officer. Since their agendas are wildly dissimilar, why not provide each with a link to click and then hit them with a targeted message? One size does not fit all.

We would say that CFOs and COOs (hospital or large practice) would be the best contacts. They own revenue and compliance issues and have authority to buy a solution. They think big picture. Regardless of title, find out who owns revenue and compliance issues – and that’s not likely to be the CIO, whose only role is probably to veto if the technology is risky.

And like most hospitals, the first question is "who else is using it?" Your customer sites are excellent.

We like the OIG/compliance pitch, but until a provider is busted, how do they know they have a problem? Nobody buys compliance solutions proactively, at least not since HIPAA was found to be a toothless tiger. And in our experience, compliance officers don’t have a lot of clout when it comes to changing systems or workflow. It’s the secondary message to improving billing accuracy, especially since most organizations underbill, according to your customer. Focus on the incremental revenue opportunity, but use compliance as the nobler way to get that message across without making the prospect feel greedy.

Here’s what we’d want to see: some kind of checklist or online worksheet that tells me if I have the problem you’re solving. People buy solutions. That implies problems. How do I know I have one?

Say what you’re selling me – often. A computer product? Peace of mind? Enhanced revenue? Pick an honest yet sexy marketing message and sprinkle it liberally everywhere.

This is the area we’d focus on first since it spans all aspects of marketing the product, not just the web site.

Management Credentials
A small company’s executive team and board attract three audiences: customers, partners, and investors. LingoLogix has a strong team when it comes to investors, but not so strong for customers and partners.

We’d like to see more operational healthcare experience represented. If you’re selling solutions for billing and compliance, get people with impressive experience in those areas. General business experience in leadership gives the perception that a company is a technology vendor rather than a solution provider, which the company clearly isn’t – it has real-life, deep domain offerings. We’d make that statement more strongly, perhaps with a strong advisory board of provider-siders. Get people who are similar to your target prospects.

It’s a well-credentialed team. Get some heavy healthcare experience as an advisory board and it would be much stronger. Or, have a third party "expert" from a well-known consulting company review the product and provide a quote about how great it is (assuming they think it is).

Focus on Results
We see a lot about what the product does, but not enough about what benefits the customer enjoys from its use (and from its customer, there are many). The customer says the ROI is impressive, so tell me about it (or better yet, give me tools to predict it at my place). Show me the workflow before and after. Let me feel what it would be like running it.

ROI is important when it comes to passing that first hurdle. Put it in the prospect’s face.

Business Benefit is Strategic
No problems here. Customers don’t often buy solutions that don’t align with strategy. Who wouldn’t want revenue enhancement and compliance assurance? Companies often miss that point – even a great product won’t get a second glance if it doesn’t solve a strategic problem. This one’s a natural.

Innovation – Why Are You Better?
We recommend more information here. We don’t know who the competitors are or what our strategic alternatives might be. Tell us! You don’t need to be innovative from a technology standpoint (people buy solutions, not gadgets), but give the CIO something to grab onto – architectural diagrams, interfacing information, hosted vs. locally installed, etc.

And if the rules-driven NLP is more sophisticated than the usual text decomposition (which the customer says it is), then tell the CIO. Just don’t expect the rest of the customer’s people to care. They want results.

Do you have any services, support, updates, etc.? Do clients like it?

From what the customer tells us, GoCode is damned impressive at consistently and accurately creating accurate charges from documentation, easily measured and monitored by running it against "gold standard" documents of known quality. That might the most compelling sales point available. Remember Kasparov vs. IBM’s Deep Blue chess matches? Even people who didn’t follow chess got interested in the man vs. machine angle. Pit expert coders against GoCode and publicize the results (no matter who wins). The PR possibilities are endless and the resulting message is razor sharp.

Or, hitting the compliance angle, get statements from neutral third parties on the value of having an unbiased, consistent billing tool vs. humans. The customer has done that. Or, offer an accuracy guarantee or to appear with the customer if billing is called into question.

While doctors aren’t heavily involved in the decision, the customer tells us there’s a strong argument for them. Billing more procedures accurately means higher numbers,which may mean bigger bonuses with no extra work whatsoever. Physicians could help seal the deal.

We wouldn’t talk yet about the tool’s obvious potential to build or mine data warehouses. That would just confuse customers. Stick with the single message.

Conclusion
LingoLogix has a happy prestigious customer, an apparently highly functional product that delivers big strategic benefit, and some smart technology people. Like many or most small companies, they’re still working on their message and positioning.

We like the company’s chances of success. Few have the big-name reference sites that LingoLogix has, plus the strong possibility of some huge deals upcoming. Bring on some sales and marketing expertise after the next big sale, we say, and go looking for investor money if you need it. And be ready to build a strong support organization for a wider user base.

We’re most encouraged that LingoLogix opened themselves up for our critique. We said we wouldn’t mince words (we said it would be like Kitchen Nightmares, where Gordon Ramsay rips into a restaurant to help make it better). We’re confident that the average decision-maker would have similar reactions to ours, although they wouldn’t make recommendations for improvement – they would just move on if they didn’t get the picture quickly.

Now It’s Your Turn …
We said upfront that we would give LingoLogix the chance to respond to our observations and recommendations. Secondly, and arguably most importantly, we offered the expert opinions of HIStalk’s readers. We gave our thoughts for free and invite you to do the same.

Do you agree or disagree with what we said? What advice would you give LingoLogix? What else should they know about their market? What partnerships should they seek?

Add your comments below. I guarantee that a lot of people, including everyone at LingoLogix, will be hanging on your every word.

Monday Morning Update 4/21/08

From Ralph Hinckley: "Re: replacing Vista with XP. I just did it. Make sure your licensed version of XP on a CD is bootable. Boot from the CD. Nuke the partition when given the chance and install XP. If you attempt to do it while Vista is running and insert the XP CD, that will fail."

From Dnomyar: "Re: Epic .NET rumor. At the Epic User Group Meeting last fall, one of Carl’s announcements was an intention to move the Hyperspace environment from a native client to the web in an incremental fashion. As I remember, he estimated that that the full conversion would take at least five years, although some specific modules or applications (e.g. Prelude) might be deployable on the web sooner. Haven’t heard whether Epic has picked .NET for their toolset, though."

From Geek99: "Re: Epic .NET rumor. Epic moving to web deployment (regardless of whether they use .NET or some other application tier) does not necessarily have anything to do with the ‘end of Cache in healthcare’. Epic is a client-server application moving to an n-tier application. It’s highly unlikely that they would change databases on the back end just because they are changing the presentation layer."

From B: "Re: Epic boycott. Probably worth noting that Epic itself doesn’t support PP – certain employees do. Each employee gets to direct a portion of the yearly giving to area/national charities of their choice. Kind of sad that it comes to this, as I imagine this will end up affecting where some people want to have their charitable giving directed." Actually, as a reader pointed out, that page the first reader sent in is over two years old, which I missed because it looked like a news item. So, whatever the boycotters hoped to accomplish apparently hasn’t happened since Epic seems to be doing just fine. Nothing to see here, move along.

From Arse-Enio Hall: "Re: Epic’s non-compete. Here’s the latest list of companies that Epic identifies as competitors for non-compete purposes." On the list: Allscripts, Cerner, eClinicalWorks, Eclipsys, GE Healthcare, Google’s healthcare area, InteGreat, McKesson, Misys, Meditech, NextGen, and Siemens, along with all parent companies, affiliates, joint ventures, etc. including those pending. I’m pondering: is being on the list a good thing since that means Epic is taking you more seriously than other vendors?

