HIStalk Interviews Eric Fishman MD, President, EHRConsultant

I ran across Eric Fishman, MD a few months back when I stumbled onto his EHR Scope, a compendium of information about physician system and speech recognition. Ambulatory systems continue to be very hot in the marketplace and it was interesting to find a practicing physician who was putting so much time and expertise into that market.

Since then, Eric has decided to put his full time and attention into his business, which also includes a free service to help physicians choose an EMR/EHR and a package of products and services related to speech recognition for physicians (based around Dragon NaturallySpeaking). Note: I’ll mention as a disclaimer that Eric’s company recently decided to sponsor HIStalk, although our plans for the interview had already been made by then.

Thanks to Eric for bringing me up to speed on the complex world of physician practice systems. Big changes are happening.

Give me some background on yourself, the company, and how you got interested in physician automation.

I’m an orthopedic surgeon. About 14 years ago, one of my secretaries came to my office and said, “I know you like computers. I just took my son to a pediatrician and he was talking to a computer.” He was using a voice recognition product from a company called Kurzweil, which had been started by Ray Kurzweil.

I decided to buy it. Ours was a three-physician office at the time. The $26,000 cost was hard to swallow, so I opened a company to sell voice recognition software 13 years ago. And so the rest is history, although I didn’t want to say that because it sounds overly grandiose. [laughs]

I always refuse to use the term EHR since vendors started using that name in talking about their old EMR products without changing anything. Am I being too much of a stickler?

Yes. I have a treadmill in my garage with a wireless mouse and keyboard and I do a lot of Internet surfing. I don’t call it by the time, but rather by the mile. When I surf, I can do five miles.

John Naisbitt is the author of Future Trends. He made the rational conclusion that what is important to the present and what will be important in the future can be measured by how often items come up in newspapers. I compared “electronic medical record” and “electronic health record” to see how often they showed up in Google. I wrote in an article that the term “electronic medical record” would have become less prevalent when the lines met. Right now, “electronic medical record” is 46 million in change in Google hits and “electronic health record” is 71 million. Three years ago, it was exactly the opposite.

There are subtle distinctions. An EMR is used by a physician in the office to take care of patients. An EHR is more connected and takes care of the community. Connectivity is the distinguisher.

The manufacturer calling it so doesn’t make it so. The terms are very frequently interchanged. I changed the name of my company from EMR Consultant to EHR Consultant in recognition of that change, although you’ll see Word changing EHR to HER. [laughs] In EHR Scope, we talk about how Microsoft Word versions can be corrected to stop doing that.

Notwithstanding all the above, I frequently use the terms interchangeably.

What’s holding back widespread adoption of practice automation?

It’s a few basic issues. Physicians are the ones who pay for it, both with cash and, more importantly, blood, sweat, and tears from the angst of changing how the office functions. Third parties are the ones that benefit, like government and patients. That disequilibrium is disconcerting to many physicians.

I’m a strong proponent of using voice recognition. It substantially minimizes the inconvenience of electronic recordkeeping. It allows physicians to alter the way they interact with patients to a lesser extent.

Despite the significant amount of time and cost, essentially every physician who has been involved with a successful implementation says they would never go back to a paper office, myself included.

I saw recently that a physician insurer is offering a discount for EMR users. Is that common and will that benefit be attractive to fence-sitters?

I believe it’s common. It’s probably not a sufficient amount of money to pay for the software, but it could be meaningful. I was pushing that idea in 1994 with insurance companies to use Kurzweil and structured reporting systems. Physicians who prove they can provide greater quality of care will not only have greater gross revenue due to pay-for-performance, but will also be offered more meaningful malpractice insurance discounts.

Can a one or two physician practice implement a good EMR with reasonable cost and effort?

You used the term EMR either intentionally or not, so I’ll speak to an EMR specifically. Yes. But, you can’t implement a state-of-the-art, easily interconnected EHR with all the bells and whistles and billing capabilities for $5,000. However, if you want to take a substantial step in the right direction and automate reports, absolutely. In fact, a number of those systems are CCHIT-certified, surprisingly.

Speaking of CCHIT, is it accomplishing what it was intended to accomplish?

I’m not positive that I know what it was supposed to do. I feel badly about specialty-specific programs that were not offered the opportunity to be CCHIT-certified. If you wrote a state-of-the-art, phenomenal program for OB-GYN or ophthalmology, you won’t be certified because you don’t have the features they require. Certainly that will change.

I’ve heard scuttlebutt about the $28,000 certification fee and the hundreds of thousands of dollars needed to bring products up to CCHIT specs and whether that has caused a material increase in the cost of software. It probably does weed out some of the mom and pop operations.

I spent a substantial about of time and money developing what I called an EMR that was more of a documentation product. I stopped developing it about three years ago, so I can feel the pain of someone who spent years to develop software that helps people accomplish what they need to in their specialty, but because of CCHIT certification, may be put out of business. Over time, under-funded companies will go out of business.

If its purpose was to give comfort to physicians buying software or to make it easier, I’m not sure it accomplished that. I’m not seeing it. One of the bits of data I maintain from people going to EHR Consultant and telling us what they’re looking for is whether they want a product that is CCHIT-certified. Maybe 20% of our clients say they won’t look at non-CCHIT certified programs. That means that 80% will. Many say it’s of no consequence to them. Smaller offices seem to care less and larger offices care more, but that’s a subtle trend.

You offer a free EMR evaluation service. How does that work and are other companies offering something similar?

I went to HIMSS 3½ years ago and rapidly realized that most mortal human beings would be incapable of learning about the wide variety of programs in order to support them, which is what is consultants do. I decided to do an evaluation. I devised a vendor questionnaire of 600 questions and then asked doctors 200 to 300 questions.

If you look up electronic medical records on Google, a surprisingly large number of responses are from companies that will gladly help you find the proper EMR. My experience is that many of them ask name, address, phone number, number of docs, when purchasing, and not much else. They’ll say, “Here are the top five products.”

Our methodology is that there are dozens of qualified products and not all are appropriate for an individual office. There are a number of cars, Mercedes and BMW, all of which have different styles in the marketplace.

By matching the 200 to 300 questions the physician has answered against the 660 the manufacturer has answered, we can make a qualified match of the appropriate technology. It’s a matter of judgment, but we give large positive grading for EMRs designed specifically for one specialty for somebody of that specialty. In that way, we’re best able to give a good number of very appropriate software program recommendations to each individual physician.

Is speech recognition software underrated in its ability to help physicians save time?

Absolutely. I’ve been doing it and selling it for 13 years. You’re not supposed to take returns of open software, but if someone returned it, I took it back. In 1994 to 1995, I had a 50% return rate. Nobody asks me to take it back any more. You get 99% accuracy. You can speak like a New Yorker. It’s like transcription with no fees.

The sweet spot is a rich EHR. I can click through the physician exam, click through the review of systems and family history, and social history. I dictate the history – how the accident happened, what restaurant they were at when they started choking. The specific factors that make each individual’s history unique are important. Speak those first two paragraphs. Minimize the transcription cost and let the EHR do what it’s supposed to do, which is get good data capture.

I have some confidential information as a distributor. It used to be a meaningful event when a medical group would buy five or 10 Dragon licenses. With increasing frequency, we’re quoting and selling 100- and 500-license opportunities. If somebody bought 10 licenses, then 50, by the time they’re buying 500, they know it works.

What’s the penetration of speech recognition in practices?

Tens of thousands of physicians use Dragon NaturallySpeaking. That’s probably still single-digit percentages, but it’s increasingly rapidly. I have no visibility into the market of companies not selling Dragon NaturallySpeaking. They’re clearly the market leader, but I don’t know the percentages of the others.

We’re a distributor, so we sell to 100 Nuance-certified solutions providers. At the present time, I’m doing an ambitious project, which is finding out from each reseller which EMR packages they’ve installed Dragon with. I’m putting together a series of Google Maps. I can point them to a page on the Web that will have a map point for each qualified, certified Dragon reseller that has experience with their particular EMR program.

I just sent an Excel worksheet to 160 resellers with 362 EMRs listed down the left hand side and a dozen different qualifications across the top: have they used it, have they developed macros, do they help install it, etc. We’ll tabulate that onto Web pages to display that data.

What do you think about AcerMed’s situation?

As I understand it, there was an intellectual property infringement lawsuit that led to substantial legal fees. That was the immediate cause of the demise of AcerMed, not the fact that the program didn’t work. I’ve spoken to people who liked it and people who didn’t.

Functionality didn’t lead to AcerMed’s demise. I don’t believe that CCHIT is in the business of looking at the financial aspects of companies.

Will that event change how doctors look at software?

If you’re a single doctor spending $10,000 or $15,000 on software, I don’t think you need to pull out all the stops. Larger installations spending hundreds of thousands should get financial information and do a Dun and Bradstreet or Hoover’s check.

What changes would you predict in the physician office system market over the next 3-5 years?

There will come a time where a specialist is no longer getting referrals from their general MD because that doctor has an interoperable software program with the specialist across town. When that happens, you’ll see rapid adoption because they’ll need to stay competitive.

You’ll see greater use of non-MDs putting medical information into the history, either the patient or less highly paid people to enter the data, whether a physician assistant or nurse practitioner or medical assistant. I think that’s an inappropriate use of an MD’s time. They should be spending their time diagnosing people. It can be a substantial change of physician time to document an encounter and I think it will be attacked in different waysE

The EMR industry seems to be polarizing, with legacy, expensive vendors on one end and modern, inexpensive products on the other. How will that shake out?

That’s absolutely an accurate depiction. I am somewhat surprised, and I’m not politician, but hospitals are permitted to pay 85% of software costs that are compatible with hospital legacy systems. I was expecting to see a sea of change where legacy systems would run over these new companies. I haven’t seen the new companies being quashed like I expected.

What does that mean?

New companies that are selling 10, 20, 50 million dollars of software a year in to medium and increasingly larger practices have a very bright and rosy future. As I think should be self-evident, I do analysis for physicians for free, but I have some referral agreements with a very few vendors. I’ve been doing this for 3½ years and I used to get an intermittent check from these companies for sales to a one -or two-physician practice. Now I’m seeing small companies selling to 10-, 20-, or 100-physician practices.

Are they taking away business from the legacy vendors or selling to first-time customers?

In 2010, they’ll be taking their business away. I don’t think that the current sales being made in physician offices for a few thousand dollars would have been made for $75,000 if the smaller companies weren’t there. Those sales would not have been made.

If I were a large public company with product installed in hospitals, I’d rapidly provide an inexpensive offering to the local physicians to stay competitive.

So you like the Misys-iMedica deal, where Misys will resell the small vendor’s product instead of developing their own so they can get to market faster?

From Misys’s perspective, it was the proper thing to do. I have the pleasure of having thousands of offices telling me what they like or don’t like. Misys will likely benefit from having a new, up and coming, recently written, capable software program. They’re a billion-dollar company with long marketing reach and having a product that physicians are happy to use will be a welcome opportunity for them.

Will the smaller vendors be bought by the larger ones who worry about the competition?

I don’t think big companies will buy them because they’re a threat. They will buy them because they provide an opportunity.

I live in the same county that Dr. Notes was headquartered in. I was appointed by the bankruptcy court to sell the company’s source code to its .NET version. They had a Windows-based program and were allegedly 90 days away from shipping a .NET program. They went into bankruptcy and I’m helping sell the 400,000 lines of code.

I sent 360 e-mails at 9:00. By 9:01, I started getting responses. People from the up-and-coming companies wanted to buy the code. They wanted a billing module, which Dr. Notes didn’t have, or wanted their customers, or wanted their code.

Then, I noticed that the people calling me were saying things like, “Well, Dr. Fishman, since you seem to be in the business of buying companies, can you find someone to buy mine?” That happened dozens of times. Others said it wasn’t exactly what they wanted, but wanted to hire me to find them an ASP CCHIT product within 30 days.

There will be a lot of churning of these 1, 2, and 5 million dollar companies in the near future. That’s a particular interest of mine. In next EHR Scope, we have half a dozen pages about recent transactions written by an investment banking firm.

Was it a surprise that McKesson bought Practice Partner?

Andy Ury did a great job having a company of McKesson’s stature helping them do the marketing. I don’t have any insights into McKesson. The phenomenon of having billion-dollar companies snapping up EMR companies with eight-figure revenue will continue.

Do doctors like the idea of personal health records?

I don’t think it’s happening in doctors’ offices. Companies are interested.

I’m potentially involved with a PHR company and a clinical practice guidelines company interested in getting more entrenched into the personal health records. I think it’s something that will be very important and I’m surprised it hasn’t taken off more quickly. I stopped practicing 3 1/2 months ago and had zero patients express interest in interacting with me in that way. It’s not happening yet.

What about Google Health’s rumored PHR project?

It amazes me what Google knows. I think if they set their mind to it, they will do it. I understand they had some change in staffing at that level. I’m not qualified to offer an opinion as to whether they will or won’t do it, but I spend money advertising on Google and thinking about their algorithms and how much they know about people.

They certainly have the computing power to enter this space and pharmaceutical companies spend tens of billions of dollars in advertising their products. Google would certainly be willing to accept some of that.

A magazine just released its 100 Most Powerful healthcare people. If someone asked you, “Who are the most powerful and influential people when it comes to physician use of software,” who would you say?

The CEOs of those dozen up-and-coming EMR companies that I refuse to name. [laughs] They are involved in determining what the software that they’re producing will look like. They are profitable companies with millions or tens of millions of dollars of free cash flows without the shackles of having it burdened to something from their past.

They will decide whether to encourage or discourage interaction with patients, like personal health records or smart cards or thumb drives. They have the resources and knowledge and motivation to be in the doctors’ examining rooms around the country showing how healthcare will be delivered. They have the wherewithal to acquire technology, like clinical practice guideline technology, and integrate it in their software.

I know a little about nanotechnology. A friend asked me where to buy a portfolio of nanotechnology stocks, but they’re mostly privately held. If I could invest in a portfolio of smaller EMR companies, I’d do it in a heartbeat. You could reasonably choose a handful that will be successful, though I can’t pick them all, but the small ambulatory EMR industry will do very well financially.

My specialty is the smaller office, but two weeks ago, I got call from hospital CIO with 525 physicians on staff. He mentioned two legacy EMR systems they were interested in. I mentioned a couple of smaller systems and there appears to be some interest. Some of these up-and-coming players may play a role in hospitals

What about retail medicine?

I don’t want to grow old and decrepit in this country because healthcare won’t be as good as it is today. Retail healthcare is here to stay. Healthcare should be touching and care, but it’s clear that retail clinics aren’t going away any time soon. I don’t get my care at one.

Will retailers develop their own software or buy from those sexy companies?

I have made successful introductions between retail pilots and one or more of those dozen hot, sexy companies I won’t name. I don’t mean to be evasive, but I have relationship with those companies.

If an HIStalk reader is interested in ambulatory EMRs, what information do you provide?

EHR Scope is a free publication, over 150 pages, and the next issue is in October. It has a meaningful amount of information on over 200 ambulatory products. It comes out in a PDF and if somebody’s a cardiologist, they can search cardiology and find systems appropriate for them. They can quickly get their Web sites and contact information. I think it’s a very valuable resource. The electronic version is free.

Any final thoughts?

I love what I’m doing.

Monday Morning Update 9/24/07

From Dr. Lisa Cuddy: “Re: Philips entering the European HIS market. A likely target may be Agfa. No revenue growth, no big sales, but solid installed base. There are rumors about divesting the Agfa healthcare group and potential bidders are GE, Philips and 3M.”

From The PACS Designer: “Re: Oracle 11g Advanced Compression. The subject of compression stirs a lot of debate when discussing digital image files and what degree of compression to use without destroying the technical composition of the reviewed file. Oracle isn’t addressing image compression in 11g, but they are addressing compression techniques to speed overall system performance, such as cache memory and I/O query/retrieve from your database archive. Oracle 11g has the capability to do table compression to more efficiently use storage resources and, at the same time, improve overall access time to satisfy the ever-increasing demand for faster results from large databases. Another new feature is to store frequent transaction requests in cache memory so that the next request is processed sooner by requiring less information from the archive.”