From Roy Loney: "Re: Firefox. For some reason, HIStalk causes the Firefox 3 Beta 5 browser to consume a very high percentage of CPU. IE uses less than 2% after the page is loaded. It’s not HIStalk and it’s not Firefox, but the combination is a problem. Maybe FF3 is inefficient with those separate Flash objects for sponsor ads and will be cleared by by the time it’s GA." I noticed that it handles Flash poorly on other sites, particularly video (always stopping a couple of seconds in). It also doesn’t work with my employer’s web E-mail client or portal. Guess that’s why it’s a beta, but I’m still using it.

From Dash Riprock: "Re: VA. VistA is bulletproof when run in one instance per hospital, with at most an hour a month for maintenance. What has happened since the VA’s reorganization and move to regional data centers  is unprecedented in scope and inconceivable to staff. This is more than 30 outages in the past six months. Most are 1-2 hours long so they don’t make the press." Link. An April 10 outage in 12 medical centers was caused by hardware failure in the VA’s Denver data center. In addition, Qwest had a one-hour outage just as the VA began troubleshooting its own problem. Stakes are higher when you centralize IT.

From Dr. Chumley: "Re: CEO Enrichment Index. How about this one? The interim CEO at Grady Memorial Hospital is a state representative who missed 177 of 233 House votes this year. She is managing partner of her  law firm, a Grady board member, and was appointed to the Grady non-profit corporation. After firing the CEO, she took the position herself and accepted the $600,000 salary, She has never been a CEO." State Rep. Pam Stephenson was named a couple of months back. Here’s a little reporting error: a Grady official was quoted as saying that Stephenson is "imminently qualified to run the state’s largest public charity hospital." Unless she’s expecting a just-in-time dose of executive experience, I think the intended word was "eminently." A fellow Representative said he will introduce legislation prohibiting board members from taking executive positions at hospitals they oversee, calling Stephenson’s appointment "a conflict of interest of epic proportions."

From Carb Venturi: "Re: Cerner. I’ve noticed that web search tracking tools are showing a spike in searches for  ‘cerner layoff’ and ‘cerner layoff age discrimination’. I report this, but I have no idea what it means."

From McK-Nuggets: "Re: McKesson. John King, son of former McKesson/HBOC CEO Graham King, is appointed to SVP of sales, central region, for Mckesson." It is good to be King.

Here’s a reader’s submission for "Name That Hospital". Looks kind of ominous to me.

Patient Privacy Rights (Deborah Peel) issues a press release about the NEJM article on PHRs. "Contrary to popular belief, the ‘P’ in HIPAA does not stand for ‘privacy.’ Rather, HIPAA allows millions of healthcare businesses to snoop in our personal health records without our permission for ‘treatment, payment and operations’ (TPO), which allows data mining, marketing and the sale of our electronic records." The NEJM article seems to be getting a good deal of attention.

Look for a fun writeup on Monday or so: HIStalk 911. You asked for more coverage of small vendors, so we offered to give a volunteer company a CIO-level first impression. We got information from an executive there, did a telephone interview with a customer, and sifted through everything on their Web site and our e-mailed question responses. Inga and I will offer our thoughts on how they could improve. The company won’t see our conclusions until they read along with you, so you can bet they’re sweating right about now. HIStalk 911 is a dramatic but misleading name (the company isn’t desperate and we’re not passing ourselves off as esteemed experts), but we thought it was fun. Best of all, we’ll ask for your thoughts, too. Companies willing to accept public critique in return for visibility are welcome and we’re doing it pro bono, of course, although it does take a fair amount of time so we can’t do it too often. See you then.

A new study says healthcare IT needs 40% more people to implement advanced systems on a national level.

Jobs: IT Director of Business Applications (NC), Consultant (MA), Cerner PathNet Consultant (PA). Gwen has a deal for HIStalk sponsors running position listings.

Meditech co-founder and MIT professor Ed Roberts wins an MIT entrepreneur mentoring prize.

Clinical reference provider Epocrates, fresh off its iPhone stage time with Steve Jobs and apparently unafraid of a terrible stock market, files for a $75 million IPO. It’s profitable, anyway.

If you subscribe to Google Alerts and are getting updates from Advance for HIE, I’d ignore them. They apparently screwed something up and are blasting out all kinds of undated news story links that are years old (I don’t know why you’d ever post a news story without a date, but they do). Inga was atwitter over a QuadraMed news alert she received today that was interesting, but when I found the original press release, it was from early 2006.

All the geeks are aroused over Second Life, so I gave it a try and left unimpressed, at least for its business usefulness (maybe it was a pop-up offer to buy avatar genitalia about 30 seconds into the orientation that did it). It was a resource hog and isn’t easy to figure out, although it’s kind of cool. Maybe I’m being curmudgeonly, but it seemed like yet another time-waster for Internet hermits desperate for phony friendships or cybersex. I can’t imagine companies building Second Life storefronts and training centers will get their money’s worth.

This guy is interesting: at 26, he earned OHSU’s first PhD in biomedical informatics and is now a Harvard Medical School instructor. His interest and doctoral dissertation topic: working on the Nationwide Health Information Network.

E-mail me.

The PACS Designer’s Open Source Software Review

TPD was happy to see our fellow blogger Shahid Shah posted a list of 100 open source software programs for medical professionals. TPD has decided to review some these programs for HIStalk readers. It will  be a review of their usefulness in daily work activity and not much about their technical aspects. The first review is about Debian, which is an alternate operating platform than you would traditionally see in a medical practice.

Debian looks like it would be useful in work environments of small practices where one of the staff members has a broad knowledge of operating platforms and has done some previous installs of similar systems. Since there will be frequent bug fixes, you will have to evaluate each fix as to how it will affect your system. It would probably not be useful in large institutions unless it was first tested in a pilot of a select group of users.

Debian is available on the hardware platforms of  Hewlett Packard, Dell, and a few other hardware suppliers. Support functions can be outsourced to them if Debian is deployed in your practice. There is also a broad developers network and many universities across the world are using Debian.

TPD Usefulness Rating:  8.

Link 1, Link 2, Link 3, Link 4.

An Epic Customer’s Impromptu Visit to Verona

I’m a general surgeon and Epic user. You might be amused by my impressions of Epic and my poor cell phone photos of the campus.

While I was in Madison WI, my wife and I drove out to Verona. We could not find Epic’s address in our GPS, so we just drove out. Once in town, my wife just went up to the counter of a mini-mart and asked them, "Where is Epic?"  Everyone knows where Epic is! We got directions with only one turn, and voila!, we were looking at the familiar view from Google Maps.

We just drove around this HUGE campus, with many buildings still under construction, and nervously parked our car at what appeared to be a visitor’s parking spot and walked up the steps and hill to the Mecca. All around you see whimsical little sculptures and paintings and themes, like this one of Humpty Dumpty sitting on a wall holding a laptop that says "Epic!"

There are multiple finished buildings in a general circle of top of one hill all generally constructed in a brown, red, and grey theme, but each one designed differently. Across an artificial ravine, about 1/2 mile away, there is another massive office building of green and chrome glass, presumably an office and training center, which will dwarf this current new campus.

We walked inside and introduced ourselves to one of three secretaries and explained we came on short notice to visit. She said she would arrange a tour. In the entry lobby, we got the impression of the Pacific Northwest, with artificial trees, tree trunks framing a staircase nearby, and little ceramic photos and items hanging on the walls. Wood paneling and dark browns and greens mingled with Geek cultural icons like the head of Yoda of Star Wars perched on some end tables where visitors wait. 

There are some photo books that I should have picked up, 24 Hours in the Life of Epic, featuring photos of employees getting up, getting ready for work, driving into work in minus 11 degree weather, and at work around the world, in airports, and on site.

It turned out there was no one to give us a guided tour, so we were given a four-page color brochure of Epic’s "Intergalactic Headquarters" and map of the campus and told we could take our own unescorted tour. We were introduced to the "Lake Conference Room" (on a lake theme with a rowboat in the side of the room framing a large paper tablet). More scenic sites were hard to figure out, "Wall of Hands," "Sunroom and Fireplace," or "Galaxy" or "Ice Palace." We were perfectly free to wander around and look inside offices and conference rooms which seemed to be about 1/3 full and 2/3 unoccupied.

People were pretty preoccupied. There were a few people sitting on couches with laptops, dress was casual, there were grease boards up in every office, many computers and laptops about, and all sorts of juxtaposed sculptures, furniture, artwork in whimsical arrangements and themes — an overview of our popular culture. It was at once distracting, interesting, and full of play.

There seemed to be little concern for stealing trade secrets or unauthorized access. In several very large auditoriums, there seemed to be large employee orientations going on, teaching them principles of responsibility and responsible reporting.

Different buildings had different themes and names. We did not venture into the dining area, "Cassiopeia" but we found out that building "Formalhaut" was in a New York City theme with city streets, park benches, subways, and stuffed dummies adding to the décor. We did meet a few denizens of the building "Ganymede" who showed us around a little.

We were late for a dinner, so we stopped by the entrance, said goodbye, and drove off, musing at what is in store for Epic, a privately-held company with business expansion, lots of employees and space, and no significant financial debt. It looks like a company to watch.

Inga’s Update

Seems as if some TriZetto shareholders aren’t pleased by the company’s plan to be acquired by Apax Partners for $1.4 billion and are filing a class-action lawsuit. Mr. H predicted the acquisition might not be a slam dunk.

Medford Medical Clinic in Oregon is deploying Krptiq’s eScriptMessenger for eRx.

The University of Tennessee Medical Center selects GE Healthcare’s Centricity Perioperative Solution.

E-mail Inga.

News 4/18/08

From Mr. FA Queue: "Re: MUSE. Not a rumor, but certainly a head-scratcher. Replacing John Cleese as the keynote speaker at the 2008 International MUSE Conference… drum roll … Fran Drescher. What don’t I know that makes her appearance pertinent?" What’s all this, then? She wrote a book about her cancer experience. I’d rather see her in character as Bobbi Flekman with the lads.

From Spurious Emissions: "Re: GE. GE’s disappointing earnings at the corporate level are finding their way down to their hospital and physician customers. 30 FTEs in their physician solutions area (Flowcast and Groupcast) have been laid off and more may be impacted. After a long winter in Burlington, this is a tough start to the usual joyous spring." Unconfirmed. That does kind of suck – the only advantage of being absorbed by a humorless conglomeratized beauracracy is job security, then one bad quarter unleashes the pink slips (not a new concept for those in Burlington since the acquisition, unfortunately). I bet FAHC is getting pummeled with IDXers hoping to learn Epic.

From Ovid: "Re: EHR vendors. Lots of communication going on between eMedicalFiles (MDAware) and Propractica (StreamlineMD). Word is that these two CCHIT-bearing companies might be joining forces. Also lots of talk about a biometric application that might be adaptable to any existing EHR vendor platform."

From Pat Robertson: "Re: Epic. To all those Christian healthcare organizations spending tens of millions on EPIC’s EMR. Did you know EPIC supports Planned Parenthood? How does that compute with your healthcare ministry?" Link. Epic is newly added to a pro-life organization’s boycott list for supporting Planned Parenthood, along with Oracle and Merck. Already on the list: American Automobile Association, Kaiser Permanente, American Cancer Society, Girls Scouts, Kiwanis, Rotary International, March of Dimes, Susan G. Komen Breast Cancer Foundation, and American Diabetes Association. There’s nothing I can say that won’t make somebody mad, so I’ll just ride the fence.

From Jill St. John: "Re: Epic .NET rumor. If Epic decided to move to .NET, it would take billions of dollars and a decade or so. Can you call Epic or ask a big client?  This really would be game changing info and likely mark the beginning of the end of Cache in healthcare." Confirmation, anyone? I’m pretty sure Judy won’t take my calls, so if anyone knows, chime right in. 

From Pastor Taco: "Re: Sunquest. The situation at the ‘new and improved’ Sunquest has not changed. People continue to bail left and right. They still have leftover Misys executives who live in Raleigh (makes sense, huh?) and other senior management from the Misys era. Over the past several months, key senior managers have been pushed out of the organization without as much as a severance. Check with your sources – they will validate that not all is well at the good ole SQ. Everyone there is in fear for their jobs and under dictatorship rule. The numbers look good, but Vista really needs to look under the covers." Unverified, but confirmation welcome. It didn’t make sense to me either that they kept all the old Misys management and left them sitting thousands of miles away from the troops, as though the inconvenience of relocating to run the new company was too much to ask. I know nothing about them, but I would have cleaned house just to shake the Misys cobwebs off.

From Mikey Likes It: "Re: Art Vandelay on Epic. He states ‘the company supplying the consulting services is making the gold mine’. In my humble opinion as a grunt consultant, we earn every dime. Epic installs and go-lives are no picnic:  a) being away from home 14 days straight because an implementation manager scheduled me one day off during a go-live; b) working a 15-hour day correcting the instruction manuals because the client let his staff slip their due dates; c) being assigned a work space for five months smaller than my powder room at home with no intranet connectivity and being told ‘you figure it out’. I make a good salary, enjoy implementing Epic, and chose my profession, but please don’t whine that consultants make good money. 99.9 percent of us are dedicated to your success, willing to do whatever it takes, and we earn it every day."

From Tommy Pischedda: "Re: HIMSS booth race. All the companies I talk to are looking at ways to scale back on HIMSS booth size and investment. Times are very hard and HIMSS will really have to pad the numbers to show an increase if things progress as it’s looking. Many small start ups with small HIMSS booths are dying by the wayside – they are  way undercapitalized and in the midst of the recession (whether we call it that or not) that’s hitting healthcare and HIT." How about some multilateral HIMSS disarmament? Everybody cut back 20% from what you spent this year. Agreed? And I’m sure HIMSS will show an attendance increase, even if it means offering cheap day passes again (like this year) to move the turnstiles. Maybe that’s another reason to hold it in the puzzling choice of Chicago – more locals who’ll commute over.

From Rogue: "Re: XP support. MSFT support for XP is due to expire June 2008.  Please sign the petition at http://weblog.infoworld.com/save-xp/ to persuade MSFT to keep XP around another year or two until Vista or its successor can come up to snuff. I love my XP and if anyone can send Mr H. a good link on how to uninstall Vista and install XP (my new home desktop – no other option from Dell), I’d be way grateful."

From Mr. FA Queue: "Re: Hackensack. My deep inside source tells me that Siemens has not been booted from Hackensack University, but that they are looking at other vendors, including EPIC. This source tells me that the reason this is on the table is not because of Soarian, but because Siemens has not addressed the replacement of technology that already exists within their Invision environment. Plus the fact that Soarian Financials are way past due and there doesn’t seem to be much light at the end of the tunnel."

From Leroy Brown: "Re: Soarian. Siemens has web information showing Soarian implementations. The install activity and number of live applications is growing, but I’d estimate that Siemens has only 15-20 US customers live with one or more Soarian applications. Not a lot after all those years and billions." The most recent newsletter link is here. Leroy compared it to previous issues to draw conclusions. It says 80 customers, but I’ll trust Leroy’s number-crunching.