From Art Vandelay: “Re: Joel Diamond of dbMotion interview. How is your product different from 3M’s Clinical Data Repository with configurable workstation, health data dictionary, and alert writer?” Joel was gracious to provide a response. “First of all, let me congratulate you for your fantastic HIStalk interview. I wanted to respond to your ever-insightful commentary and question. While we don’t comment on specific competitors in the public domain, I would like to answer your question in a general sense by pointing out that the dbMotion product is unique in that it is one of the only solutions on the market today which addresses the interoperability problem in an end-to-end manner. Other products can provide partial solutions, such as a centralized patient view (portal), messaging, or result delivery. dbMotion, on the other hand, provides a complete platform that doesn’t stop there — it goes a few steps further by enabling its customers to maximally leverage their existing IT infrastructure to address current and future needs. Our SOA architecture and sole focus on interoperability allows us to address all aspects of this complicated arena, including security, vocabularies, and semantic knowledge. We often find that alternative solutions involve assembling together a set of tools which are normally sold and thus often operated independently. Even then, most companies still need to add components from external vendors to provide necessary functionality. We also pride ourselves in the fact that our solution is pragmatic in that it was built to serve imperfect environments– not just those that have ideal interfaces and harmonization of technologies.”

From Dave Unger: “Re: Bronx-Lebanon. I saw ECLP announced the deal. Any idea of deal size?” You heard it here first, of course, from Inside View, although In the Know was wrong just a few weeks earlier when he/she called Cerner as the winner. I haven’t heard the contract size so far, but I bet I will.

From EMR Guy: “Re: CCHIT. I heard the 2007 CCHIT certification process was much more difficult than previous years, and that one of the reasons why so few vendors entered the certification process was because it was so difficult. In other words, that many vendors could ‘get away’ with promoting their 2006 certification, leaving the impression that they were recently certified.” For that or other reason, 2007 certificants are in far fewer supply, with many vendors still displaying 2006 stickers (or none at all). Some would say that’s what CCHIT intended – make it easy to get that first stamp of approval, then rely on competitive pressure to move vendors up the ladder to meet increasingly tough standards. It’s interesting that newer, smaller, cheaper vendors have already nailed the 2007 standards, while older, larger, more expensive ones haven’t. The guard is indeed changing.

From Bud Kruger: “Re: Quovadx. Likely based on the Latin quo vadis, which means ‘where are you going?'” Good name for an interface engine company like Quovadx if so, although their product name Cloverleaf is better.

From Joe Seluchi: “Re: Eclipsys. Are you hearing anything about Sunrise XA performance or how the early adopters of Sunrise Pharmacy are doing?” I’ve spoken to one Sunrise user and one Sunrise Pharmacy user (not the same hospital). The first said they were having performance issues, but didn’t elaborate. The second seemed pretty happy with pharmacy, but also didn’t elaborate. First person reports are welcome.

From Steven McCroskey: “Re: Rep. Murtha. John Murtha of PA, the guy who brings home all the bacon to the Johnstown area, including government money for HIT research through a Conemaugh Health System spin-off, is named one of the most corrupt in Congress by Citizens for Responsibility and Ethics Washington.” Murtha was already identified as having more earmark projects (i.e., wasteful pork barrel projects) for his home district than anyone else in Congress. He moved up from “dishonorable member” to “corrupt” after charging across the House floor to threaten a fellow Congressman for questioning a $23 million Murtha pet project, the National Drug Intelligence Center, to be located in the high tech mecca of Johnstown, PA. I knew about Conemaugh subsidiary InforMedx Group, which was doing some kind of simple research for the DoD using grant money (i.e., your federal tax dollars) that Murtha arranged. One company employee, I notice, is named Murtha. Probably a coincidence.

From D. C. Simonton: “Re: Epic. Epic reported at their annual conference that they’re planning to move to a web-based client from their current Windows/Citrix approach. They claim it will take them 5-7 years to complete the transition!” Appreciated, unverified, confirmation welcome.

From Ted Striker: “Re: QuadraMed. San Bernardino layoffs rumored – several project managers, developers, customer support people, managers, and a director.” Unverified.

Want to help kick some crippling disease ass? Click here and watch the four-minute “Augie’s Quest” video on ALS. For your time, Allscripts CEO Glen Tullman will donate $1 to ALS research, along with another donor who will do the same. Your four minutes thus contributes $2, each and every time you watch the video. Pass it on – it’s Glen’s money going toward a good cause.

I got a fun e-mail from Danny Sands of Cisco after our interview. I’d told him that, based on the experience of others I’ve interviewed, he’d hear from lots of folks quickly, and likely some who had been out of touch for awhile. He e-mailed today: “I was on the road and finally had time to read the interview. Thanks. Based on e-mails I received, I am impressed with how many read HIStalk. Someone I hadn’t seen in years happen to run into my mother and told her about it!” That’s cool. Made my day.

I haven’t recently mentioned my weekly editorials for Inside Healthcare Computing, a long-time HIStalk sponsor and, as I’ve said before, the only HIT (or IT, for that matter) publication that I’ve ever paid to receive. Good news, opinion, and fact-finding. The only place I know of that you can get a detailed description (pricing and terms) of what hospitals paid for Cerner, McKesson, Eclipsys, etc., nimbly pried from reluctant fingers using state and federal open records laws for journalists. Anyway, what I’ve opined recently on their platform:

• Healthcare Software: No, You May NOT Have It Your Way
• The HIT “Trendulum” Starts its Swing Back to Administrative Systems
• Private Investors Will Create Competitive Newcomers
• Google Health: Does Anyone Still Care?

Several folks responded to the “Judy in a wedding dress and mock ceremony with new customers” rumor. Fact: the Wedding March is played over Epic’s PA system when someone signs. That’s it. The point missed by those who e-mailed me to decry this as a ridiculous rumor: Epic’s so quirky that non-employees didn’t bat an eyelash at the idea. That’s the trouble with eccentricity – it isn’t always selective. (Say, maybe I just coined a new GE product name – Eccentricity. Or, what you could call a deinstall: Ex-Centricity). And as one reader offers, “Epic sees customer relationships as marriages. But, as Phillips found out, Epic is usually pretty good at writing pre-nups as well.”

A couple of new Picis deals: Mercy Medical Center of Baltimore chooses perioperative automation and Kennedy Memorial (NJ) goes with ED PulseCheck.

Killer IPO: athenahealth. Shares were priced at $18 (above the expected $14-16 range), but demand pushed the IPO-price to over $35, a quick double and the best first-day gain of 2007. Great news, unless you were an insider and noticed that your big-name underwriters obviously set the open too low and let early buyers take the profits. In their defense, the company is losing money with $80 million in revenue, so maybe the unexpected share demand was irrational. Jonathan Bush has $25 million worth.

Cerner co-founder Cliff Illig on entrepreneurship: “Impatience is a virtue. Have a constant sense of urgency.” The article included a tidbit I didn’t know: the founders renamed the original Paterson, Gorup, Illig and Associates to Cerner, which they took from the Latin cernere, meaning ‘to sift or understand’. Cliff again: “We had a list of things we knew something about, a list of things we didn’t know anything about. One of the things we didn’t know anything about was health care.” And this statement, which some would say still reflects reality: “And to us it always seemed like if you were going to start something you needed to go sell something. So very early on, we went and sold a lab system that didn’t exist.” Good article, good thoughts.

Seton Family Hospitals (TX) outsources infrastructure management to Dell. Seems odd, although cynics might point out that one of Seton’s hospitals is Dell Children’s Medical Center, named for the Michael & Susan Dell Foundation that paid for it. Probably a coincidence.

Here’s the press release announcing the November 5-6 conference I mentioned in a text ad to your right. An executive-level HIStalk reader has already let me know he’ll be attending, so I hope to get a report. The speaker lineup is “sick” (I heard that word used by a college student at a football game this weekend and it apparently has a superbly positive connotation, so I’ll throw it out there as a hip nod to young readers not likely to be attending a C-level conference like this anyway). HIStalk is a media sponsor (we swap ads, in other words). I wouldn’t have done it if the agenda wasn’t strong.

I tried to get an update from Kim Pederson after Allina’s Davies win, but the e-mail address I have isn’t working. A couple of readers asked what she was doing now, but it looks like I won’t be finding out after all.

Welcome to new HIStalk Gold Sponsor Premise of Farmington, CT. The company’s products deal with the urgent hospital issues of patient throughput and business analytics. Products: Bed Management Dashboard, BedXPress Dashboard, Transport Dashboard, Executive Dashboard, and Asset Management Dashhboard. Great case studies and testimonials are on the site. I mentioned a couple of weeks ago that the company doubled its customer base in the last year and had a 100% “would buy again” customer ranking from KLAS. I’m really interested in products like these (having worked on a throughput project in the past), so I hope to interview CEO Eric Rosow about best practices. I don’t know of any hospital that doesn’t have all these problems. Welcome and thanks to Premise for supporting HIStalk and its readers.

Epic’s user group meeting is over. Report, anyone? A Judy quote to users on the $150 million Phase I campus cost: “We try to be extremely careful with your money. (But) sometimes, it’s counter intuitive [because of private office productivity gains] … In five years, the buildings are paid for. The buildings, parking, artwork, everything. In five years, we’re rent-free.” Also mentioned: a PHR project code named Lucy, Epic’s first international customer in Netherlands (home of Philips), and the company’s 2006 revenue of $370 million.

Speaking of Epic, Fletcher Allen Health Care wants to spend $57 million on Epic. Ironic: IDX founder Rich Tarrant is a big wheel there, although he’s downplayed his influence after some of its management went to jail over lying to regulators about construction costs.

Misys says revenue was up, although healthcare’s only mention is to once again label it as underperforming and losing ground with a 2% drop in revenue.

For the ten people who still care, Leapfrog announces its CPOE-centric top hospitals. Even Leapfrog says only 10% have implemented CPOE, which is a testament to its lack of clout. If the CPOE pioneers weren’t coming back with arrows in their backs, Leapfrog wouldn’t have to arm-twist.

MedAvant will provide claims connectivity with Aetna.

Siemens gets a Soarian sale in Germany.

The federal government awards $4 billion in CMS IT contracts to the same vendors it always chooses, although none them are in Johnstown, PA.

E-mail me.

Inga’s Update

Skeptic posted a note that was critical of the many excesses at HIMSS. Skeptic’s opinion was that all those big costs ultimately damage healthcare. “It’s never made sense to me,” Skeptic says.

While I agree that there may be too many wasted dollars being spent at HIMSS (and other shows), I am not convinced it is all money wasted (though it goes without saying that a far better use of a company’s marketing dollar would to be an HIStalk sponsor, but I digress …) Here are some reasons I believe a vendor can justify an “investment” in HIMSS sponsorships, exhibits, and the rest:

• The least expensive booth is $2,700. Last year over 24,000 folks attended HIMSS. There are many, many smaller shows out there that charge a similar amount and have only a few hundred attendees. Less than $9 a body is pretty cheap. (Yes, I do realize there are additional costs above the booth rental.)
• The exhibit fees subsidize the cost of the conference. The attendance fees are already high – how much higher would fees be without the sponsorships? If the fees were significantly higher, would attendance be affected? I think so.
• Last year there were over 900 vendors. Sometimes it takes more than free pens to differentiate yourself from the pack and attract people your way. Is it necessary to host big extravagant parties? Perhaps not necessary, but it can make some sense when you have so many clients and prospects all in one place at one time with nothing better to do than go back to a hotel room and order room service.

I suppose an argument could be made that there should be rules restricting vendors from giving away any items worth more than $5 and not allowing complimentary espresso or cocktails (sounds boring). And, maybe it doesn’t all have to “make sense.” If some people have moral objections to the excesses of some vendors, it is their right not to do business with them. I think generally people are smart enough not to be swayed by big marketing dollars when it comes down to making the most important business decisions. If the vendors want to spend big money, then all the more fun for the masses. (I just want to make sure I get an invite to some of the really good parties).

A reader forwarded me a note about a new website being launched, www.medziva.com. It’s still in its early stages, but it appears it will be a site where consumers can inquire about particular labs and lab tests. In terms of addressing the growing trends of consumer-driven healthcare I think the concept is good. I suppose sites such as WebMD provide information about different types of tests or recommended tests for particular diagnoses, but, this site will also allow discussion of the benefits of the labs themselves. Will this be a trend we see more of?

eClinicalWorks has opened a new office in the Big Apple. In April, eCW signed a $19.8 million deal with the NYC Department of Health and Mental Hygiene to provide EMR/PM to 1,300 physicians. eCW will have about 30 employees initially in the new facilities in order to better manage the NYC project.

ACS announces the promotion of Kevin Kyser to CFO. Kyser had previously served as the VP of Finance. He replaces John Rexford, who will remain an Executive VP over key corporate development initiatives, including mergers and acquisitions.

E-mail Inga.

HIStalk Interviews Daniel Sands MD, Cisco Systems and Harvard Medical School

A couple of readers suggested I talk to Danny Sands. He’s an assistant clinical professor of medicine at Harvard Medical School and senior medical informatics director for Cisco Systems. If anything interesting happens in the industry, he will hear about it while wearing one of those two significant hats. I have to figure out what whole bicoastal, two paychecks thing since he seems to be having a ball.

Dr. Sands earned his medical degree from Ohio State and a master’s from Harvard. He did his medical residency at Boston City Hospital and an informatics fellowship at Beth Israel Deaconess Medical Center. He’s also on AMIA’s board and is a fellow in both the American College of Physicians and the American College of Medical Informatics.

Thanks to Danny for spending time with me.

Describe your job at Cisco.

My position is as the senior medical informatics director. I work in a part of the organization called the Internet Business Solutions Group, or IBSG.

Cisco has always been organized around engineering and sales. There was no verticalization of the organization at all. Five or six years ago, the company started to understand how it could do verticals better and created IBSG. We have maybe six to eight verticals and healthcare is one of the most mature.

IBSG can be thought of as the global, no-fee consulting organization of Cisco. We’re vertical-specific. We do consulting in a limited way with important customers around the world. In healthcare, our job is to help Cisco understand healthcare in a very deep way and to let our customers know we understand healthcare.

Given our size, our consulting engagements aren’t like Accenture’s. They’re just six to eight months. We work with CxOs to understand business and clinical problems and develop solutions, often employing technology. We think deeply about the industry, always thinking about what’s happening in healthcare and healthcare IT and how we can effect change in healthcare through our writings and working with Congress and ministries of health around the world. We’re transforming health to practice in the most clinically safe and high quality and cost-effective manner possible.

Everybody’s talking about Cisco’s recent announcement about its healthcare growth. What’s driving that growth?

Healthcare is an industry in which organizations have under-invested in technology for so many years. Back when computers were just becoming ubiquitous, every industry that viewed itself as information-intensive was investing in infrastructure to put in the fundamental applications. Now, they’re investing 8-10% of revenue and doing very sophisticated things.

Healthcare has not viewed itself as an information-intensive industry, which is quite a shock to those practicing in it. It hasn’t viewed itself that way, except for billing, and hasn’t built up infrastructure and put in fundamental applications and databases to deliver care effectively.

Healthcare is investing 2.5% of revenue and still falling behind. For years, it was even less, under 2%, and there’s a lot of catching up to do. Many organizations are behind the eight ball and it will take awhile to catch up. They’re beginning to understand that this is an information-intensive industry, and for quality metrics, they will need technology.

There’s a huge market in healthcare. What we’re interested in doing isn’t just selling stuff, but helping people do business and clinical work effectively. Cisco started investing several years ago because we saw the technology was underutilized and we could really help the industry.

Does Cisco manage healthcare the same as other vertical markets?

Yes. The IBSG has verticals in retail, public sector, entertainment, financial services … so we have a bunch of these things. In this consulting group, we have 225 peple around the world, so it’s not a huge organization. Intel has more than 200 in just their digital health organization.

My counterparts do similar things to what we do. Some of them do more traditional consulting instead of the thought creation we often do. So, healthcare is pushing into areas that not all the verticals have done yet. We also have a sales force dedicated to healthcare.

I think we go about things differently because we’re offering to be a partner that understands healthcare. In our group, we have expertise across the spectrum: healthcare consulting, nurses, nurse practitioner. People who understand networking, homecare … someone from life sciences, someone in the payer market. We have a breadth of expertise becaue we’re coming at it from so many different sides.

What are the biggest technology challenges in healthcare?