From The PACS Designer: "Re: Zimbra. As we move forward in bringing new concepts to healthcare, it would be nice to have tools to support this activity.  Zimbra is a next-generation messaging and collaboration software tool from Yahoo that has seen some application in educational institutions and may be a good tool for teams planning to improve the efficiency of working together daily. Ohio State, UCLA, and Georgia Tech are some of the universities already using Zimbra." Link.

Listening: 60s cult faves Flamin’ Groovies. Also, Fine Young Cannibals.

Two Children’ Boston doctors (at least one of them a long-time HIStalk reader) write an NEJM article warning of the privacy implications of personal health records, specifically those offered by Microsoft and Google, and the fact that those companies aren’t bound by HIPAA. We might as well raise the white flag right now and admit that HIPAA hasn’t done much for privacy except to raise awareness.

If you work in a hospital, give me a few seconds and be (anonymously) counted in my three-question survey (what’s your job description, what hospital do you work for, and what city is it in). I’m curious who’s reading. Thanks.

New poll to your right: what will happen to Cerner’s share price after its April 22 earnings announcement?

Call center software vendor Amcom Software says it grew 68% in its just-ended fiscal year.

Quantros announces its Disruptive Event Manager software for hospitals. That’s not defined, but other references suggest it means harassment, discrimination, and medical errors (but I’m still not sure). I guess if you’re a prospect, you’d know.

A British surgeon suspended for not keeping computerized records after being ordered to do so by overseers says he was misled. "My only problem is computers. I didn’t like computers. I was not computer literate and I was misled. I was told computers were coming, but not that it must all go on computer. You can do it manually as well."

Bringing home the pork: a Vermont counseling service gets $191,000 in federal money to pay for an EMR system, allowing it to move its own money into a big construction project, the opiate of nonprofit healthcare.

Bizarre: some Philippine surgeons are in big trouble after a YouTube video showed the entire OR crew laughing, cheering, and taking cell phone video during surgery on a male patient brought in after a New Year’s drinking spree and one-night stand with a male partner. The surgeon extracted six-inch long metal canister from the patient’s rectum, triggering a shout of "Baby out!" and resulting cheers from those in attendance. The doctor then chased staff around the room, spraying the can’s contents at them. Med and nursing students from the OR next door came over for the festivities. The patient says he was too drunk to remember how the can got there.

The Cayman health authority gets GE PACS for George Town Hospital. I only mention that because I’ve been there a few times. It was darned expensive even before the dollar went to hell.

WellPoint announces some kind of vaguely described medication surveillance system that will detect adverse events. Hopefully they’re not selling patient information to drug companies.

A West Virginia ambulance chaser gets a law passed to hide damages sought in personal injury and wrongful death lawsuits. He was prompted by a WV suit against McDonald’s that claimed a guy’s two Quarter Pounders Without Cheese were actually Quarter Pounders With Cheese, causing him a near-death allergic experience worthy of a $10 million lawsuit. Peering under the bun, even to preserve one’s frail and ephemeral human existence, was apparently beyond the plaintiff’s capability.

I haven’t done a CIO Salary of the Week for a very long time (and I’m not sure if anyone really missed them), but here you go: Albany Medical Center, Albany, NY: $310,433. HIStalk CIO Enrichment Index: 443. Wakemed, Raleigh, NC: $256,441. HIStalk CIO Enrichment Index: 38. Baylor Health System, Dallas, TX: $419,287. HIStalk CIO Enrichment Index: 154. Extra points if you can remember how to calculate the Enrichment Index because I couldn’t.

Thanks for reading, commenting, and e-mailing. It keeps me interested during the very many hours I sit here alone in front of the computer. Feel free to use the secure and anonymous Rumor Report to shoot me juicy stuff.

E-mail me.

Inga’s Update

From Greg Focker: "Re: VISICU. Talking to a VISICU sales rep, they are waiting for some of their installs to publish results of remote ICU citing positive patient outcomes and (of course) a huge economic benefit. They then expect to double their sales and support staff to handle the anticipated orders flowing in." Unconfirmed.

NextGen announces (warning: PDF) that Arkansas MSO Practice Plus will implement its EMR/PM suite. Practice Plus will utilize the PM product for its 200+ physicians and EMR for its employed physicians.

Apparently to Mediware’s surprise, Constellation Software of Toronto purchases 6.1% of Mediware’s outstanding stock. The stock price has fallen more than 50% over the last year.

The Rural Wisconsin Cooperative Information Technology Network selects HMS to provide EHR infrastructure for four Wisconsin community hospitals. The hospitals will share a data center and eventually exchange clinical data.

This week we ran Mr. H’s Inside Healthcare Computing 2006 editorial about the HIMSS booth arm race. Q posted a comment that he/she disagreed with my self-proclaimed curmudgeon boss who said he didn’t know anyone who enjoyed the exhibit hall experience. Like Q, I love running into folks I haven’t seen in years and find the people-watching aspect very entertaining. Q – I happen to be an ENFJ, so I totally get what you were saying.

A reader asked if we knew if many readers were planning to go to AONE. If you are a nursing exec heading to Seattle this month, feel free to drop us a note with updates.

Infosecurity Europe surveys 576 office workers and concludes that women are more likely than men to give away their passwords to strangers in exchange for chocolate. In fact, 45% of women and only 10% of men felt a chocolate fix was more important than security. If it were dark chocolate, I am pretty sure I might be inclined to share all sorts of secrets! Anyway, you have to love those crazy Brits for their ingenious marketing techniques.

A Florida radiologist will pay the government $7 million to resolve a healthcare fraud case. The doctor is accused of billing for procedures not performed, not ordered, and not deemed medically necessary. Seems the government also thought he was paying other physicians for referrals. A whistle-blowing ex-employee gets $1.75 million of the money.

Eclipsys announces that Cancer Treatment Centers of America has achieved 100% CPOE adoption on the first day using the Sunrise solutions. The Centers just activated the system simultaneously at all of its hospitals (four, I believe).

SCI Solutions  releases an upgraded version its Order Facilitator online order communications tool.

Arkansas convicts its first HIPAA violator, a nurse who accessed a patient’s PHI. The nurse’s husband took the information, called the patient, and threatened to use the information in an upcoming legal proceeding. The nurse pleaded guilty to wrongfully disclosing a patient’s health information for personal gain and faces up to 10 years in prison and a $250,000 fine.

E-mail Inga.

Which Trolley Goes to the Massage Tables? The HIMSS Booth Arms Race Is Getting Out of Hand

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in February 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

I didn’t learn much at the HIMSS conference last week (despite having attended several purportedly educational sessions.) However, I did arrive at one conclusion: the exhibits are out of control.

I’m a confessed curmudgeon not entirely thrilled to see the Neon Gulch exhibit hall outgrow all but a handful of convention centers, a marketplace in which vendors pay millions for a few hours of exposure to the largely indifferent masses.

We all know that decisions aren’t made and contracts aren’t signed at HIMSS. In fact, real decision makers are so vastly outnumbered by vendor staff that the yellow badgers often demo their latest PowerPoint-powered vaporware to each other just to kill time before their expensive dinners. Booth traffic seemed to be down this year even by Tuesday, with shell-shocked attendees wandering around like the confused zombies in Dawn of the Dead, seeking familiar comfort from free pens and phony sales smiles.

I’ve yet to meet anyone from either the vendor or provider side who actually enjoys the exhibit hall experience. Odd, since it’s hard to dislike a place with free cookies, scantily clad rent-a-babes, and chances to win sporty midlife crisis mobiles. Maybe because I know it’s all fake. Interchangeable booth employees are eagerly trying to convince low-ranking non-decision makers that their product is Hot and Wonderful and maybe even Sucks Less than it did last year.

You might believe this after your first HIMSS conference, but surely not after your second.

Attendees are steered to the exhibits like cattle in a slaughterhouse. Hmm, I wonder why no educational sessions are scheduled for Monday afternoon or at other obvious times? It’s to make vendors feel good about their foot traffic, best measured in quantity rather than quality.

HIMSS encourages the booth arms race. You want to erect an acre’s worth of steel on two levels? No problem, as long as you can afford it and have your HIMSS points. Throw it out and start over next year? Do it! Bring your best gimmicks, your toothiest glad-handers, and your choicest trinkets and beat your competitor. It’s fun! Don’t be a tightwad! We reward big spenders by letting them spend even more!

Does anyone remember when HIMSS limited booth sizes to something like 20 by 20 feet, which was enough when you didn’t have booth babes, cookie and popcorn machines, cheesy celebrity look-alikes, and a fleet of cars to be raffled off? Were you really less well-informed when you didn’t need a sponsor’s trolley to haul you around the sprawling acreage of magicians and massage tables? If you’re really going to buy, won’t your vendor come to your place instead of waving you over at HIMSS?

We’re mostly a non-profit customer base. The country’s economy and competitive advantage are getting destroyed by escalating healthcare costs. Many of our organizations struggle with capital shortfalls and indigent care. And yet our big conventions (whether HIMSS or RSNA or ASHP or whatever) are looking more and more like Comdex 1999, apparently encouraged by us fun-loving representatives anxious to live it up on someone else’s dime. You know it’s bad when even the keynote speakers make fun of the excesses.

I personally could enjoy HIMSS with smaller booths, fewer gimmicks, less noise, and better disclosure of which demonstrated products are real vs. wishful thinking. I’d like to see little companies be able to exhibit without being slandered as “struggling” by their bigger-boothed competititon. I’d like to go home after the conference less tired, less embarrassed at wasting my employer’s money in sending me there, and better informed. But, that’s just me.

Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

CIO Unplugged – 4/15/08

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

Culturally Relevant Leadership
By Ed Marx

One of my favorite things to do as a youth was to visit my dad’s office. To get into the French Army compound unnoticed, I had to be smuggled, cloaked in an air of mystery and suspense. I’d hide under the dashboard of our military sedan as French security forces saluted our vehicle through the gate. Once inside, my dad would park the car in front of the U.S. Forces headquarters and, when given the clear signal, I would run inside where I savored a free existence among the U.S. military and civilian officials.

As my dad worked, I would pull up a chair to the massive wooden conference tables and desks and play office. I toyed with paper clips, erasers, pens, rubber stamps and other office paraphernalia. I loved using the electric typewriters and placing my classified papers into filing cabinets that filled much of the hallway space. I made pretend phone calls to other consulates and raided whatever candy jars were available.

Fast forward…

In recent years, I have entered ex-IT leaders’ offices to discover that not much had changed since my youth! Searching desk drawers, I was surprised to unearth rubber stamps, legal pads and stickers. (Remember those gold stars teachers used to put on report cards?) With the exception of computers, these offices were even equipped with yesterday’s furniture. Although digital automation was functioning, you’d never know it by the amount of documents printed and processed via historical methods. Despite all the digital storage media available, I’d speculate that we still store more paper than ever before.

We have an aging leadership issue, and I’m not necessarily referring to chronological age. Evidence supports the likelihood that our antiquated styles and methods are creating hindrances in raising the next generation of IT leaders. These future leaders need our wisdom; but are our succession plans hip enough to give us credibility? I am not the most avant-garde CIO out there, but I am cognizant of my need to continuously update my team and myself lest we become irrelevant to those whom we lead and serve. So I push myself. I still have a long way to go.

If I have offended you thus far, check your desk drawers before you reply.

Cultural relevance manifests itself in many ways: how we dress, lead, talk, use tools, interact with staff, innovate, etc. Assuming you already have the requisite IT skills, endeavor to keep up with cultural trends. What was relevant when you graduated is not so for today. Here is a test. Bring your father into your office. If he is comfortable with the tools you use on a regular basis, give yourself an F!

How to stay culturally current:

• Hire and promote it. Do not be afraid to hire new blood right out of school. Promote talented individuals even if they don’t have years of experience. If they’re talented, they’re teachable.
• Hang out with culturally current people. Having had two teenagers in our home has acted as a catalyst for me. I have also created advisory groups to keep me on my toes. The best one was made up of second-year residents who gave me advice. I first learned of wikis and the power of blogs from them.
• Experiment. If you don’t already have a LinkedIn and MySpace account, you are way behind. Bonus points if you conduct business via SecondLife.
• Hang time. Set up monthly after-work parties at the local watering hole, where people will be more likely to let down their guard and deepen relationships on a different level. You’ll reap the benefits back at the office. I even had a foosball table in my office that helped eliminate intimidation and similar barriers.
• Cross-pollinate. Avoid spending your conference investments solely in health care. Attend non-healthcare venues and get to know people who don’t look like you or share the same points of view.
• Wardrobe. Honestly, how old are your suits and ties? I picked the sharpest dresser in my IS shop and had him stop over to my house. He systematically eliminated about 75 percent of my work wardrobe. He then took me shopping — and not where my dad shops.
• Read voraciously. Read blogs! Read from non-traditional sources of media. Gain fresh perspectives on everything from innovation to leadership. Managing Gen X requires different diplomacy than Gen Y, which requires completely different techniques than do baby boomers.
• Speak and write. This process will force you to differentiate and expose yourself to new ideas, vocabulary and trends.
• Reduce e-mail. Email is from the 90s. As my kids say, e-mail is for when you want to send a thank-you to your friend’s mom for having you over for dinner. Push the limits with IM, txt msg and video.
• Furniture. My office furniture has no place to store paper. There is no table, except for coffee. There is no trashcan. There is no printer. Everything (phone, projector, tablet) is wireless. We are tearing down several cubes in favor of contemporary design that encourages innovation and collaboration.
• Music. Hey, I love 80s music. But I do my best to mix it up with the latest in sound. Listen to all — yes all — that your employees listen to, from Mozart to Moby. Admittedly, I still struggle in Texas with country.
• Phones. Do you still have a flip phone?

Being culturally current cannot be delegated. Be proactive, otherwise you’ll end up only attracting employees who like to stamp documents and store them in mammoth filing cabinets. Candy jars are acceptable.

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.”

News 4/16/08

From Pretty Kitty: "Re: Fletcher Allen Health Care. It is a full Epic implementation, managed by CSC. It will take up to five years to complete."

From Inside Outsider: "Re: Vista vs. XP. Now is a great time to go over to the Apple store and see what the future looks like. If you need a Windows security blanket, you can run Parallels or Boot Camp and use Windows as well."  I wish the price was closer to my usual beige box PC. In fact, news came out today that a company is offering a $399 Apple clone with a lot more horsepower, at least until Apple shuts them down (which will probably be in the next five minutes).

Do you work for a hospital? Would you mind telling me (anonymously) your job title, the hospital you work for, and its location? I’m just curious who’s reading. The survey is here and it will take less than 30 seconds. Thanks.

Former Misys Healthcare CEO Tom Skelton ended up here. Don’t bother clicking  if you’re not running Internet Explorer since IT noobs built the site using Office (the HTML source is horrendously bloated) so it doesn’t work in non-proprietary browsers.