The biggest challenge is the lack of capital to invest. Still today. If we look at organizations, larger healthcare organizations will spend more money and will be more forward-thinking. Intermountain, New York Presbyterian, those centers of excellence. We have these name brand organizations that have clearly spent a lot on IT and have done neat things.

You have others that big who have the margins to invest. You have others that are struggling financially. Hospitals are running near-negative margins. If you’re in a business with no margins, you’re just trying to keep your head above water.

It’s similar in practices. They mirror hospitals in that larger ones have infrastructure and staff and revenue, but in the smaller practices where most care is delivered, no margin, no infrastructure. The biggest problem is appropriate investment in technology.

One barrier is a misalignment of incentives. Who is investing the money and who is benefiting? Clearly, if a hospital invests in technology, they need to see some return on investment. Some may come from reduced cost of handling records. It’s a lot harder for practices to make these justifications. Larger institutions are doing better in being able to step back and look at their issues. We’re focusing on large enterprise users for that reason.

We have a very hands-on business in healthcare. We can’t replace people, but we must keep them in mind all the time. We need to remember that people have a limited capacity to change, so you have to help people apply the technology in their work. Healthcare is hands-on and so is introducing technology into it, so we want it to be done appropriately. There have been too many situations where hospitals have invested money and their projects haven’t been successful, often because they didn’t involve clinical staff from the beginning.

Is “medical grade network” a technology or a marketing approach?

That is a technology. When I talk about setting an appropriate infrastrucrtre, that’s what I’m talking about. It is an architecture for building a network that is resilient and reliable and secure and has survivability, those things we need in a mission-critical environment.

You can’t afford to have a network go down in healthcare. It must be hardened and tough. This is like plumbing or running water and electricity and needs to be that reliable. We say the fourth utility is a converged network. It brings together all the low-voltage circuits into a very reliable, robust network that’s expandable and can be managed. You need to be able to grow a network as you add more functionality and nodes. Sometimes that means adding to it, sometimes shutting parts down without bringing down the whole network.

You were at Beth Israel in 2002 when network failures caused what might be the biggest patient-impacting systems outage in history. Is it ironic that you’re working for Cisco?

It’s a great point. I tell that story often. Fortunately, I had no responsibility for the network management there. [laughs] The situation was that nobody was minding the infrastructure.

A network is a living, breathing entity. One needs to not only create an architecture, but maintain it to ensure it performs well. At Beth Israel, we weren’t investing in maintaining the infrastructure. Not only was it no longer architected correctly, it wasn’t managed over time, so it was vulnerable.

That sort of travesty could not occur with what we’re architecting now. I’m sure that will never happen again at Beth Israel. [laughs]

Wireless networking in hospitals is suddenly prevalent. Have caregivers and clinical software vendors embraced the concept that computer users aren’t chained to desks any more?

That’s one of the big waves that’s coming. We no longer have to think in terms of desktops, but can think of devices. Whether tablet or desktop or biomedical engineering equipment, everything becomes a node on the network. That’s the way that more progressive IT groups are thinking about things. That doesn’t mean there’s no role for the desktop PC, but there are roles for other wireless devices.

We need to think more about untethering hospital personnel from walls so they can interact with their hospital information system while sitting at a patient’s bedside. It could be a wireless phone so patients can communicate with them. Because it’s an IP phone, it’s part of the network and can share any information from the network. We can ID a patient, get a test result.

It shouldn’t matter what kind of device it is, whether it’s a wireless phone or tablet computer or PDA or desktop. All of these can interoperate on the medical grade network. The last mobility trend in hospital was COWs. Those are fine, but there are a lot of places you can’t wheel one in. It’s nice to have something that’s truly portable. The interoperability becomes important.

As we introduce new varieties of devices, whether phone or PDA or tablet, we’ll need to reinvent some of these applications, creating applications that are customized to that form factor. We have already seen some of this, like PatientKeeper and MercuryMD. We will have to see more hospital information systems that run on a tablet computer, for example.

Cisco is building unified communications. It doesn’t matter what device you’re using. You can communicate with all. Open a directory and communicate with anyone in whatever manner they want to be communicated with. Dr. Smith may say they’d like to be text messaged first. Everybody can have their own preferences. That’s a more effective way to start communication with people, by not annoying them by contacting them in a way they don’t like.

They can seamlessly move from a text sesson to a phone system or a collaborative session on the Web where we’re sharing a screen. Unified communications will change healthcare. So much of what we do in healthcare is communicating, yet our technologies are primitive.

Give me the Cisco perspective of the Cisco-sponsored HIMSS Community for Connected Health.

We wanted to form a community of people thinking about the connected health concept. That’s almost the form of a user group, but it’s a community. People can share ideas with each other and with us. I don’t know how this worked with HIMSS, but we’re really just trying to reach out and think about community.

As an aside, Cisco has embraced the idea of Web 2.0 and groupware and collaboration. We’re trying to experiment with that in many different ways, like wikis and a new directory that’s almost like Facebook. We think the future is collaboration. When I watch my teenaged daughters on the computer, they’re collaborating all the time. They don’t use traditional means, even e-mail. They skip that and go right to Facebook and MySpace. We’re trying to do these things in Cisco.

Cisco tries to do the things that it gets other people to do. If we think it’s a coming trend, we try in on ourselves first. Another example is Second Life. We have a community there, where we’re trying to push the envelope. We don’t think we can continue to grow the way we’re growing unless we’re collaborative.

John Chambers says he wants us to reduce our travel 20% over the next year using the technologies we sell. TelePresence is a totally game-changing technology. It is totally unlike videocoferencing. It does what videoconferencing promised to do. You really hear people in high definition, see people and even see them sweating, and feel like you met the people on the other side of the table. It’s almost entirely transparent to the users. We’re not really aware it’s there. The problem with videoconferencing is that you’re always aware it’s there, with jerky motion and synchronization problems.

We’re using TelePresence internally. The first customer was Cisco. We put it in all our major offices all over the world and we’re encouraged to use it so we don’t have to fly anywhere. I’ve been able to avert flights all over the country by using TelePresence.

Are today’s electronic medical records systems too tied to the paradigm that physicians have to enter their own data to give and receive value from those systems?

There are many potential sources of information. Some are machines, some are people, and some are people and machine at other institutions. We have to figure out what is the most efficient way to get information from these places and present ot to the clinicians.

There is a large amount of information that we acquire in the course of interaction with patients. Much of it has to be entered by us, one way or another. There’s a large body that clinicians are responsible for entering that should come directly from the source. It would be preposterous to look at a printout of a lab test and type that into a computer. Likewise, why is it that we interview a patient and enter their information into the clinical information system? There’s a practical barrier if the patient is lying down with a gunshot wound, but in many situations, we can take advantage of the patient. The patient is the most important yet underutilized source of information in healthcare.

We’re often very keyboard-centric. There are lots of ways I can interact with a computer – a stylus on a tablet; dictating and having it trabscribed by computer or human; and typing, which can be templated or free-texted.

There’s another aspect to your question, which is that our information systems tend to be very doctor-focused, or let’s say clinician-focused. Just as we don’t ask our patients to enter information into a computer to help their health, we often don’t share the information in the computer with our patients. Patients need to play a bigger role in healthcare.

We don’t think of them this way, but patients are our customers. That leads to problems where we don’t share information and don’t make it easy for patients to make an appointment or get a referral or get test results. We should do these if we’re truly patient-focused. When patients have access to information, it can be more satisfying to both doctor and health.

The physician brings a complementary skill set. You’re an expert in you. If we have a common database and bring our expertise together, we can make tremendous things happen and improve the way we deliver care. There’s some preliminary evidence that patients engaged in this way have better health outcomes.

What about other information types, such as video and voice?

We need to be storing more rich multimedia information about our patients. The first wave was the PACS movement and that’s terrific. It’s amazing as a doctor to be able to see the image instead of just reading the text report. We need more of that. PACS was developed separately from the HIS.

We need a convergence of text and multimedia and it shouldn’t just be radiology images. Cardiology images, photos of a wound, video of a patient walking, pathology images, voice files -– all should be part of the record.

That necessitates data acquisition that we don’t have right now. We’re lucky in a clinic if there’s a digital camera around. We need to think in terms of multimedia acquisition devices. There are digital ophthalmoscopes and otoscopes. We need to acquire that information, capture it, and store it in the record. That requires a new set of input devices and interfaces to the hospital system so that multimedia objects can be stored and retrieved as part of the record, not as a separate system.

A digital image is not only far more effective at delivering information, you can manipulate it. It also requires efficient storage and an efficient network to convey those large objects. Those last two areas are what Cisco is interested in. We do storage area networks to store information more cost effectively. We’ve also pushed network convergence, where video can travel across the network. We’re partnering with some of the big HIT vendors to develop new functionality.

You were an advocate of electronic patient-physician communication. What’s the status of those projects?

A lot of doctors haven’t yet embraced the technology for the same reasons – time, liability, and reimbursement.

An exciting trend is the number of practices and institutions offering patient portal services that offer patient-provider communication. Kaiser rolled out Epic MyChart to millions of patients. That’s huge. It’s far and away the largest deployment of that kind in the world.

We’re seeing adoption among larger practices and more enlightented healthcare institutions in deploying patient portals that provide secure communications. I choose to look at it as a positive trend, even though figures haven’t taken off like I would have thought. The volume of messages a doctor gets from patients is very modest, even when you’re not charging a fee. At Beth Israel, for every 100 patients registered on the system, they’ll generate less than one e-mail a day to the doctor.

What IP-connected devices will have the most impact on healthcare delivery in the next 5-10 years?

Home care. I think there is no question that we need to be reaching into patients’ homes. That’s where patients are sick with chronic conditions. I think we’lll go beyond that and catch patients earlier in their disease or when they’re pre-symptomatic. It will be commonplace to interface with your set-top box or glucometer.

Home care, along with nursing homes, is quite technologically backward. It’s a real shame because these are our most vulberable and sickest people. These will be new markets where we can make a huge impact.

Location-based services, like tracking of things in a hospital,will be successful. Once you’ve deployed a robust wireless network, you have two ancillary benefits. One is the ability to do tracking, or location-based services. I can put a tag on my wheelchairs and infusion devices and code carts and track them throughout the institution through the wireless access points. It’s exciting that you can find out where the equipment is that you need.

You can also create a second wireless network for guest use. When you’re going to visit someone, you can connect your laptop to a public network that’s separate from the secure internal network. Most hospitals aren’t set up this way. They have one wireless network that’s for staff. Offering this for patients, especially for those in units like cancer units where they’re in for a long time, is a great service.

Any final thoughts?

This is a very exciting time to be in healthcare IT. Because of the robustness of the technologies and the ability to implement them effectively, it’s a tremendous time and I’m excited to be part of the industry and Cisco.

I really salute all the people working in this space. We need to remember that we need all kinds of players to effectively implement these systems. It’s not something an IT department alone can do. Vendors, C-level executivess, providers …  it’s an important collaboration pushing IT out to physicians, nurses, and patients. If we do this intelligently, we can make a huge difference. That’s why I’m in this business.

News 9/19/07

From The PACS Designer: “Re: Oracle 11g partitioning. Oracle has a new feature in Database 11g which they call Enhanced Partitioning. Through this new technique, you can create large object files (LOBs) for things such as resource scheduling and other institution activities. The LOBs can then be encrypted to protect them for HIPAA and other security purposes and also give management a view of the organization’s activity daily, weekly, or for other time periods. For example, you can create large object files for the summer vacation periods of July 1 to Labor Day for each year using Oracle’s new enhanced security option SecureFiles to do trend analysis on the efficiency of various departments during the peak vacation period of the summer.”

From Kesuke Miyagi: “Re: CCHIT. Here’s a chance for your readers to put their money where there mouths are and participate in the CCHIT public comment period. Stakeholders can share their opinions with the groups that are actively developing the 2008 certification criteria. I’m new to CCHIT, but have really been impressed at the openness and integrity of the certification development process.” Link.

From Yancy Derringer: “Re: Kaiser Permanente. Adrienne Edens is out at KP and replaced by Diane Comer, CTO from Firemans Fund. Looks like the second of mass changes by CIO Phil Fasano. He is a major proponent of outsourcing and Comer got all her name recognition from doing a major outsourcing at FF.”

From Rogue: “Re: Siemens MedSeries 4. It still runs on an AS/400, though ones much more powerful than those of yesteryear. You’d be surprised how it’s grown from green screen through Web-GUI to Web-capable. When I worked with it for awhile earlier this year, I was very impressed. One nice option – you own/manage the hardware or Siemens hosts it and all you need is a fat T1 or T3 line. Practical for the small IT departments.” Thanks for that update. I thought Siemens nearly sold it off a few times over the years and I’d heard nothing. I’m not claiming I hear everything, but it doesn’t seem like Siemens is very good at getting the word out.

From Ali Mills: “Re: MS4. Siemens has been investing in MS4 clinicals. Growth on top of 425+ customers, huge R&D, 21 new hospitals last year. MS4’s mantra is ‘three clicks to patient information’. MS4 beat out Meditech, McKesson, Cerner, and Epic at Texas Scottish Rite. IBM has pumped over $1 billion into iSeries (formerly AS/400) in two years. Glad to hear the story getting out.”

From Daniel Larusso: “Re: Epic. I’ve heard that when a new customer signs, there’s a mock marriage ceremony in Madison, complete with Judy in a white dress and with wedding cake. That’s just plain weird if true.” I’ve heard that, but not lately. Seems gauche to wear white in more than one wedding. Confirmation, anyone? Maybe some wedding pictures or the little happy plastic couple from the top of the cake?

From Terry: “Re: Craneware. The company has IPO’d in London.” Link. I’m familiar with their charge master maintenance product and it’s good.

This conference sounds cool: Transforming Healthcare through Health Information Technology, The Most Exclusive Summit for Healthcare Leaders on November 5-6. I got a flattering e-mail asking HIStalk to be a media sponsor, which caught me by surprise because I’ve never been asked. What that means: I let you know about the conference (which I would have done anyway) and they mention HIStalk (looks funny up there with all those real companies). What caught my eye in the first place: the speaker lineup, some of whom I’ve interviewed: Martin Harris of Cleveland Clinic, Danny Sands from Cisco, Don Holmquest from CalRHIO, John Wade from St. Luke’s, Holly Miller from UHHS, Neil Martin from UCLA, Jonathan Bush from athenahealth, Jeff McCaulley from Wolters Kluwer Health, Glenn Tullman from Allscripts, and Andy Eckert from Eclipsys, among many other big names from notable organizations. I’ve been to intimate conferences like these a couple of times and they’re a blast, with upscale amenities, personalized presentations, and casual access to industry bigwigs (it’s like a VIP pass to HIMSS). Sweet location, too: the five-diamond Peninsula Beverly Hills (great spouse trip). Another part of the deal was a discount for HIStalk readers: use code HISTALK2020 online or by phone and you’ll get a $750 registration rate. I put up a text ad to your right to remind you. Maybe you could write it off by turning in a first-person HIStalk report.

Clarification: I said that Visicu was dropped from the Inc. 500. True, but misleading. The original newspaper article said, “Other companies dropped off the list entirely due to going public, not being able to maintain the rapid growth or some other reason. That occurred to Visicu.” A couple of readers pointed out that the poorly worded sentence was trying to say that Visicu was dropped because the company went public, which I breezed right over.

Those who signed up for Brev+IT got it by e-mail Saturday. If you like what you see, sign up for your own free copy each week.

I knew Isabel CEO Jason Maude would respond better than I could to the reader who mentioned the lack of PubMed articles about the company’s diagnosis product. “So far, around 20 articles have appeared in peer-reviewed journals, including a study entitled ‘Validation of a diagnostic reminder system in emergency medicine: a multi-centre study’ which appears 5th on PubMed if you enter ‘Isabel’ as the search term. I would argue that Isabel is, in fact, one of the most validated healthcare IT products around. You can see the full extent of the published work on our website … in 10-12% cases that a physician uses Isabel, he/she is reminded of an important diagnosis that he had not thought of. When done live across three hospitals, it was found that, in 25% of these case,s it turned out the be the actual final diagnosis.”