Listening: The Sword, Gods of the Earth. It’s like traveling back in time to a 70s arena and having Black Sabbath’s Tony Iommi steal your girl and break his guitar over your head during their War Pigs encore. I’m percussing with all four extremities.

Cardinal Health announces $1 million in patient safety grants awarded to 34 hospitals.

Burlington Free Press opines that Fletcher Allen’s $89 million EMR project (their figure) and an impending $32 million claims surcharge to pay for interoperability is good, but premature without a plan to protect patient privacy. Odd: ACLU was an interested party in Fletcher Allen’s certificate of need review.

Philips joins GE in having a bad quarter: flat revenue, profit down 28%. Unlike GE, though, healthcare was a bright spot, with sales growth of 5% and unchanged profit margin. Their problem was TVs.

Jobs: SQL Report Writer (MA),  Clinical Systems Analyst (WI), PathNet Consultant (PA).

E-mail me.

Art Vandelay on Converting to Epic

I am certain much less than $1B is going to Epic as part of the Sutter implementation. From their press information in 2004, it is one part of a $1B+ transformation. I have seen press about their underestimating the Epic install.

The cost of Epic licensing isn’t that high compared with other vendors (Meditech excluded). Big-money Epic installs are due to third-party services, the cost of the client’s staff (if tracked – it varies everywhere), the cost of the infrastructure, and supporting applications like Cache, Oracle, and Citrix. Add-ons from companies like Capsule, Ingenix, Zynx, and Sentillion need their own infrastructure. Those add on a few more million.

The most difficult parts to swallow with an Epic decision are:

1. They will tell it like it is if you don’t have the right quality and quantity of staff, if your support processes and tools are weak, or your training isn’t very good. Few people want the truth. Everybody loves the "high" of the "first hit" off the promise of the future without thinking about what it will take to get there.

2. They will tell you data conversion is possible. FORGET IT. You can do basic conversions like MPI, basic schedules, and possibly "flat" clinical results. Do not entertain the idea of complex data conversion (insurance, battery style micro-lab data, accounts receivable) without God-like patience, a fat wallet, and a healthy dose of contingency time. Epic’s M data structure is 10x more complicated than a flat file or relational format. I have never had the pleasure of trying M to M. I could only imagine how much balder I’d be.

3. Epic’s flexibility is a killer. It will be a long, expensive, and hard installation and support challenge if each hospital and clinic is allowed to dictate the full scope of decisions. Avoid this with a strong base install model, good governance processes, and negotiation of changes.

4. The recurring maintenance fees can be pretty high. Smart organizations spend more time negotiating the recurring costs, especially the transaction-based fees. Ongoing cost of ownership can be an eye-opener.

So – $1B isn’t going to Epic. The company’s total revenues in 2006 were $422M. The company supplying the consulting services is making the gold mine.

Inga’s Update

Hope everyone had a happy tax day. I had to write a check, so mine could have been better.

Another nice win for eClinicalWorks. Salud Family Health, one of Colorado’s largest FQHCs, will implement ECW for more than 100 providers.

The Defense Medical Logistics Support-Defense Logistics Agency awards $54.8 million of your money to CACI International. The five-year blanket agreement covers professional services and information technology solutions for managing medical supplies and services for military forces.

Microsoft wins Frost & Sullivan’s 2008 Global Healthcare Information Product of the Year Award for HealthVault. Frost & Sullivan said, “The HealthVault initiative is a definitive step towards making online sharing of personal health information a mainstream activity that has the potential to improve doctor-patient relationships.” Perhaps. However, how much value does such an award have when it comes from a company that announces 3-4 “awards” to various companies on a daily basis?

Greenway Medical says it’s now the largest integrated, single-database EHR/PM/interoperability solution provider for OB/Gyns, with more than 260 practices on board. That equates to 1,334 doctors, 7,921 users, and 532 sites.

The town of Middleton, WI wants a piece of the hotel business generated by visitors to Epic Systems. Epic apparently generates 60,000 room nights a year and Middleton wants to offer free shuttle service between the airport, Middleton hotels, and Epic to take advantage of some of that tourist business. To get from the Madison airport to Epic headquarters, you have to travel through Middleton.

Sage predicts its financial results will meet analysts’ estimates, though analysts are still concerned about the company’s North American growth. One of the financial experts noted the healthcare division is still facing “zero revenue growth and flat margins.”

I suppose we have all concluded that hospital staffers in Hollywood like to peek in medical charts to feed the country’s gossip fix. In New York, however, all one medical worker was concerned with was how those charts could make him a buck. A New York-Presbyterian Hospital/Weill Cornell Medical Center employee is charged with stealing nearly 50,000 patient files and selling at least a couple thousand of them. Apparently he got $750 for one sale of 1,000 charts, which included patient Social Security numbers but no medical data.

E-mail Inga.

Monday Morning Update 4/14/08

From Fall Guy’s Bride: "Re: UCLA. I have worked at several hospitals and I can tell you that many employees are improperly viewing files on a regular basis. That goes for everyone from the aides to the nurses and even the physicians. One of my employers was much better at limiting access to necessary viewers than the other. I think this is a common occurrence among hospital personnel and I do not believe for a moment that this woman was a ‘rogue’ employee or that she did not share the information. At the least, she would have gossiped to her friends and co-workers. The laws guarding privacy need to be tightened! I would never go to the hospital I worked at because I knew my nosy co-workers would snoop." I agree. Don’t ever go to the same hospital you work in. You’re records will be widely viewed, even though mostly likely with the best of intentions and concern.

From Malvern: "Re: Eclipsys. On April 11, Eclipsys filed an 8K with the SEC in which it announced the termination of the poison pill by May 8, 2008.  Although the company said in the announcement that there is no anticipated transaction (read: acquisition of Eclipsys), it is hard to fathom why the board decided to do this without at least some thought towards an acquisition." A lot of companies are letting those agreements expire. A shareholder rights provision only protects the company from an uninvited takeover attempt, as I understand it, so it’s not relevant to voluntary acquisition. Sounds like good governance – in the absence of a poison pill provision, shareholders get to vote. On the other hand, removing the provision may signal interest in hearing from suitors.

From Just a squirrel: "Re: UPHS. Mike Restuccia named CIO of UPHS? Mike also owns a consulting firm. Guess which consulting firm UPHS uses. Hmm."

From Fish n’ Chips: "Re: Sutter. Sutter nurses are getting ready for their fourth strike. Meanwhile, the cost of the Epic migration is approaching $1B! What does Judy do with all that money?" I’ve always wondered. She doesn’t seem like a conspicuous consumer. Once you’ve got more than a few million, I suspect it doesn’t matter (but I’m not speaking from experience, of course).

From Californiasunshine: "Re: Keane. IMED is DEAD. They haven’t sold it for years. Now they are looking for everyone to move to Patcom. Lots of stuff going on with India, though."

From Dutch Treat: "Re: Philips. I noticed quite some coverage of  Philips on HIStalk related to a lot of acquisitions. Hot off the press – the latest ‘value” scoop." Link. Philips buys Chinese patient monitoring company Shenzhen Goldway Industrial, saying it likes that company’s products not just because they’re big in China, but because they’re suitable to other "value-conscious, high-growth markets around the world."

Eclipsys clarifies that its $90 million of auction-rate securities weren’t traded for $45 million of cash to by EPSi, but rather as collateral for it, just in case any finance weenies were holding passionate water cooler discourse about it.

Want to be an athenista? athenahealth’s growth has opened up quite a few jobs, including some clinical ones.

A British private equity firm will buy TriZetto Group for $1.4 billion and take it private. Apax Partners also owns India’s Apollo Hospitals, which runs a chain of medical tourism hospitals and related facilities. Apax has backed out of deals before, though, and shareholders still must approve.

Auditors of Memorial Health System of Colorado Springs say its software has serious security deficiencies that allow unauthorized employee access. The systems weren’t named, although they’re a big Cerner shop if I’m remembering right.

A newspaper article on physician EMRs neatly encapsulates the conundrum of getting docs to use them: "But doctors don’t get paid more by health insurers when their office staffs are more efficient. And they actually get less money when they take better care of patients. If a doctor cures a patient’s ailment in one office visit instead of two, he receives half as much money. Health insurers pocket the savings."  

GE Healthcare’s disappointing quarterly performance drags down the company’s earnings and sends the stock (and the stock market) into a tailspin. Healthcare’s revenue was flat and earnings were down 17%. GE missed expectations by 7 cents, of which healthcare’s poor performance accounted for 1 cent. Competitors shouldn’t gloat just yet: the company blamed hospital reimbursement and credit issues, which I’ve been saying will hurt most vendors. I expect Cerner to have bad news when it reports on April 22, although not as bad as GEs since its exposure to diagostic imaging reimbursement changes is minimal.

Fletcher Allen Health Care (VT) gets state approval to spend $57.2 million on a clinical system. The article didn’t mention the system, but I’ve said before that it was Epic (that’s obvious from the price, I think.)

E-mail me.

Inga’s Update

With all of McKesson’s recent acquisitions, perhaps they’re having cash-flow problems. Sheriff’s deputies padlock an Ohio mental health services company over a $13,500 debt owed to McKesson. If McKesson resorts to such tactics over $13K, I can’t imagine what they do when a hospital system owes them millions.

George Washington University will use Mediware’s blood management software product.

University of Kentucky Chandler Medical Center goes live on Eclipsys Sunrise Ambulatory Care.

Cardinal Health is handing out $1 million in grants to 45 health systems and community health clinics for the implementation of programs with creative and replicable methods of improving patient care. They claim 700 organizations applied for the grants.

The MA eHealth Collaborative announces an extension of its EHR program, providing participants an additional six months of support. The organization says that MA BCBS used the initial $50 million in funds so efficiently that there is enough money to continue certain aspects of the pilot, including participation in an HIE. They claim that 417 of the 435 participating docs are live on EHRs, but also note that the technologies are difficult and time-consuming to get up and running.

Our friends over at the HIT Transition Group are running a survey over the next week entitled, “The NPI Contingency Status Survey.” Michael Christopher says, “We’re doing it for free, and making the data available free, too. It’s a big project, designed to rapidly tell us (and the industry – especially including CMS) what problems there are in the NPI implementation right before CMS’ current contingency period ends.” If you are a healthcare provider, payer, clearinghouse or otherwise involved in claims processing, take a moment to support the creative guys that did our HISsie Awards announcement.

E-mail Inga.

News 4/11/08

From UPHS Employee: "Re: CIO. Mike Restuccia was named CIO of University of Pennsylvania Health System on 3/31. He was interim from early 2007 until now."

From The PACS Designer: "Re: DCP. TPD coined the acronym DCP for the relative new concept of the Digitally Connected Patient.  Now, it appears the concept is gaining momentum, as Philips Healthcare has released a survey on the effects of DCP in home care agencies. (1) 17.1% of agencies use some type of telehealth system. A much higher percentage of large agencies (32.0%) report that they provide telehealth services. (2) 88.6% report that telehealth led to an increase in quality outcomes, with 76.6% reporting a reduction in unplanned hospitalizations and 77.2% reporting a reduction in emergency room visits. (3) 71.3% report that telehealth services improved patient satisfaction, with no agency reporting that it reduced patient satisfaction. (4) 83.9% state that fewer than one in ten patients refused a home telehealth system."

From Spud Webb: "Re: HIMSS. Big names were part of an end-of-day panel at a regional HIMSS policy forum on April 8 in a city just outside of Boston. Jonathan Bush of athenahealth lived up to his reputation as an engaging attraction, saying, among other things: ‘I’m so sick of standards’ and ‘I hate the word interoperability.’ Also on the same panel were Girish Kumar of eClinicalWorks, Sumit Nagpal of Wellogic, and others. Pretty impressive gathering organized by HIMSS, New England Chapter." Another reader comment about the meeting: "I saw you mentioned the New England HIMSS meeting. I was able to attend today and have to say the CEO panel was very well done. The athena CEO and eClinicalWorks CEOs are both very compelling. These things are usually very boring, but this was one of the better lineups."

From Dutch Treat: "Re: OHT. In Europe, quite a buzz around the Open Health Tools initiative. Pretty quiet in the USA as observed from this side of the pond." Link. It’s an interoperability framework based on Eclipse that will link healthcare systems, with the first tools due on by January. The VA and Oregon State University are among the members, as are IBM, Oracle, and Red Hat.

From Gov’t: "Re: AHIC. Secretary Leavitt wants to take it private before the end of the Bush term. The various successor committees met for the first time this week. Not everyone is happy about privatizing AHIC – Pete Stark." Link 1, Link 2. Stark’s comment: "Secretary Leavitt wants the blind to lead the blind. If the private sector was interested in developing or able to promote interoperable standards for health information technology, it would have done so years ago – and private companies wouldn’t today be asking the government to pay for it. Self-interested private firms have and will continue to fight among themselves over specifics, further delaying the adoption of money saving and lifesaving technologies. It is well past time for federal leadership to fix this market failure."

From OneWizer: "Re: Keane. I had not heard that they lost the CHS account, but I do know that the First Coast system is being phased out, with clients expected to move to the Patcom and iMed solutions. Seems they have lost a number of hospitals of late with many of those moving to Meditech." No Paragon? Surprising.

Healthcare Growth Partners has its Q1 healthcare IT M&A transaction summary ready to go.

Roger Madura has a new edition of his VistA & Open Healthcare News, which I find to be one of the most interesting and well-written newsletters out there (even if you don’t follow VistA and open source all that much, like me). You can download it here (warning: PDF). A few factoids I extracted: Picis has ported its periop suite to work with VistA, a couple of best-selling healthcare books talk about the VA and VistA, and Roger has his take on the VA’s recent big outage and its intended replacement of VistA’s LIS with Cerner. Most interesting: the effect of putting a lot of DoD people in charge at the VA and their cultural bias toward big-ticket contractor software development (like ultra-expensive AHLTA). "Well, as a result, MHS is now facing a exodus of physicians and nurses. Because AHLTA does not work the way clinicians do they are having problems working with their patients and are having to spend several extra hours a day entering data into the system. Contractor-designed and built, AHLTA meets all the specifications,yet unlike VistA it very hard to use."

Kaiser Permanente tells 800 specialty nurses to either leave their union or lose their retirement benefits, so the union claims. The union withdrew its representation of the nurses, apparently the first time that’s happened since KP formed a partnership with them to avoid labor strife.

The folks at what used to be InteGREAT had to swallow some pride and pick a new name after one of those "too close to ours" complaints (even made-up words are off limits, apparently, leaving no names left except random combinations of letters and numbers that resemble a strong password.) Anyway, as their text ad to your right indicates, they’re now Orchestrate Healthcare Consulting. 

My editorial in this week’s newsletter: Perfect Is the Enemy of Good Enough: Waiting for IT Nirvana Kills Projects and Patients. It’s in the electronic update, just in case you’re looking.

Jobs: Clinical Informaticist (CA), Orders Systems Analyst (FL), Regional Managers Consulting Services (MA). 