Now here’s a story I bet you haven’t heard elsewhere. A reader clued me in that the ambulatory EMR products of several legacy vendors are not eligible for the Stark exception because their CCHIT certifications are over a year old (they didn’t earn 2007 certification yet, in other words). The only 2007 certified ambulatory products are Medent 18, eClinicalWorks, e-MDs, Greenway PrimeSuite, McKesson Practice Partner, NextGen, and Purkinje CareSeries. Hospitals can’t provide doctors with any other system under Stark unless they earned 2006 certification less than a year ago. That means you can’t, at this moment, give doctors Allscripts Healthmatics and TouchWorks, Cerner PowerChart, Epic Ambulatory EMR, GE Centricity, McKesson Horizon Ambulatory Care, Misys EMR, and Sage Intergy EHR, among others. Check CCHIT’s page for products with a date more than a year ago and not listed on the 2007 page. According to HHS, “The exception and safe harbor provide that EHR software will be ‘deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the [physician/recipient].'” Bet you won’t read that in the certification-bragging brochures, especially since these are the kinds of legacy vendors that hospital CIOs flock to.

Heard: Phreesia gets $10 million in funding. The company offers free (adware-supported) wireless touch-screen devices to physician offices that replace clipboard check-in forms for patients.

A eHealth Vulnerability Reporting Program study questions the security of EMR systems. Among the issues: systems allow penetration with standard tools, vendors don’t tell customers about security holes, and no industry watchdog creates and monitors standards.

Big employer healthcare coalition Dossia, after falling out with Omnimedix Institute, turns to Children’s Hospital Informatics Program of Boston to pick up development of its personal health record application. That’s Isaac Kohane’s shop. He e-mailed me once as an HIStalk reader, so maybe an interview can be wangled.

Everybody’s piling on the big guy. First Google threatened Microsoft Office by offering an enterprise version of Google Apps for a low price. Now IBM will offer a free download of Lotus Symphony, apparently developed from Star Office/OpenOffice.org. We old-timers remember the DOS version of Lotus Symphony/Jazz from the 80s, although not all that fondly.

Interesting thought: could MP3 recorders replace stethoscopes? Apparently the sound quality is higher, the files can be computer analyzed, and of course you have a digital record for later review (assuming legacy EMR vendors had a way to integrate MP3 files with other clinical data, that is).

Congrats to HIStalk reader (and occasional commenter) and Penn researcher Ross Koppel, PhD, who has published a new article in JAMIA on the unintended consequences of healthcare information technology. Ross and colleagues worked with AHRQ in developing guidelines for identifying those automation-induced safety issues. His 2005 JAMA article had vendors howling, mostly Eclipsys because the problems he catalogued were TDS-related even thought he was making a general point, but you’d be hard pressed to find anyone today who would disagree with the overall idea that HIT can cause new problems even as it’s solving others. My comments on a similar article remain the most-read HIStalk piece ever.

A hospital director in Japan who implemented the first hospital EMR system in that country has been arrested for accepting a contractor’s bribe of a plasma TV.

The CEO of the informatics group of Philips says the company may offer an EMR product, but only in Europe because competition here is too stiff (as Epic taught them). An acquisition is likely, he says.

Internet-based hospital report cards have old, incomplete, and conflicting data, a new study says.

Orion Health says the company is New Zealand’s largest developer of exported software.

E-mail me. I sound knowledgeable on occasion only because smart readers tip me off.

HIStalk Interviews Art Vandelay, A Reader Who Knows His Stuff

by Inga

HIStalk has a surprising number of great posters who provide thoughtful commentary. One such reader is Art Vandelay, whom I decided was a genius after he provided a terrific analysis of how healthcare would be impacted by Wal-Mart. I had to think of a creative excuse to talk to this great mind, so I convinced Mr. H that Art would be a great interview subject.

Inga: Art Vandelay is not your real name. How did you select it?

Art: I really enjoy Seinfeld and saw a few references to it in HIStalk, so I took it to see if anyone knew what I was talking about. Art is not a real person. He is an artificial character, so I can relate it to my alter ego.

How long have you been reading and posting on HIStalk?

I have been reading since mid to late 2006 and never really went too far back on old posts, but definitely read it as soon as it comes out. I find it interesting and timely. An interesting phenomenon is that some of my old colleagues have left healthcare. HIStalk replaces some of the old shop talk I used to have with my colleagues. It’s a good bridge for that.

What can you share about your background? What do you do besides write interesting commentary on HIStalk?

[Laughs] Right now I am working for a large delivery system. Essentially, I am responsible for a lot of their different initiatives. It’s a lot of project-based work. It involves pieces and parts of an enterprise architecture, but they really don’t call it that.

Prior to that, I was working for a large healthcare outsourcer and had done some cutting edge development work on that. It was really interesting work. I got to work with some old legacy systems and integrated them with newer technology using Web services.

Before that, I worked with a Big 6 consulting firm, back when there was a Big 6, primarily helping with system selection, organization strategic reviews, and package system implementation. I burned out on that really fast. You do double the work you do with other organizations. But it was a great experience.

I graduated with a Masters in healthcare management and was really intent in landing on the business side of healthcare, but the money was on the technology side and I’ve really enjoyed it.

What would you say is your primary area of HIT expertise?

Wow, I never really thought of that. I have a very strong understanding of the vendor space and a general understanding of the architecture. I am more of an apps person than an infrastructure person. I operate more at a business interface level and have worked more with business unit sponsors on the projects I have worked on.

Some of your postings are fairly technical.

Yeah, I have gotten to know a lot of that because of a lot of the things I was involved with before. You can’t work with all the vendors without knowing all the blemishes around them. But I consider myself more on the business side.

Do follow other HIT blogs?

Actually, let me check my RSS reader [Inga laughs because it is such a techy thing to do – even if Art is just on the “business side.”] Shahid Shah The Healthcare IT guy, Medical Connectivity, Neil Versel, Candid CIO, Ignacio Valdes, MD – Linux Medical News, NeoTool Healthcare IT, Running a Hospital, and LabSoftNews.

You are well read.

Yes. I like reading little snippet things. The blogosphere is good for that.

Are there any HIT companies that you believe are doing things right?

I think overall that some of the niche vendors are more innovative. Companies like SCI. They have made a good niche for themselves, but need to more aggressively market themselves. They need to promote their value proposition, to get in there and push their story better. I have heard really good things about them.

NeoTool has an interesting niche around interface delivery using BizTalk. Offering a competing product is a bold move because it may cause channel conflict. Medseek has done some interesting work and is addressing some unfulfilled niches. Emergin is very innovative, have a great niche. It will be interesting to see what do they do next, if they will they take their product to the next level. They have a very strong position from which to build.

The biggies aren’t doing a lot right now or at least not showing a lot of value. Cerner, Eclipsys, Siemens, Epic. They are trying to be too many things at one time right now.

Are there any up and coming trends that you think are going to be big?

A lot! [laughs]. I could talk about that for a long time. Retail, I think, diverse delivery locations and anyone doing medical storefront. Consumer-driven health plans. With high deductibles, consumers will have more control over where they go if they have a particular condition and they can choose their specialist. Medical tourism will probably pick up because of consumer-driven healthcare. It might be overseas or in a vacation spot.

So, what I really see being pushed is more continuity of care record, CCR. There will be a bigger push because you are going to receive your care in different places and you need to bring your medical record back with you.

You are definitely going to see a lot of virtual alliances, like people partnering with Wal-Mart locally to meet referral patterns or Cerner working in Dubai and Cleveland Clinic in the Middle East. A lot of health systems are trying to take their brand images overseas, essentially putting their Good Housekeeping seal of approval on the overseas facility. From a practicality standpoint, that means more network linkage. Some growth of teleconsulting will come with that.

Really, when you start to look at consumer-driven healthcare, it might lead to patient liability estimators. If I go to health system X, I can expect to pay $10,000 on a surgery and $12,000 at health system Y. Then I can decide how I spend my money.

There is going to be a big push on outcomes information, high-level stuff. Everyone defines an outcome in a slightly different way. When we capture it, we discretely capture it, but, each entity defines it differently.

With consumer-driven healthcare, you probably will see more push for access statistics. How quickly can you can get into a location? If you can’t get in to see a physician, who cares how good he is?

The pay-for-performance trend will drive the need for more metrics. There needs to be a lot of work to define things and there needs to be standardized data definition. I could keep going …

Great! Keep going.

Direct contracting will make a comeback. Health systems will try to directly work with employers to get the every last bit of margin out. But they will have to watch what they are getting into. I can see payers trying to prevent entry of providers, which will affect costs even more. Managed care contracting, referral management, decision support around cost modeling – all will make a comeback.

Increased consolidation among payers and providers. Who would have thought someone would partner with Wal-Mart?

Another big trend is centralization. You see this within organizations and in a technology-enabled way with remote monitoring. A lot of people are making moves in the home monitoring space. Folks are discharged as inpatients, but need some monitoring at home. Monitoring elderly folks with RFID to make sure they are eating, not wandering, going to the bathroom.

PACS, allowing remote diagnosis. As that becomes more prevalent in other specialties, you will see a push for some health systems trying to brand themselves. Wouldn’t you want a Mayo doctor to look at your EEG?

With that, a lot of the remote consults would come up. Get a second opinion with Cleveland Clinic. Within organizations, I see consolidation between clinical engineering and IT. The medical device manufacturers are introducing mainstream technology with a whole new slew of challenges in terms of maintenance, integrating, and day-to-day maintenance. Integration is a new skill set that IT companies can bring to them.

Labsoft News talks about convergence between lab and radiology departments. That will definitely come about. Nicholas Carr, a Harvard professor, talked about “IT doesn’t matter”. In my mind, it gets down to our IT departments. Will they deliver commodity services, or, will they become partners with the business side? Organizations are expecting their investments to show return. IT departments either will step up or will be relegated to utility.

Because of the economy, I think there will be a big focus on value. How do I squeeze the most amount of capability in all the technology I have invested in? Which goes back to IT partnering on the business side. IT has to really get involved in the business.

I would expect a growing number of organizations to have CIOs take over the business function. You are seeing it a little in other industries and I think it will come out in healthcare. CIOs are ready to take another step. For CIOs that have made promises, they are going to be asked to step forward and show ROI.

I think we are going to see a return of some best-of-breed. As purse strings get a little tighter, I think best-of-breed will come to show the best ROI, rather than a full Cerner or Epic system.

There is focus on squeezing the value out of investments and a lot of vendors are acquiring because of that. They will go for some of the niche vendors that can add value to their systems. Around revenue cycle systems, who really has done anything new? No one has any investment in R&D that is showing anything. The big vendors will buy small niche players to tap on to the maintenance stream and fill the product gaps.

Who do you admire in the industry ?

Mr. HIStalk, because he makes some very good observations and has great commentary. It’s true. I think I have made some comments about Emergin’s CEO. It’s going to be interesting to see what they do next.

I admire the Epic leadership team. They have created a brand around themselves. I don’t know if it was meant to be that way, but I think it gets them a lot of attention. Among a lot of the biggies, they have delivered the best and kept promises.

Anything else you would like to add?

One question that you forgot to ask, my dream job. A consultant who really didn’t have to travel that much. What drugs am I on – no travel? Think tank analyst. I’d love to be able to what-if all day, debate with someone, and get paid for it.

Realistically, it is anything where I could feel I am making a difference that would provide a solid standard of living so I could consistently be with my wife and kid.

Monday Morning Update 9/17/07

From Dusty Wong: “Re: Quovadx. How in the world it THAT pronounced? Is this the company where Superman’s impish pest, Mr. Mxyzptlk, works?” Kwo-VAD-ix. Guess they didn’t have to worry about taking a name somebody else already owned.

From An HHC Employee: “Re: CPR. As a Misys CPR user (NYC HHC), I am stunned to see Quadramed’s optimism about the product, especially being tied up in Cache’. Misys has been promising the Cache’ transition for many years, but never came through with it. Is Quadramed lacking in due diligence, or just talking up the same game Misys was? The CPR product is good for integration, but is years behind in other features – not Web-enabled, no way to easily integrate decision support, the list goes on.”

From Lester Golub: “Re: Isabel. I’ve never seen a product with such a huge popular press vs. biomedical literature imbalance. I’ve never seen a peer-reviewed article on Isabel and the stuff on their website, though positive regarding the product, doesn’t appear to have made it to anything indexed in PubMed.”

From John Winger: “Re: Misys/West Michigan Physicians Network. From the hospital side, it’s largely a Cerner/McKesson town. I seem to remember hearing recently that there’s a collective effort underway to subsidize physician technology adoption, but I thought that was a Cerner-based effort. Curious how Misys will do. I do know they had already lost one big account in that area.”

Investors are supposedly excited about next week’s athenahealth IPO, mostly because of the company’s recurring revenue model that’s based on a percentage of physician collections. We’ll know for sure soon.

Those same investors are also supposedly bullish on WebMD, speculating (no pun intended) that Adam Bosworth’s departure from Google means the company will shift its strategy to buying market share (i.e, WebMD) instead of building its own healthcare products.

HIMSS announces the 2007 Davies Award winners: Allina Hospitals & Clinics, Minneapolis, MN (organizational), Valdez Family Clinic, San Antonio, TX and Village Health Partners, Plano, TX (ambulatory), Illinois-National Electronic Disease Surveillance System, Springfield, IL and Institute for Family Health, New York, NY (public health). Kim Pederson of Allina talked about their Epic implementation in this HIStalk interview.

West Penn Allegheny Health System (PA) chooses Allscripts for its 165 physicians.

Revenue cycle vendor MedSynergies names John Payne CIO, coming over from Perot.

Jobs:

CIO, Bethesda Healthcare (FL)
VP, UPMC (PA)
Sales Executive, PM/EMR
Senior Implementation Project Manager (PA)
McKesson Horizon Clinicals Consultants (AL)
Patient Care Informatics Officer, Methodist Healthcare (TN)

Philips consolidates into three organizations, one of them being healthcare, and sells its stake in Nuance Communications.

This physician’s practice was at a loss when its PM/EMR system went offline because of a server problem, “.. going back to the dark ages. Paper receipts. Paper-only records. Vestiges of a bygone era.” That would be a great, feel-good EMR testimonial showing that not all docs are paper-bound. Except that he’s a veterinarian.

GE Healthcare gloms off the questionable US News & World Report‘s Best Hospitals issue, or actually the Honor Roll subset of it. It says GE is “humbled”, although that’s a bit of a stretch since that claim was made in an entirely self-serving press release. Does anyone believe that Centricity had anything to do their success? What’s the percentage of the also-rans using Centricity?

A CNN article on hospital infections and TheraDoc’s infection and antibiotic software contains a buried fact I hadn’t heard: TheraDoc customer UPMC has bought 22% of the company.

IT workers with server virtualization experience are in high demand.

Visicu falls off Inc.’s list of the 500 fastest growing businesses.

I didn’t know it was even still being sold: Texas Scottish Rite Hospital for Children buys Siemens MedSeries 4. I assume it’s still running on an AS/400.

Loma Linda University Health Care will use open source OLAP business intelligence software from Pentaho, replacing Access and Excel for that purpose. I’d never heard of the Orlando company, but I liked them instantly because of the founder’s two-sentence intro that includes: “you can usually find him near an empty Captain Morgan bottle or wandering around in the woods with his GPS receiver.” Ditto the title of one founder: “chief geek”. Or, this FAQ snip: “What do the Dodo, Hispaniolan Edible Rat, and the Syrian Wild Ass have in common? They are extinct. Like the Dodo, Hispaniolan Edible Rat, and Syrian Wild Rat; competition, innovation and choice will become extinct if Microsoft Corporation hit their goal of attaining 100% of the Business Intelligence market.”

E-mail me.

Inga’s Update

Thank you, Big Nurse, for forwarding me this note: “Not sure if this is of interest to you, but here’s some information on a recent report from the University of Rochester that appears to provide evidence of ROI associated with an Allscripts (Touchworks) EMR implementation. I hadn’t seen this information mentioned elsewhere (maybe I missed it), but it seems to offer valid evidence, though I am only able to read the abstract. It was cited in an article in Crain’s Health Pulse as a rationale for North General Hospital in NYC to go forward with its plans to implement an EMR, even though they are nearly bankrupt.” I found the original study, apparently first published in the Journal of the American College of Surgeons. The study involved 28 physicians across five offices and looked at the capital investment, plus various administrative tasks (chart pulls, support staff salary, and transcription costs) and efficiency aspects (days in A/R, etc.). The bottom line: the system paid for itself in 16 months and provided an ongoing annual savings of $9,983 per provider with a neutral impact on efficiency and billing.