Google announces its App Engine that lets developers upload, host, and run applications for free, with 500MB of storage and 5 million page views a month and the eventual option to buy more. Great if you code in Python since that’s the only language supported for now. Video showing a Hello World app being built is  here. 

Two Gartner analysts say that Windows is collapsing because of legacy code issues that prevent innovation. Their conclusion: Windows needs to be killed off in favor of a modular solution. I’m hitting the three-year mark on my desktop and considering a quad processor AMD, but then the decision: XP or Vista for about the same price? Vista’s doing fine on the laptop, so I might be tempted by it even though MSFT had to begrudgingly extend XP support because Vista isn’t selling.

A securities analyst says companies with a lot of auction-rate debt could be hurt by increased financing costs. Named: Eclipsys, HLTH Corp., and Cerner. One example is that Eclipsys got $45 million in cash for what I assume was its EPSi acquisition, but had to trade $90 million worth of those securities to get it.

Jim Bradley is named chairman and CEO of claims processor GTESS, moving over from its board. Big-time loaded, I assume. He used to be with Abaton.com and then iMcKesson (that was an unpleasant memory there for a second).

Microsoft launches the former Azyxxi in Europe.

The LA Times outs the now-fired UCLA nursing secretary who snooped into the EMRs of 33 of its celebrity patients. She declined to answer when asked if she sold Farrah Fawcett’s cancer information to the National Enquirer.

Bizarre lawsuit: a woman whose husband died a month after a liver transplant is suing PetSmart, claiming the liver donor was infected with a virus caught from a hamster she bought there.

And another: a Louisiana jury awards a couple $5 million from Chrysler after their Jeep ran over the pregnant woman as they were leaving for the hospital delivery room, killing her baby shortly after birth. The husband told deputies he left the Jeep in reverse while getting his cell phone, but the lawsuit claimed it spontaneously shifted from park to reverse. He changed his mind after reading claims that one model year of Jeeps could do that, even though his wasn’t one of them.

E-mail me.

Inga’s Update

The faculty physician organization at Duke University Medical Center selects Hayes Management Consulting’s MDaudit software. The solution will help Duke’s Private Diagnostic Clinic reduce compliance risk.

When it comes to sensationalizing the news, those Brits have got us beat hands down. Earlier this week, Barts and The London NHS Trust went live on Cerner and The Sun reported the hospitals “descended into chaos” when the systems failed to function properly. Hospital officials denied that the system crashed, though one admits there were some “teething problems.” (Don’t you just love those British-isms?)

Sunquest names Kelly A. Feist VP of marketing. Feist was previously senior VP of marketing for Eclipsys and Siemens before that.

Since my top pick for the NCAA basketball pool lost early (Duke), I sort of lost interest in the whole thing. $10 down the drain (not that I was betting – there was a charity involved!) My only consolation was coming in way ahead of Mr. H, who has shown to be far better at predicting HIT company mergers than college basketball winners. Thanks to the fun vendor folks for including us and sending humorous updates. They’ve sent over a nice chunk of change to Project Bethlehem.

Shar posted a note earlier this week on the HIStalk Forum asking if anyone had heard that EMR vendor Catalis was going out of business. After a bit of investigative reporting (I picked up the phone and called over there plus got an e-mail from an employee,) I got a little information. Apparently since last summer, they have had some major management shake-ups including most of their board and their President. They then hired a well-known management consulting firm and the proposed “solutions” actually led to more problems. They are now trying to dig out from the various issues and say they still have plenty of money.

CCHIT announces receipt of an additional 27 applications for ambulatory 2007 certification and four inpatient applications. CCHIT claims that if all four of the inpatient applications are approved, then more than 50% of the estimated market will be certified. All certifications are expected to be announced by July.

From Dr G: "I heard Mr. Hammergren, CEO of McKesson, on talk radio this morning (Ronn Owens show, KGO AM). One caller said, ‘John, you’ve swallowed the Kool-aid. You’d be perfect for a cabinet post in a McBush administration.’ The radio station offers podcast downloads, but that hour of today’s show (from 10-11 a.m.) wasn’t downloaded yet. The promos for Hammergren’s interview he would be discussing issues facing health care in America today. If you heard the interview, feel free to share." Link.

Former McKesson VP John Danahy joins Medsphere as vice president of sales. Apparently one of Danahy’s primary responsibilities will be to generate new business by leveraging Midland Memorial Hospital’s designation as one of only twelve Stage 6 healthcare facilities in the U.S.

The Center for Connected Health claims that connected health technologies, such as remote monitoring, are empowering patients to take a more active role in managing their health, and are helping clinicians provide more timely interventions and information to improve patients’ overall quality of life.

E-mail Inga.

Give Some Love to Nurses Who Don’t Love Computers: Why Nerd-Designed Clinical Systems Are Underused

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in May 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

In working with nurses for many years. I’m always amazed by two things: (a) they are shockingly caring and helpful to complete strangers who are experiencing pain, fright, and human emotion and I love and respect them for that; and (b) they are terrible computer users.

Before the nurse readers of Inside Healthcare Computing rise en masse to lynch me, allow me to present my flimsy, anecdotal evidence. I’ve known at least 500 nurses over the years, many of them in informatics or IT roles. I’ve yet to see more than a handful who are good computer users and no more than a couple who can program or fix hardware and software problems.
Watching them navigate through complex clinical applications is like watching your kid play tee-ball from the stands – we nerds try to help them with muttered urgings (“Press Alt-Tab … Alt-Tab”) or subtle body English. It doesn’t come natural.

The part of the brain that makes a great nurse has some sort of limbic dominance over the nerd center of the brain. That’s not the case with lab techs, pharmacists, physicians, or most other healthcare professionals. It’s not good or bad, it just is.

In  short, there are few geek nurses, which is great news if you’re a patient who needs comforting or complex clinical care. Do you want a nerdy programmer or network engineer inserting your urinary catheter?

Who are the main users of our clinical systems? Nurses. Who designs their systems? Nerds, with occasional help from nurses (usually formerly practicing nurses with a little more of the nerd center, actually.)

I can’t think of any other industry where the front-line workers (and darned busy ones at that) are expected to interact at a high level with computers at all times. Lawyers, professors, artists, executives, and salespeople don’t. Maybe we’re asking too much for good nurses to be good computer users, too.

That’s where software design comes in. We’re still installing software that assumes that end users know and love the programmer’s way: poorly designed screens, unhelpful edits, and workflow that doesn’t match reality.

A just-released study found that routine overrides policy: 44% don’t always follow the two-identifier rule and a fourth of ICU nurses give critical meds without a double check. I suspect we don’t want to know how often nurses fail to chart meds electronically, clear their work lists, or reconcile orders.

While IT people sit in meetings and see policies in black and white (just like the absolute right and wrong of computer programming,) nurses are out there caring without much of a safety net. They often don’t know or remember the rules; sometimes they break them because it makes sense.

I’m not blaming nurses. If you asked programmers to suddenly start taking care of their co-workers when they’re sick, you get the idea.

Systems being sold today require too much training and computer savvy to ever expect a large body of nurses to master. They are not usability tested or certified against a panel of typical nurses. Not surprisingly, they aren’t particularly well used, either.

Rewriting old applications to make sense to nurses isn’t easy or cheap. It isn’t even necessary, since the bar hasn’t been set all that high. Still, I can’t help but think that the lack of clinical system success will eventually be tracked back to sub-optimally designed applications, which might spur at least one vendor to market a system that thinks like nurses, is easy to use, and doesn’t require compromising workflow. That’s what I’d like to see.

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