First Consulting Group, Inc. completes the sale of its FirstGateways product business to MedPlus. FCG is selling off this segment that has been losing money and expects to realize approximately $8 million of after-tax cash proceeds from the transaction.

Nigerian officials are ordering their banks to stop using attractive women to persuade customers to open accounts. Apparently the unacceptable practices include employing beautiful ladies and giving them targets to meet. I wonder what would happen if HIMSS banned vendors from hiring beautiful women to increase booth traffic? Would there be a revolt from all those techy types?

Make Inga happy.

News 9/14/07

From The PACS Designer: “Re: Oracle Database 11g. It takes quite a bit of innovation to get TPD excited when it comes to healthcare IT. Oracle has just done that by releasing a new database solution called Oracle Database 11g. It appears to be just what the doctor ordered (no pun intended) when it comes to bringing healthcare some new exciting solutions for its diverse population of databases. One key feature is the ability to store DICOM image files along with other data parameters, such as XML, 3-D spatial data, and any other multimedia data to give users a central location for all of their data. TPD will be highlighting other new features in upcoming posts.”

From Health CIO: “Re: North Shore. I hear that North Shore Long Island Jewish Health System is looking for a new CIO. Anybody know who’s interested?”

Google’s main healthcare guy, VP Adam Bosworth, has left the company. It didn’t sound amicable, but you never know.

And speaking of Google, the company is working with Stanford and NASA to map the human body by scanning cadavers, with the possibility of an eventual Google Body that would be similar to Google Earth.

Sentillion announces its expreSSO single sign-on product for healthcare. Key points: “plug and go”, lower cost, graphical intelligent agent creation, support for graceful single sign-off, fast user switching on shared workstations, support for proximity authentication, password reset, and appliance-based deployment with five-nines uptime. I hope to get more info soon. Sounds pretty cool, especially if the price is good.

Rumor heard: Healthvision will announce the sale of the company in the next few days. I contacted CEO Scott Decker, who confirmed that Healthvision is in the final stages of negotiating a sale to a new investor. He couldn’t name that company, but I’ve heard it’s Quovadx, which went private in its own April sale to private equity firm Battery Ventures. Supposedly Verisign’s investment in Healthvision never panned out and employees have left in significant numbers after a June layoff. My February interview with Scott is here. I hope it works out for all involved.

When doing some vanity Googling, I ran across my own comments in Healthcare Informatics. I’d forgotten that I gave them permission to run some stuff I wrote awhile back called “Guide to RHIOs for CIOs in ten easy steps”. I appreciate the quote and the link.

Parkland’s use of ER kiosks from Galvanon makes MSNBC.

A Canadian company brings medical services to cell phones: dietitians who analyze meal snapshots sent in by users, on-demand conferencing with freelance nurses and doctors, and a baby application. Pulse and temperature can be transmitted and conversations are archived.

Scott L’Heureux, formerly of SIS, is named CEO of Jackson Therapy Partners, an Orlando-based therapy staffing firm. I didn’t realize until I looked at their site that they’re a sister company of throughput software vendor StatCom.

Rush-Copley Medical Group chooses athenahealth along with Eclipsys Sunrise Ambulatory Care.

Good Samaritan Hospital (CA) will use Medseek’s portal services.

Optio announces Q2 numbers: revenue down 2%, EPS -$0.05 vs. -$0.02.

Even newspapers can’t spell Misys. There’s just no excuse for spelling it “Mysis,” any more than there is for typing “gentamycin”.

Capgemini wants to profit from offering support services to enterprise users of Google Apps Premier Edition. That’s odd enough, but now Microsoft jumps into the fray, bashing the product and thereby instantly lending it credibility, like all competitors it tries to squash with trash talk. MSFT criticizes Google’s “perpetual beta,” which I would counter-argue is at least labeled as such, unlike Microsoft’s far-from-free trial balloons labeled as production-ready software instead of a series of desperately scheduled service packs. Actually, the version that Cap is pitching isn’t free; it’s $50 a year. Overall, I’d buy (or keep) Office instead unless I had rock-solid and limitless bandwidth (who wants to be called with the Internet is slow?) and didn’t have any Excel or Access power users. You could probably buy Office for what that $50 a year adds up to, although you’d still have to support its local installation. That doesn’t count Cap’s charges, either.

Midwest Medical Insurance Company will offer a premium credit to physician policyholders who use electronic medical records. Requirements for the 2-5% credit: the EMR must be CCHIT-certified, software updates must be current, 75% of docs in the practice must use it, it has to have been running for at least a year, and at least two of six listed EMR functions must be used.

A UK hospital is embarrassed when a hard drive containing patient information is sold on eBay. And speaking of breaches, here’s a first-person description of how a bored hospital visitor did some innocent hacking.

Miss Nebraska is a senior in bioinformatics at University of Nebraska-Omaha, which I thought was noteworthy enough to warrant a pic from her site. Some enterprising vendor could sponsor an appearance in their HIMSS booth, you know.

Inga’s Update

I feel I have arrived because I received my first email from Matthew Holt. Unfortunately, he was making fun of the fact that I am just now discovering Sermo, a company that he claims he practically made famous through his multiple mentions in THCB (he is making it hard to feel like a diva).

On the other hand, Mike H. was very appreciative of my “insights” on Sermo (Mike seems to understand that divas need appreciation). He also said: “Just read your post about Sermo.  I’ve been reading about them a bit lately and also think their business model is intriguing.  I ran across what appears to be a similar site that makes a similar claim about size (we’re the biggest …) You might be interested in looking at their site as well. It’s www.within3.com.” I did check out www.within3.com (I like the name) and it reminds me a bit of LinkedIn, but for physicians (and those in related fields.) It will be interesting to see in time to see if either of these models (or other similar ones) is sustaining.

eClinicalWorks is selected by the Sisters of Charity of Leavenworth Health System (SCLHS) to provide their EMR/PM solution, as well as their Patient Portal as part of the Ambulatory EHR initiative. The ECW system will be made available on a voluntary basis to its 200 employed physicians and the 5,000 physicians on staff. The ECW solution will interface with SCLHS’s existing GE Centricity hospital system. The ECW press release doesn’t really say if there is any dollar commitment involved or if the health system is providing the software to any of the physicians for free and/or a reduced cost.

In another vague press release, Misys announces that West Michigan Physicians Network (WMPN) in Grand Rapids has endorsed Misys EMR, Tiger, and Connect for their 450 member physicians. WMPN will be eligible for “pre-negotiated contract terms and favorable product pricing” for the solutions. No mention if the endorsement is exclusive.

And, in less vague EMR selection news, HealthPort announces that Biloxi, MS based Coastal Family Health Center and the Mississippi HealthSafeNet High Impact EHR project have selected HealthPort EMR for its regional EMR system. HealthPort is the company that was formed after Companion Technologies and SDS merged. The Mississippi project is made up of seven organizations and recently was granted $1.4 million by the Health Resources and Services Administration to fund the EHR and related projects.

Zotec Partners and EmPhysis Medical Management announce a merger. Both are in the practice management and billing fields, primarily focused on hospital-based physicians. As others have mentioned recently, the billing side of healthcare IT is not dead!

E-mail Miss HIStalk.

HIStalk Interviews Joel Diamond, MD, Chief Medical Officer of dbMotion

A reader suggested that we might want to talk to Joel Diamond MD, chief medical officer for dbMotion, practicing family physician, and a former CMIO with UPMC. “You should try to interview Joel – he is smart and funny and really knows his stuff.”

Joel is working on an $84 million initiative to jointly create a healthcare interoperability model that will use dbMotion’s technology to connect clinicians across UPMC’s 19 hospitals and 400 outpatient sites and doctor offices. Thanks to Joel Diamond for sharing his thoughts with the readers of HIStalk.

Inga: OK, you ready to go?

Joel: Yes, though I am really nervous. Is this really Inga? [laughs]

[Laughs] Yes, but don’t be nervous. So, you do read HIStalk?

All the time. I am a huge fan.

So, you came from UPMC where you were CMIO. What led to your decision to move to dbMotion?

I have been following the interoperability plans for UPMC for a very, very long time ever since I was involved in establishing UPMC’s CPOE at one of UPMC’s remote hospitals. After the success of CPOE and other projects, it was clear that interoperability was the solution of the future. I dug in and learned about dbMotion. When I found they were looking for a medical director in the US, I jumped on the opportunity. dbMotion is great and it is a fun job.

Tell me about your position as CMO with dbMotion. What type of activities are you involved with?

The bulk of my work is this massive UPMC project, which has two separate parts to it. First, the core interoperability project itself. There is a lot of work to be done here in terms of customizing the physician views and integrating the multiple disparate platforms. The UPMC project itself is massive because we are trying to interface many, many disparate systems.

Also there is a joint development project between db and UPMC that is just getting off the ground. We are trying to develop a product to enhance patient safety issues. Trying to have the product reflect the needs of individual clinicians is one of our major goals.

In October, dbMotion and UPMC announced an agreement to create a joint development partnership. What is the scope of the project?

It is centered around a product called SmartWatch. SmartWatch is focused on looking at populations of patients and then being able to get lots of disparate data and then turn it into something actionable. For instance, we could define what child abuse might be and what to look for, and then put in certain parameters in order to monitor it. Patients with certain characteristics can be found and then you are able to report it to a particular organization or entity. Or it might involve bio-surveillance on a large scale.

We have a couple of use cases we are developing with UPMC. One of them involves transfer of care. When going from one venue to another, determining what needs to be done to ensure that the handoff is done properly and the patient information is collated properly. One of the other use cases is readiness assessment. If a patient has to schedule a procedure, then determining everything that needs to be done on an administrative level and making sure it is done. Third is chronic disease management and it will likely center around diabetes.

Are you involved with any of the international projects that dbMotion is working on?

No, because we have a CMO of dbmotion in Israel, Dr. Ran Goshen, who oversees all those projects.

What about any non-UPMC activities?

Dr. Diamond: Some with the Bronx RHIO project that is underway and has an expected go live in May of ‘08. I am also involved in the evaluation of new business opportunities in the US market.

Are you also visiting potential clients?

Yes, as well as trying to explore new areas where dbMotion might be needed other than what we have been focused on.

There have been a number of announcements over the last few months of RHIO efforts that have failed, either due to financial issues or lack of support from the community. Does that concern you?

It really doesn’t. It really isn’t a surprise. If you look at the Gartner’s Hype Cycle, we are at the Trough of Disillusionment. There had been some unrealistic expectations. We are now much more realistic about what RHIOs can do.

I am not pessimistic about RHIOs all. I think our focus will change a little bit. A lot of people set out to do RHIOs, but didn’t have the technology to do it. I think that is where dbMotion makes a difference.

Who does dbMotion see as competitors?

A lot of people are in the so-called interoperability space, but we don’t necessarily see them as competitors because they have a very different focus than us. A lot of people are in the portal space and that is more of a forum to view information. There are several companies trying to collect data to see in a single space. dbMotion is different because we have the Unified Medical Schema and we are focused on aggregation and integration of data.

So, explain to me how dbMotion is different than a company like Healthvision?

dbMotion has very, very unique architecture that allows it to handle a lot of the complicated interoperability issues in a very, very short time. It has a broad and deep reach. We are not a product that just has the ability to point you to the information you need or just display data you need.

In a true schematic operability, you can exchange information because they have a common understanding. You may link up a disparate system that has different terminology for the same diagnosis. We have the ability to take the data and present it as a single common knowledge piece and do whatever needs to be done. It can be used by an individual in a format that is meaningful.

The other thing that is different is that if you are just presenting data, it becomes a very huge list for people to scroll through. A large data dump may discourage users from using it. Looking at a list of allergies, you may overlook important data if you don’t present the information in a format that is relevant to the physician. Our technology allows the information to be displayed in a more meaningful format. It also helps with patient safety.

Why are UPMC’s interoperability projects surviving?

There has been a tremendous vision from the start. In addition to that, the people involved in the project, from IT to doctors and nurses, have really kept the focus on the entire project more on a quality. So, focus plus talented people, and then they keep building on their successes. They have also had a very steady and well-constructed ambulatory project for EMRs that has allowed for integration of all the data, along with a goal of improving patient safety.

So the goals are good and people are good.

Yes, and they haven’t been afraid to change their course when appropriate. They realized at some point that having a one-size-fits-all model was not going to be sustainable. At that point, they realized they needed multiple solutions and needed some central ability to control the processes. And that is when the decision was made to partner with dbMotion.

I understand that in addition to your work with dbMotion you are still seeing patients. How do you balance your dbMotion work and your clinical activities?

Yes, I am still seeing patients. I am balancing it very carefully. [laughs] I need to maintain seeing patients on a personal level because I enjoy it so much. And, two, without seeing patients, I am not sure I can maintain credibility and an understanding of physician needs.

Having an EMR for so many years provides me access to my patients’ information in so many ways. I have a patient portal and use e-prescribing. Many of my patients I have known for years have access to me by cell phone 24×7, so my situation doesn’t mean they have any less access to me. I work one full and very long day in the office seeing patients.

You spent some time working with Misys in an advisory role for their EMR and CPR products. Any thoughts on the recent changes, including selling off the hospital pieces and re-selling the iMedica product?

I have mixed emotions on the CPR sale. I think it will help their focus. There were so many great people associated with that product. I think it was one of the best products I had ever seen.

I can’t comment on the business reasons and whether it was a good decision. But the product isn’t going away, so that is good. And, I wouldn’t know enough about the iMedica situation to comment about it at this point. I will say that Misys’ focus on the community is a very, very smart play.

Who do you admire in the industry?

Hmmm… Mr. HIStalk and Inga? It is a very, very long list after Inga and Mr. HIStalk.

News 9/12/07

From The PACS Designer: “Re: ILM. One of the tools that can be used to better manage archives for data parameters is to employ ‘information lifecycle management’ techniques. Through ILM, you can prioritize data and image files by time periods so that you more effectively manage the speed of accessing those wanted recent files. As older files become less relevant, they can be compressed and stored in less expensive storage spaces, either onsite or at a remote storage facility provider. TPD will be highlighting the features of a new software database from Oracle, so watch for more postings on database management solutions.”

From Gwen Fabin-Blunt: “Re: that physician EMR company you keep mentioning. I hear that, in an attempt to reduce financial liabilities, management is trying to negotiate paying certain sales reps a reduced percentage of commissions owed if payments are made today, versus when clients pay. Additionally, management wants to reduce the number of vacation hours that can be rolled each year, again to reduce liabilities.” Doesn’t seem too harsh since employees still have the option. What I really dislike are those vendors that demand long hours or personal sacrifice like it was somehow your obligation to bail them out and keep management in bonuses. If they don’t have profit sharing, why is their lack of planning or resources your problem? If they need more than 40 hours a week of your time without paying for it, then they need to hire more people. Think WWCD (What Would Contractors Do).

From Byron Davies: “Re: codeine overdose. Turns out it was an unusual genetic profile (1% of Caucasions) that caused the mom to metabolize codeine into morphine. She was at home, not in the hospital.” Link. Few hospitals have systems that will catch drug-pregnancy and drug-lactation problems, not that it would have helped here. Maybe this will spur interest.

From Dominique Adikadika: “Re: Acermed. Dead and shut down for good. Got the letter today. The cause was lawsuits against them and the illness of one of their executives.” There’s always that risk when dealing with a non-publicly traded company or conglomerates. Of course, those larger companies could screw you as equally and quickly by sunsetting your product or by choking you slowly through ineptitude or lack of product focus. No matter who certifies, recommends, or guarantees a product, in the end it’s just you and your vendor because only they know what goes on behind their closed doors. Caveat emptor, especially in this consolidating physician systems market.

From Real World User: “Re: AJAX. The simple AJAX Solitaire game posted here seemed impressive for a web page, but was sluggish compared to the real thing. As a regular user of Yahoo Mail and Gmail, my sense is that at its best, AJAX makes web pages great, but it is always slower and more sluggish than a real program. This kind of sluggishness is fine if I am just checking e-mail, but it would drive me crazy if I had to see it all day in an EMR.” The Solitaire game is unusually graphics intensive since it shows large, full motion graphics. I don’t find it any worse than the usual Citrix front-end to healthcare apps and certainly better than the usual “click and wait a couple of beats” browser applications.

From Philip Rivers: “Re: QuadraMed. Here in San Diego. Just beat the Bears, so I stopped in on the QuadraMed User Group at the Harbor Sheraton. Looks like a good turnout and lots of buzz surrounding this new thing they call CPR. Clients are really saying nice things about what they see. As a player, I am impressed with the CPR clients and their presentations. I think we may have something here!!” I, too, am cautiously optimistic. QuadraMed has had its own troubles not unlike those of former CPR parent Misys, but at least not under current leadership. Whether they’re too late to save the aged patient remains to be seen.

From Glenn Welsch: “Re: Allscripts. When Allscripts makes a sale that isn’t an interface to an existing IDX installation, then you can consider them a player. That will show that the overall product is what the market is looking for. How many times do they sell a unified solution to a new client? Not many.”

From Tucker Livingston: “Re: McKesson. News about McKesson and First DataBank inflating drug $ seems to be few and far between. If the accusations are true, wouldn’t it be Medicaid fraud? Where are the feds?” Good question. If the government pays based on AWP, then they’re a customer like those others who could join the class action suit. Are criminal charges possible? I’m not sure, but I bet somebody out there does.

From Dr. Allan Pearl: “Re: physician systems. How well does hospital-small office system integration work? Have there been problems with compatibility when affiliated practices use different EMRs? Are EMRs in office practice really the next best thing since ballpoint pens, or just a way for number-crunching administrivia units to get physicians into the corral of quantified performance measurement? Sometimes the numbers seem to obscure more than they reveal, especially when demographics of patient population are not taken into consideration. Having the same health insurance plan, age and sex does not make for comparability of patient groups, nor does process measurement necessarily correlate with clinical outcome. These may be obvious public health research principles to some, but not to the majority of health administrators, in my experience.” My knowledge pales in comparison to that of some HIStalk readers, so I’ll invite their comments. What motivates hospitals to integrate affiliated docs into their systems and how well does it work?

From PMGuy: “Re: (company). Word on the street is that (company) is close to going away. As a client, this concerns me. I heard the entire consumer group quit after the contract with (company #2) was canceled due to non-payment. Heard it Friday from the support desk when I called to ask for help resetting a password.” I’m uncomfortable naming names, but it’s a struggling vendor who bet big and early on interoperability. I hope this is a false alarm, but I wouldn’t be surprised either way.

From John Wheelwright: “Re: Epic. Ian MacDougall will be the keynote speaker at Epic’s UGM.” Link. Starts September 17, 6,000 attendees expected, 5,500 of them from Kaiser (kidding).

Brev+IT top five stories this week:

#5 – Ingenix Acquires Healthia Consulting
#4 – Former Hospital Employee Sues After Data Loss Firing
#3 – SEC Interested in Germany’s Siemens Investigation Records
#2 – Report Says RHIO Market is Small Unless Philanthropy Kicks In
#1 – Mr. HIStalk Says Subscribe Here Free So You’ll Know Next Time

AmerisourceBergen will pay $21 million to former Bridge Medical shareholders who claimed it paid less than promised when it bought the company,sold in turn to Cerner in 2005.

VeriChip shares take a pounding after reports that federal regulators overlooked data suggesting that the company’s implantable RFID chips caused cancer in animal testing.

Speaking of VeriChip, here’s a picture of a guy with one stuck in his arm, John Halamka, CIO of Beth Israel Deaconness. It’s in the blog of his boss, Paul Levy, BIDMC CEO, and shows him standing on a big rock, supposedly keeping in touch with the office via BlackBerry.

Reminder: the search box to our right will plow happily through 4+ years of diarrhetic HIStalk output. I’ve mentioned just about every company and product here at least once, so give it a click. You can sign up for the e-mail update while you’re over there, too, so you get instant notification when I write something new.

Inga mentions the upcoming HIT investments of David Brailer’s private equity fund. Show how smart you are: e-mail me your choice of growing HIT-related companies in which you’d recommend he invest: software companies, service providers, whatever. Lots of private equity firms are looking for investment, so what companies are worth a look? Tell me why you like them. Maybe we’ll do some profiles of the lesser known.

Microsoft’s healthcare interest is outlined. Says they have 600 people working in healthcare. Maybe it’s been mentioned before, but I hadn’t heard it: Microsoft is working on a standard for personal health records, with announcements coming in the next few weeks. Acquisitions are coming, the article says.

PACSGEAR says it got its 600th customer. The product allows sending documents to PACS. I’m not a fan of all-capitalized company names, especially when the logo on their site has it in lower case, so I’ll attribute that annoying inconsistency to some confused marketing types.

Baylor docs can order images from their BlackBerry.

A Mayo doc says an “intelligent EHR” can populate an EMR using static text records, something he calls “minimally invasive informatics”.

Another RHIO is spawned, this time in Minnesota. They’re making the same mistakes their failing counterparts have made: trying to start out big, relying financially on the big hospitals and insurance companies that started it, and discouraging use by charging subscribers. The universal, ancient PR example is offered to the press: “You’re in the ED unconscious …”

Inga’s Update

Re: the new SCI ads. I noticed the superhero ad before Mr. H pointed it out and I really like it. When I first saw it, I wasn’t sure whose ad it was, so I had to watch it for a few moments until the SCI logo came up. Anyway, I think Bob LaBla is a scrooge for his comments … it is eye-catching and fun.

I just read something about a company called Sermo and became intrigued by their offering. The news bit I read concerned the $25 million in Series C funding they just raised, with Sermo labeled as “aggregators of healthcare information.” Checking out their website, they claim to be the largest online community of physicians and serve as a site where physicians can communicate to one another online to discuss “medical insights” and “improve patient outcomes.” There is a “top postings” section where physicians had made notes of complicated cases and asked for other physicians to provide feedback. Of course, I wondered where the money came from, especially since there were no ads on the site. I liked the wording of this: “Sermo’s business model is one of information arbitrage, the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare.” I didn’t get what that was saying (or not saying) the first few times I read it. Digging deeper, it appears they sell aggregated data to financial institutions, pharmaceutical companies, healthcare organizations, and government agencies – any organization that benefits from early insight into clinical events. Clients can also pay a subscription fee that enables them to post questions to the Sermo community. I thought the concept was pretty slick. I also noticed that the Cambridge, MA company was hiring, in case anyone is looking. The benefits look terrific – you can bring you dog to work, they have free catered lunch every day, and they have an Xbox (which reminds me – I am getting really, really good at Guitar Hero).

David Brailer and his Health Evolution Partners firm are ready to start giving money away. The health care private equity firm has commitments for $500 million to invest in late stage health care companies. Another $200 million will be invested in early stage ventures through partnerships with other investment funds.

Someone suggested that I might want to look at a particular company that offered some slick technology. Though I try pretty hard to fake it, I am not too much of a technology girl, so it didn’t take much to confuse me as to what this company did. I went to the guru, Mr. H, to help me understand it all. To which Mr. H made the wise commentary about many of the slick technology companies in general: “It’s no wonder people don’t get interested in all (this stuff) … they have zero marketing ability and just expect people to plow through the geeky exterior to get to the even geekier interior.” I thought it was a great observation that even the best technology is going to be overlooked unless some attention is given to the marketing side.

A class action lawsuit has been filed in Florida on behalf of purchasers of Health Management Associates Common stock. The suit alleges that certain company insiders sold over 900,000 shares of HMA stock for gross proceeds in excess of $17 million between January 17 and July 30, 2007.

The Doctors Clinic in Bremerton, WA selects Sage Healthcare for their 75-physicians multi-specialty medical group. The clinic will implement the Intergy suite of products for all EHR, practice management, analytical, and radiology management needs.

I really liked this story. Meditech is offering free classes in MAGIC programming in the community of Fall River, MA. Meditech is in the process of building a new site there and plans to move 500+ plus jobs into the area. Meditech needed more skilled programmers, so they worked with UMass Dartmouth to develop a program to provide a 30-hour course for participants. Though completing the course does not guarantee a job, it certainly will provide an opportunity for many. And Meditech has a new pool of trained programmers.

Poke Inga.

HIStalk Interviews Nick Jacobs, CEO of Windber Medical Center

Nick Jacobs isn’t just a popular blogger. He’s also president and CEO of Windber Research Institute and Windber Medical Center of Windber, PA. A couple of readers suggested I talk to Nick about small-hospital technology. If you think that’s an oxymoron, read on about what this tiny rural hospital of a few dozen beds is doing.

Thanks to Nick for the chat.

Tell me about Windber and about yourself.

The hospital is 101 years old, started specially as a hospital to take care of the coal miners for the 40+ coal mines of the Berwind-White Coal Company. When the town of Windber was constructed, it was seen as what would be a model town for the industrial revolution. Every house had a central heating system provided by the coal company, schools, hospitals, and churches. It was like the Celebration community in Orlando. The commitment was made that this hospital would be one of the most outstanding in the US.

For the first 40 years, the starting physicians were innovators, to the point they held numerous patents and successes. They studied with the Mayo brothers, like learning to remove the thyroid without leaving scar. Celebrities came for the surgery, like Betty Grable, Arthur Godfrey, and Jeanne Woolworth.

We’re 30 seconds from where Flight 93 went down. I came in 1997. We have 550 employees now and a $21 million payroll.

The issue for me when I came was that the hospital had been given a death certificate by Ernst and Young. In the coming era of capitated managed care, the hospital had a short life left. That gave me a chance to challenge my board. I told them, “We can let it go, or we can try to go back to innovation and technical advancement and high-touch care.”

We had the first hospice in the US, founded in 1977, for a rural area. I was able to use that as a model for physicians and the board, telling them, “Look how people are treated in the hospice. I want to take this hospital-wide.” We’re a Planetree hospital now, the third in the US of what is now 200. We embraced the concept of spiritual, holistic, mind-body-spirit care, the highest touch concept.

Having interviewed at Boys Town Hospital in Omaha in 1992, I got to a hospital that looked like Windber but was called National Research Hospital. I asked a priest why. He had 38 PhDs and was a genomics center in 1992. I found myself at a dinner party with our local Congressman talking about the Dean Ornish CAD Reversal Program. I explained it to him. He said, “We’re spending $1 billion a year on heart disease in the military.” We launched partnership with Walter Reed the following year.

Then, a board member got breast cancer and came to our hospital. That made me uncomfortable. I wondered why she didn’t go to Sloane-Kettering or MD Anderson. She went through it at our place, then went there for a second opinion. She went to our Congressman and said, “These guys have figured it out.” We have massage therapy, popcorn, clowns, family access, everything. She told the Congressman that the military was spending all that money, but nothing in our district.

We built a research facility with 50 scientists and 40,000 of the most highly annotated breast cancer tissue samples. These are longitudinal studies because they’re in the military. We built a team of biomedical informaticists who have perfected software and methodologies for mining huge quantities of medical-related data.

Because I’d never worked in a research institute, and in fact didn’t get into healthcare until I was 40 because I was a high school band director, one thing I discovered is that I didn’t care about the past and wasn’t tied to it. When I had a chance to create a research center from scratch, I decided I would meet with my first three PhD hires and ask them what the bottlenecks had been. First, all science is called small science. You get an idea for secret sauce, go to NIH for money, build your team, then I might take it away from you. I decided that instead of creating divas, I’d create a ensemble of people who could work with each other.

Also, I decided that all information would be stored together instead of on individual PCs. So, we had terabytes of data to study, but had to build from scratch data mining. I hired a Penn bioinformatics director, hired 10 people, and worked with dozens of companies to come up with trademarked capabilities. Researchers in our institute can query all 40,000 ladies in our database. How many of you drank coffee? How much coffee? Then, you can do an analysis of which ones got breast cancer. This was set up in a manner so that not all donated serum and blood and tumors were cancerous. Interesting. Maybe those who drank the most coffee don’t have breast cancer. It creates a way to query issues that could be pertinent to disease states. It was not disease-specific. It can apply to any disease.

I found that PhDs don’t talk to MDs. I hired some MDs and got teleconferencing to meet weekly with oncologists and pathologists from the Army about problems with individual patients. We took those back to the bench to find solutions. That’s translational medicine. We’re way out ahead of everybody’s headlights, and for those mired in the traditional system, they’re not only afraid but desperate victims because it changes the way they get funding.

To communicate information back and forth to the Army, we have a network of OC-48 capable dark fiber. We can transfer entire hard drives in seconds. In Windber, PA, a town of 4,200 people, we have some interesting opportunities. The space and missile defense command that had the original Star Wars defense program had a civilian who put together a team of $7 billion worth of research to fuse infrared and radar together to detect missiles from outer space. His sister died of breast cancer. He vowed to have those algorithms declassified for us to fuse ultrasound and digital mammography. GE is a partner doing research with us. We have three MRIs with breast-scanning capabilities doing fusion of technologies to find better ways to avoid misdiagnosis. All in a little 50-bed hospital two hours from Pittsburgh. It’s a fascinating evolution that came from the mind of a band director. [laughs]

Describe the hospital’s IT systems and their role in your strategic plan.

Because of the system that we’ve put together, we have interest from all over the world, except in the US. Go to the Netherlands, there are eight academic medical centers cooperating, but they didn’t have tools to mine the data to make it translational. We’ve been back and forth for a year working on software we created here to mine that data.

We get breast cancer tissue donations. We can do a genetic analysis in-house to determine which genes contributed to it. Then, we have the capability of determining which proteins were contributors to spreading the disease. Both of those modalities create huge quantities of data. Then, we do histopathology and molecular research, clinical and diagnostic data. We have mountains of data. One piece of equipment can create six months of data to research. We can see the potential impact of alcohol or obesity. We think it will contribute substantially to future cures as we analyze the data.

On the downside, we’re way out ahead of the headlights. We’ve spent millions trying to get software companies to cooperate with each other and designers. In one meeting, we had six companies involved in the data collection process. We had to put them in a room and lock them in until they agreed. Everybody was afraid to let their secret out. One large company that I’ll leave nameless – they can mine huge quantity of data for retail and banks, but in biology, they walked away and said, “We can’t and won’t do it becuase something that’s brown 1000 times turns green. It just happens.” They had no way to turn their analytical tools into biological analytical tools to meet our needs.. Another company asked for a meeting and in the NDA said, “Anything you say that we can remember, we can use.” [laughs]

How important is IT overall to a hospital’s success and to patient outcomes?

We just put out another $3 million for Meditech.

Concentia Digital of Columbia, Maryland … Duane Shugars is president, a young guy. His company was hired by National Geographic to digitally catalog all their images and films. If you want a picture of a lion with a bird on its nose, you can search for it on the Web and buy it on the Web. Then the NFL contracted with them to catalog and organize plays, so when they said, “Here are Terry Bradshaw’s top plays”, they can find them. Then the CIA and FBI hired them. They came to us through an acquaintance. Everything we do is digitized and put into their repository. With 40,000 samples, a single pathologist has done an analysis. He’s a research pathologist instead of a clinical pathologist, so instead of 20 things, he looks at 120. Theoretically, any scientist anywhere in the world looking for samples can be search and those samples would come to them visually.

They say politicians can have national influence, but they still have to be re-elected by the folks back home. Windber has a lot of national publicity, but you’ve said locals don’t really know much about the hospital. How can you bring the national message back home where it can do some good?

In 1977, we had the second Johnstown Flood. We had the largest out-migration of any urban area in the US except East St. Louis, Missouri. Our demographics look like Dade County, Florida. We have large quantities of octogenarians. The average person has lived in their home for 38 years. The hospital went through a tough decade in 60s and 70s. If they have a bad experience, they don’t easily forget it.

Our publicity has been in Forbes, Fortune, Wall Street Journal, CNN, the Today Show. That’s not where they live. It’s been a 10-year uphill battle to get our locals to realize that this is a unique place. The national infection rate is 9% in a hospital. Ours has been below 1% for almost nine years. So, how do you put billboards up and say, “Come to Windber and you’ll die less”? [laughs] It’s a challenge that doesn’t make for happy competitors.

We’re starting to get local recognition, but it’s happened because of my blogs. The former public relations director of the Pittsburgh Symphony, now 81 years old, said, “Why aren’t you blogging?” I wrote my first blog in May 2005, having no idea that I was the only hospital CEO with a hospital-endorsed blog in the country. The local paper asked me to write op-eds about healthcare. Another little paper asked me to write a comedy column and I became a local folk personality, the baby boomer with the child problems. Then, there were other blogs. The bad news is that none of them pay, but we’re getting the word out. When I was in the Netherlands, they said, “We love your blog.” [laughs]

Tell me about the Planetree system.

Angela Thieriot had to have surgery in the 1970s. She went into a San Francisco hospital and had the typical hospital experience, like being a lab rat. You’re a number and an organ and it’s cold and detached and there are heavy duty rules based on the military system of triage. She came out of it wrecked that American healthcare was so insensitive and cold.

She convinced the hospital to give her a wing to design care that doesn’t require leaving your dignity by the door. A hospital in Oregon tried it and was interviewed on Bill Moyer’s “Healing and the Mind.’ She became a folk hero in a little 50-bed hospital. The movement started to get traction. It did well for eight or so years, then died. A hospital in Connecticut bought the franchise rights and I was the third hospital in the US to become a Planetree hospital.

I’ve been on their board for four years. We’re pushing 160 hospitals worldwide. It’s catching on as Baby Boomers become patients. They’re not happy with instant Sanka in a pack. They will want a decaf latte with skim milk. It’s the best of a hotel, hospital, and spa. Patient empowerment and patient care. Care isn’t centered on physician times and dates or employee’s availability. It’s based on centering care around the patient. Every patient in our hospital is touched multiple times every day by caregivers other than RNs and MDs. We provide beds for loved ones, kitchens, showers, and beds in the OB suite.

The greatest compliment was when surveyors from state were here two years ago and couldn’t fund anything wrong. The surveyor said she wasn’t from around here and it was the 35th hospital she’d been in this year, but told her husband that if anything happened to her anywhere, no matter what, bring her here.

I’m 60 years old and have six heart stents and my mission is to change the way healthcare is delivered. I’m saddened by how science works and how hospitals don’t cross the line of taking care of souls and not bodies

Can the hospital succeed as an independent and can anybody compete with UPMC in western Pennsylvania?

I don’t know. If we had not made the choice made by our board, there would not be a community hospital here. Was either decision a good one for the community? The board chose to take this on and try to compete. We only represent 6% of the healthcare in this region. It’s not like we can put them out of business. On any given day, if you say “Go Penn State” or “Go Pitt”, you’ll make half the people in the room mad. It’s not just an UPMC juggernaut, it’s also a Geisinger juggernaut.

Three, four or five years from now, will Conemaugh survive? UPMC has already made a run on this area and it didn’t go the way they hoped, but they have their joint ventures and insurance here. It remains to be seen if Geisinger comes in. We can survive only if we put all the pieces of the puzzle together. Oprah drops off her dog at a spa 20 minutes from here. If I can get her in here and beat that 30% error rate … I think the answer is yes, we can survive, but that’s an uphill challenge.

You mentioned in discussing Michael Moore’s Sicko that we’ve never had a health policy in this country. Why do we need one and what will it take?

I’m not a policy wonk and I was out front in rejecting Hillary’s last plan. It doesn’t do any of us well to have what England or Canada has. The waiting time is years. People come across the border from Canada for heart surgery. I’m not sure that plan is the best way to go.

Internationally, we’re through the roof, #1 in cost and #42 in quality of health. I’ve seen a lot of diagnostics that relate to typical overhead. With a private insurance company, it’s 20%. With Medicare, 3%. There’s got to be something in between that makes this work. UPMC is positioning themselves to be a global player in single payer. Highmark is doing that. Does that look like Medicare or a modified insurance system?

I can be the least expensive hospital in the US and it doesn’t matter because the insurance company doesn’t have to pass it on to the consumer. We have to find a solution that doesn’t permit this outrageous 47 million people to be uninsured. That’s unconscionable. Some kind of single payer has to evolve or it will become a worse and worse train wreck.

You’re speaking at a blogging conference this month. What’s your message going to be?

So many of my peers are finance guys who stick their heads in the sand and go with business as usual. It’s kept us locked in the industrial revolution. I’m doing a podcast next Friday with someone from Mayo. Transparency will be huge. Communication through the Internet is huge. We’re more connected than we’ve ever been in history. A political leader who could lie to his people is being checked internationally by hundreds of young people. We’re finally totally linked.

I wrote a blog that I thought the demise of Imus was because of that. It wasn’t that he hadn’t said something like that 1000 times before, but everybody grabbed onto it and made something out of it. Get with it and figure it out. It’s the new world order. New tools will reach out to people in a different way that will make or break your business.

If you weren’t CEO at Windber, what job would you want?

If I’d been talented eough, a top level orchestra director. It’s the most rewarding thing I’ve ever done. Touching people’s lives like this is important, though. At this stage of my life, I’d just like to speak and write to change healthcare. I love getting the message out and shaking up the status quo. It’s not my system, it’s an old system that needs re-evaluated. Some day I’m going to write a book at how being a high school band director is like being a hospital administrator. It really is.

Monday Morning Update 9/10/07

From Inside View: “Re: Bronx Lebanon. Eclipsys won. Cerner, who everyone assumed was the winner a couple of months ago, was the surprise loser. But the biggest loser was GE. They should have won, could have won, but didn’t execute and their product is a mess. The rate at which GE is losing LastWord clients is alarming.” Unverified, I should mention. Thanks for the update.

From Abe Froman: “Re: Dubai. In Cerner’s presentation at the conference, they showed how CPOE cuts medication turnaround time from hours to 20 minutes. A hospital director there couldn’t understand how you can put the ordering process in the hands of a physician. What happens if he makes a mistake? In Dubai hospitals, pharmacists are simply glorified salesmen, dispensing whatever the order says. They do not question anything. The nurse provides the review when the order is transcribed, which doesn’t happen with CPOE. The conclusion was that Cerner doesn’t understand that market.”

I mentioned tee shirts that will be worn by former employees of a certain vendor at their “glad I’m out of there” reunion. Folks asked me to run a picture. If you want a look, see here and here.

I got an e-mail from Jason Maude, CEO of Isabel Healthcare, after I mentioned the press its diagnosis product receives. He recommends a book called Super Crunchers: Why Thinking-by-Numbers Is the New Way to Be Smart. It has a healthcare chapter that covers IHI’s 10,000 Lives campaign and devotes five pages to Isabel. A quote: “House makes excellent drama, but it’s no way to run a health care system. I’ve suggested to my friend Lisa Sanders, who recommends script ideas for the series, that House should have an episode in which the protagonist vies against data-based diagnostics ala Kasparov vs. the IBM computer. Isabel’s Dr. Joseph Britto doesn’t think it would work. ‘Each episode would be five or seven minutes instead of an hour,’ he explains. ‘I could see Isabel working much better with Grey’s Anatomy or ER where they have to make a lot of decisions under a lot of time pressure.’ Only in fiction does man beat the machine.”

Researchers involved in the development of relational databases now say they’re obsolete and should be considered legacy technology. Reason: row-oriented databases are slower than column-oriented ones, especially for data warehouses. I thought the article might mention Cache’ since it doesn’t have those performance issues (remember they used to call it a “post-relational database”) but the guys quoted have already started their own company, so they’re not likely to bring up competitors.

In the UK, Cerner suspends work on the new Millennium R2 release intended for the London and South trusts.

Check out the new SCI Solutions ad to your left. Kind of a cross between the old Batman and Austin Powers.

Computers stolen from a McKesson office in July contained the personal information of thousands of patients who had signed up for prescription assistance programs from drug companies. The company said it’s “not clear” whether the data was encrypted, which is a nice way of saying it wasn’t (few users encrypt their data).

MPI vendor Initiate Systems signs a deal with Capgemini UK for a children’s services application.

A VIASYS engineer has been charged with hacking the computer system of his employer in 2003. He started by deleting files of his EEG development coworkers, then went after the executives. He was finally caught by an outside firm who located the outdated computer he used along with its hard drive, which he kept locked in a desk drawer.

A UK hospital bans employee access to Facebook after heavy use degrades its network.

The latest issue of The White Stone Group’s newsletter is out (warning: PDF). They run a contest to see which hospital has overturned the largest single denial using their TRACE tracker and workflow software. The winner: a Georgia hospital recovered $452,000 when they showed documentation of precertification notification and response. Even more interesting was the “Taste of Trace” recipe for cheese grits souffle, which of course is the food of the gods for Southerners. If Mrs. HIStalk could cook, I’d dispatch her to the kitchen to whip up a batch, albeit using Velveeta instead of fancy cheddar.

The Northwest Medical Information Symposium will be held on September 13-14 in Spokane, WA. Speakers: Gingrich, Leavitt, and Frisse, among others. Meditech is even on board as an uncommon sponsor since the meeting is put on by its customer, Inland Northwest Health Services.

An investment analyst surveys US users of its Emdeon system and “… believes that concerns about falling demand from medical practices and possible glitches in the software are overdone. However, it said that it had uncovered evidence that the group, whose core business is accounting software for small firms, had made only mediocre efforts to market its medical software.”

Throughput software vendor Premise Corporation announces events from the first half of the year: client based doubled, 100% “would buy again” results from KLAS, 100% employee growth, new financing, and new operational and board leadership.

A mother sues the makers of Tylenol #3 when her newborn baby dies, apparently poisoned by the her codeine-containing breast milk. If your hospital flags breastfeeding moms and successfully issues CPOE or pharmacy lactation precautions for specific drugs, it would be the first I’ve seen. Tylenol #3 probably wouldn’t be on the list anyway since it’s not a common problem. FDA issued a warning last month.

I’m moving on to Brev+IT from here, so if you pounced on this e-mail notification, you might have time to sign up before I send it out.

E-mail me. How hard can it be?

News 9/7/07

From The PACS Designer: “Re: native DICOM. TSS makes a valid point about the use of private attributes. I’m not sure if the HIStalk community knows that the DICOM Workgroups are expanding into modalities that were not previously DICOM-enabled, such as Pathology Workgroup 26. As more modalities join the DICOM community, it becomes vitally important that we all operate from a common DICOM platform. Why shouldn’t it be native DICOM? Wouldn’t it be better for all of us to work as a team in the native DICOM community?”

From Dale Cooper: “Re: Dairyland. Now that Mediware has a new CEO (revolving door?), looks like Mr Burgess is going to help Vista capital try to get DHS in gear. IMHO – wrong guy, wrong time, wrong place … good luck.” Former Mediware CEO (until September 24, actually, but he’s taking the Mediware job now) James Burgess was just named CEO of Dairyland Healthcare Solutions a few minutes ago (6:17 PM Eastern). Actually, Dairyland is owned by Francisco Partners, but the confusion with Vista Equity is understandable since Vista has investments in SIS and the former Sunquest. Francisco also owned LYNX Medical Systems, but sold it to Picis in July.

Guess the Company, brought to you by Ex-(Company) and redacted to keep me out of trouble: “(Executive) is a pompous ass. He is the most arrogant person I have ever worked directly for. He has vision for this industry, but has a leadership style of complete dictatorship and surrounds himself with the politically focused. The ability to execute sucks. (Executive) thinks it’s services, it has always been his half-assed development team who consistently delivers terrible code. I feel sorry for anybody still there.” The funny thing is that when I run stuff like this, several folks always guess it’s their own company, so it’s not always as obvious as you might think.

Guess the Company II: some former employees of (company) are having a reunion and somebody sent over a picture of the tee shirts they’ll be wearing. They say: “Can’t build it? Have old technology? Tired of trying to convince people that you have a great personality?” There’s also a picture of a dead animal that I won’t name. I bet they’ll be carousing and trading war stories.

From Larry: “Re: Greenway. You mentioned that you were impressed by Greenway’s recent press release. I was wondering if you or any of your readers had any comments regarding the huge capital investments Greenway has received since inception ($80-$100 million, it seems). Is their EMR product and sales performance impressive given what they’ve had to work with?” I’ll defer to those who know more about it than I do.

From Leland Palmer: “Re: Bronx Lebanon. Any update on who’s winning the battle of the Bronx between Cerner and Eclipsys?” Readers?

Special thanks to Sentillion, EnovateIT, Pring|Pierce, and SCI Solutions. Inga and I decided to offer small text ads in our Brev+IT weekly newsletter to support some expansion we’ve got in mind for it. We offered four spots to current sponsors for terms up to one year. Within within 24 hours, these Platinum sponsors had signed on for the full year (we even had to turn a couple of others away). You can’t imagine how energizing it is to have that kind of support. We know these folks and they’re doing it for one reason: they like what we do and they respect HIStalk’s readers. We appreciate that very much and will soon have some new stuff to talk about as a result. Sign up and you’ll know the Top 5 stories each week, like last week’s: (5) Cerner in the UK, (4) Indian BPO acquisitions, (3) MedAssets IPO, (2) FDA’s access to DoD patient information, and the biggest story of the week, (1) … well, let’s keep at least one secret between just us 721 subscribers.

Thanks, too, to recently renewing HIStalk annual sponsors R. Gaines Baty Associates, Healthcare Growth Partners, Picis, Hayes Management Consulting, SolCom, and Novo Innovations. I’m a little old to be saying “you rock”, but you know you do.

Shortwave Coates and others were right several weeks ago with their rumor reports that Ingenix would acquire Healthia Consulting. It was announced yesterday. “We want to share with you today some exciting news – Healthia is going to become a part of Ingenix, a leading health information technology company. Since our inception, we’ve aimed solely at staying on the leading-edge of health care consulting, and as a result we have become nationally known and recognized for the services we’ve provided to the industry. With increasing levels of opportunity nationally, we sought capabilities that better serve our customers and provide challenging opportunities for our colleagues. Becoming part of the Ingenix family of companies does just that – retains our exclusive focus on health care while giving us broader and enhanced capabilities.” Ingenix bought Claredi and Lewin Group recently as well and was rumored here to be acquiring LighthouseMD, although I haven’t confirmed that so far. I was going to list their products and services, but it’s so long it’s arranged alphabetically like a telephone book. They are definitely growing. They got a gem with Healthia, so hopefully they won’t change it much.

Athenahealth’s $14-$16 IPO price will raise around $68 million or up to $115 million, depending on which reports you read, valuing the company at up to $550 million.Cerner is sponsoring and participating in a conference in Dubai. They’re also webcasting investor presentations live Friday morning and Tuesday afternoon.

Ray Moss is named VP/CIO of Valley Presbyterian Hospital (CA), leaving Perot’s Cedars-Sinai tech services group.

Keane gets a $1 million contract to install parts of InSight at Capital Health System (NJ).

CompuGroup’s CEO does an interview with eHealth Europe. On the company’s failed iSoft bid: “Everybody knows iSoft does have problems, both financially and with its products, and these kind of problems do not become less over time. Further more in our view it became more unrealistic to receive the voting power to implement our restructuring plans in time. The whole deal became too risky for my taste and doesn’t agree with my understanding of shareholder value.” He says CompuGroup is still looking for healthcare IT software companies to acquire.Good article: 10 signs that you’re not cut out to be an IT manager.

TeraMedica will distribute its “single patient snapshot” Evercore imaging software in the Asia Pacific, integrating with Healthinc‘s RIS.

Interesting: the 2003 law that limited the workweek of medical residents to 80 hours has had no impact (good or bad) on Medicare patient mortality.

Formedic is offering a free Medical History Questionnaire patient interview application to physician offices. There’s a recorded demo there. I’m not sure I’d lead off warning the patient to enter their “chief complaint” and not their “symptoms” (are patients supposed to know the difference?), but once you get past that screen, it gets better. Nothing tells you who the company is, the domain registration has privacy block on, and the only contact is an online form and 800 number, but the press release points to the main Formedic site.

Worldwide corruption investigations into Siemens may be heading here. The SEC has requested files from German authorities who are going after Siemens for up to a reported $1.4 billion in bribery and anti-trust violations. Just announced: China is looking into possible corruption involving the purchase of Siemens medical equipment there. If an investigation opens up here, you can bet their competitors will be subpoenaing everyone within 20 miles of hospitals where Siemens got the contract. I know would.

Hopkins gets its stolen laptop back with the medical records of several thousand cancer patients intact. Odd: a lawyer knew who had it, called the local newspaper to announce that he’d get it back, and turned the occasion into an opportunity to pitch his law office’s expansion into identify theft cases.

No question: the best vendor for getting good press is diagnosis software vendor Isabel. Nice product and it’s just stunning how well they get articles about it into the mainstream press. It’s in USA Today, which not only misquoted the price as $750 instead of $50,000 per year, but also said it was “highly rated” by HIMSS, which despite many ways of cozying up to vendors, doesn’t evaluate them as far as I know. HIStalk reader Gary Kantor, MD of Case Western was kind enough to review Isabel for HIStalk last year.

The Providence Health System IT employee whose car was burglarized in his driveway in late 2005, resulting in loss of patient data tapes, is suing the health system for $1 million. He says he was fired because he called the police, not for breaking policy.

RemedyMD has integrated medication dosing algorithms from Dimensional Dosing Systems into its electronic medical records software.

Mediware announces Q4 numbers: revenue up 14%, EPS $0.06 vs. $0.07. The company was crowing about its medication reconciliation product just a couple of weeks ago, but the earnings announcement says medication management product sales were slower than anticipated (that includes the eMar and WORx products, though).

A UK health department consolidates its application databases using InterSystems Ensemble.

E-mail me. But only if you want to.

Inga’s Update

Cerner has announced the keynotes for their upcoming health conference. The “star-studded line-up” includes John Kerry and Richard Teerlink (former Harley-Davidson chairman). Will you Cerner users rush to send in your registration now that you have the chance to hear these guys? – or are vendors better off not spending all that money for speakers that know next to nothing about the products you are using?

Last month I had noted that Allscripts had been announcing a number of big wins and wondered if sales were up suddenly up or if their PR machine was working overtime. A reader suggested it was the latter. However, yesterday they announced their largest EHR contract ever with the Columbia University Medical Center. Columbia will be implementing the system in their outpatient physician group and their future community-based IPA. Fortune magazine seems to agree with me, as well as they just named Allscripts #23 on their list of the 100 Fastest-Growing Companies for posting growth numbers as follows: EPS up 138%, revenue up 38%, and total return 48% (bummer that I don’t own any of their stock). In looking over the Fortune list, I didn’t notice any other HIT companies, by the way.

Check in with the fetching Inga.

News 9/5/07

From Pluvial Bitter: “Re: AJAX. AJAX stands for Asynchronous Javascript And XML. If you use Google’s GMail, you have seen AJAX in action. The way GMail is able to check for new messages without you having to refresh or reload your page is due to AJAX. Basically, AJAX applications can be set up to make calls to a server for updated information at either timed intervals or based on a user’s interaction with an AJAX web page. These calls to the server occur behind the scenes. My company uses AJAX for a Web-based smart calendar for physician practices. Let’s say you have a practice rule that states you cannot perform a surgical procedure after you have been on-call the previous day. If a user started to enter a surgical procedure, the AJAX coding would elimate all physicians who were on call the previous day as available options.” Interesting. It’s worked great everywhere I’ve used it except Yahoo Mail, which seems to be flaky (it lost my e-mails more than once, so I went back the old interface).

From John: “Re: Brev+IT. Just subscribed to Brev+IT and received my first issue last week – what a great read. Brev+IT is an excellent complement to HIStalk as it focus on just a few key stories, going into greater depth with some good pithy analysis on each story. Thanks Mr. HIStalk for this expansion of your already excellent service to the industry.” My pleasure. The subscriber list is like a Who’s Who of the industry, with 600 folks receiving it so far. The sign-up box is to your right. And for those getting it, you can help me out by forwarding it to others (we’re a low-rent operation here, so that’s what passes for an ad campaign in these parts).

From Millie Quivalent: “Re: FDA’s access to DoD patient data you mentioned in Brev+IT. Congress is pressuring DoD to merge its software with the VA’s, which they don’t want to do. By linking up with FDA, they have another arrow in their quiver.”

I’m getting interested in the announcement coming next Monday from Sentillion. If you’ve watched their ads to your left, they keep teasing a little more each time. I don’t know the secret, but I’m waiting with you. Cool ads.

Kelly Mann is named CEO of Mediware, coming over from 3M. I missed the announcement that Jonathan Churchill had resigned from the board, replaced by former Assistant Secretary of the Navy Richard Greco. Greco sounds interesting: 38 years old, former CFO of the Navy, big private equity guy, and degrees from Hopkins and Chicago. Anybody want to bet that Mediware will go private soon by selling out to private investors? MEDW’s market cap is low for being publicly traded and the company is struggling in an up market.

Cerner co-founder Cliff Illig gets interviewed by the KC paper about his and Neal’s pro soccer team. “Entrepreneurs, I think, do organization stuff different than companies that have been around for a long time. At Cerner we think of our organization as a bunch of teams. It’s much more of a peer-to-peer kind of a model as opposed to a rigid hierarchy where everybody has a boss. We have a lot of young people working for us. You bring those young people in and you make them part of the team and you give them a mission and it’s pretty impressive what they’ll go produce.” CERN Employees: what do you think?

The Delhi, India government has spent $3 million developing and testing a hospital software package that they didn’t know was available as a free download. “Talking to Newsline on condition of anonymity, the engineer said: ‘I’m surprised that people working on the project did not know about the website. It is easily available and quite popular. The huge waste of time and money could have been avoided.’ HIMS project in-charge Dr Vijay Rai, however, said he is not aware about the website. ‘The HIMS software is the best that we have.'” The screenshots look pretty good.

Bob Fabbio, the Austin, TX entrepreneur who started Tivoli Systems, is in the doctor house-call business, along with a doc who was involved in Revolution Health. His new company offers scheduled doctor visits 12 hours a day, seven days a week. Families pay $88 a month plus $75 per visit, not including labs and meds, but some are handled by nurse practitioners. Doesn’t seem like a good deal, especially compared to concierge medicine, but that’s just me.

A Maryland dialysis center operator will test implanting VeriChip RFID chips in patients to bring up their medical records when they visit.

Speaking of RFID, a patient safety expert says barcodes are better than RFID for medication safety. The article briefly mentions 2D barcodes, which I’ve worked with recently. They’re the tiny, dense squares that you sometimes see on post office envelopes. They can encode a ton of information (several hundred characters), are readable even if damaged and from any angle, and take up a fraction of the room needed for Code 39 or even Code 128 formats. Plus, super-fast scanners that can read those plus the old linear codes cost less than $200 (I’m partial to those from Hand Held Products). I’m sold on them, even though HIT vendors will probably take forever to implement them if their readers are serially connected instead of as a keyboard wedge.

Brazil’s government will offer a medical exam portal powered by TrakHealth, now owned by InterSystems. I’m beginning to think InterSystems was smart to buy that company a few months back.

E-mail me. I need your rumors and ideas. Inga is far more enchanting, so you can always ping her alternatively.

Inga’s Update

I saw Mr. H mentioned that Modern Healthcare came out with its list of the 100 most powerful people in healthcare and he expressed disappointment at being overlooked. I wonder if he and I were the only ones who voted for him?

Phillip Rivers sent me a note about the Quadramed acquisition of the Misys CPR product. Phil comes from the Quadramed camp and offers some great insights.

“My thoughts of CPR acquisition are the following: smart, smart, smart. It is the real deal. It really does what others say they do. I have so many prospects tell me they want “integration”. Well, here it is. This is robust, flexible and proven. What more would you want?

As for the business deal, when all the numbers are made public, I think we will see this was a no-brainer for QuadraMed. I had really questioned Misys and their decision to sell the acute market products. I didn’t understand why a company would sell off a profitable part of the business. Well, I spoke with some senior Misys executives in Raleigh and they put some perspective on this sale for me. They really believe that Misys, which is known for the ambulatory products, was not able to partner with other HIS companies to fully market and sell the ambulatory into the client base of Meditech, for example. This was due to Misys perceived “competition” with CPR and the Lab products.  Shedding these will allow Misys to develop the “Channel Partnerships”. Makes more sense to me in that light.

QuadraMed will be able to take the integrated Cache database that CPR and integrate their other top notch revenue cycle products running on Cache, which is a truly underrated,extremely reliable, fast, and stable database.”

If you missed Mr. H’s posting yesterday on the HIStalk Forum (Works Sucks, Then You Die: Finding Your “One Thing”) it is worth a read. From one who has gone from the “front lines” in this industry to a comfortable seat in the bleachers, it hit home. Here is my favorite nugget of wisdom: “Every person has one thing they do extraordinarily well. You will never be happy in your job unless the majority of your time involves doing that one thing. And if you do that one thing, money and success will find you, probably when you least expect it.” I am still figuring out that “one thing” and definitely looking forward to having that money find me. Meanwhile, I agree that life is too short to not to love what you are doing. (For the curious, I am definitely having fun at HIStalk).

The Healthcare IT Transition Group has released its annual survey (warning: PDF) that focuses on RHIO financing. I didn’t see the full report, but the summary has a few data points of interest.

• The estimate for RHIO technology expenditures for 2007 is (only) $128.6 million, which represents 0.7% of the total US HIT market. If that is a real number, then that is bad news for vendors targeting this market.
• Not surprisingly, 53% of the respondents reported that cash flow was a significant challenge (see first bullet point).
• 52% of the respondents indicated they were in the startup stage, 24% in the transition stage, and 24% in production.

IPC The Hospitalist Company Inc., a North Hollywood, Calif.-based network of hospitalist physicians, has filed for a $105 million IPO. Several venture capital firms have the biggest ownership shares today, including Bank of America, Morgenthaler Ventures, Bessemer Venture Partners, and CB Health Ventures. IPC has over 600 hospitalist physicians and over 900 employees in 16 states.

I attended the first HIMSS virtual conference earlier this year and probably won’t attend the next one. That being said, it was interesting to interact with the other attendees. Since there were so many folks online at one time, there was quite a bit of posting about a variety of different topics and people were able to make quick connections. There were a number of attendees who were hunting for jobs and a fair bit of posting around employment issues. I sat in on a couple of webinars, but I guess I really am not a webinar kind of girl. I find it difficult to stay focused on the speaker when I have e-mail popping up, etc. But I am sure it works great for some folks. For people who don’t have an opportunity to go to meetings in person, it’s not a bad way to get a taste of it. If you took the time, you could learn about some new technology, etc. In terms of the vendors, I didn’t see much provided that couldn’t be found from the web. Oh, and I didn’t win any door prizes. Big disappointment.

Say hi to Inga.

Monday Morning Update 9/3/07

From Timber Roller: “Re: AJAX. See this Solitaire application, which looks like a Windows program, but which has been implemented using only JavaScript, cascading style sheets, and DHTML … so-called AJAX. That’s why AJAX rocks: not because it’s solitaire, but because thick client-like applications can be implemented without having to load and configure software on the desktop. This site uses widgets from Yahoo’s UI library for the drag-and-drop stuff.” Link. A good time-waster if your employer removes Windows games by default. It works really well – impressive.

From Chuck Lumley: “Re: open source EHR initiative. openEHR is a fascinating (and apparently already internationally successful) open source EHR initiative started by an historical EHR thought leader — Dr. Clem MacDonald at the Regenstrief Institute in Indianapolis.” Link. The website makes it hard for non-geek, non-academics to know what the heck they’re talking about, but it looks like some sort of standard rather than an actual product. My only takeaway was that Ethidium Health Systems is using the specs in its Evolution EMR product. Actually, this presentation (warning: PDF) is a better intro, although still way deep in the programmer stuff.

From Rogue: “Re: Epic’s new learning center. It is clearly shaped like a treble clef sign (as in sheet music). Hitting a high note? High-pitched screams? Anyway, I do like the dollar sign analogy the best. What, no helipad?”

From The Shelton Shadow: “Re: private attributes. TSS has been investigating the use of private attributes in DICOM Conformance Statements. Private attributes can cause problems when trying to view the image files stored in archives. Everyone making new purchases should compare the private attributes section to other DICOM Conformance Statements. Siemens and Philips look to be in good shape since their current products have no private attributes. GE is another story – their products have 20-30. Non-GE viewers will miss the private attribute data stored in an archive. The only way to see them is to store them in the DICOM Header, which will create an archive with mixed image files. GE sales reps might promote their product as better, but you are increasing the likelihood of a forklift upgrade if you decide to move to a native DICOM format supplier.”

From Edward Koogle: “Re: Misys. The former Misys office in Johnstown, originally a Sid Goldblatt Sunquest office, closed today. Remaining employees will work from home until new owners QuadraMed and Vista decide what to do. It’s sad considering over 100 people worked there at one time.”

From SG: “Re: BPO outsourcing. On the same lines as MedAssist acquisition, Indian healthcare outsourcing company Apollo Health Street acquired a leading US-based medical billing outsourcing company – Zavata.” Link. Interesting quote: “Technopak’s Singh noted that Indian hospitals and those in the US were at different phases in their investment strategy. The Indian players seek health-care consultancy for business strategy, facility design, planning and, only then, turn to health-care information technology. Most US hospitals, meanwhile, are now spending on redesigning information technology systems.”

From Darla Mackadoo: “Re: Rabbit Healthcare Systems. Consultant recommends an oncology software EMR package to a couple of clients, including Lone Star Oncology (good size group). Oncology EMR goes belly up shortly after. Consultant makes a smart move and gathers folks together to create a new EMR for resale. Lone Star Oncology becomes a big stakeholder in Rabbit. Consultant/new President goes back to all those folks that had the old belly up product and sells them the new stuff. That’s what I heard, anyway.”

No consensus yet on “healthcare” vs. “health care”. Dictionaries differ. It’s probably not a good word to describe most hospitals and doctors anyway since few are worried about “health” as they are “episodic treatment of abnormalities”. That’s another argument.

Sean McDonald, the Pittsburgh entrepreneur who started hospital robotic drug packaging vendor Automated Healthcare and sold it to McKesson for $65 million, will take his new company public. Precision Therapeutics sells a test that helps choose the most effective cancer chemotherapy. UPMC people are involved, which got UPMC in trouble previously: one of its lab directors was medical director at Precision Therapeutics and was named in a lawsuit that claimed he sent them specimens unnecessarily for his own benefit. He quit the company, although I don’t know how the lawsuit turned out.

Nova Scotia’s health department is seeking bids for a RHIO-type project.

Jobs:

CIO, Phelps County Regional Medical Center (MO)
Executive Director, Wisconsin Health Information Exchange (WI)
CIO, Olean General Hospital (NY)
Technical Project Manager (DC)
Cerner Analyst (NC)
Implementation Consultants (MN)
VP of Clinical Transformation, BayCare (FL)
CIO, Delnor-Community Health System (IL)
CIO, Sacred Heart Health System (FL)
Meditech PCS, ED (National)
Centricity Healthcare Consultant (MA)

It was the perfect feel-good hospital story: San Diego Chargers running back LaDainian Tomlinson would serve as the celebrity spokesperson for publicly owned Palomar Pomerado Health. Everybody figured it was a nice charity gesture until a reporter probed, the hospital balked at giving details (apparently not quite getting the “publicly owned” part of their governance), and a public records request revealed that the $60 million athlete is being paid $2 million over five years for his celebrity services. When nonprofits start throwing big money at their “brand”, they’ve forgotten the mission (unless it was self-aggrandizement).

HIMSS will offer another Virtual Conference on November 6-7. The first was met with underwhelming response based on pre-conference estimates, but 2,200 people is still pretty good (will they come again?) It’s kind of like Second Life for HIT, I suppose. For vendors, HIMSS is offering the usual cornucopia of opportunities to send them money, including a $5,000 deal to put your logo on each e-mail confirmation (I’m positive that will kick-start record sales). HIStalk sponsorship is quite a deal in comparison. Somewhere in all that commercial feeding frenzy is some education, although of a modest nature. And timeshare-like bribes … err, door prizes. One session is blocked out for the “can’t avoid it if HIMSS is involved” RHIO topics, although with a slightly more cautionary tone than the rah-rah of years past (a curt nod to the expanding RHIO graveyard). Seems like an overly heavy reliance on vendor speakers for a not-free program if you ask me (two of the ten sessions have a McKesson presenter alone). Pass.

Brev+IT is coming with the Top 5 HIT stories this week. Sign up here.

E-mail me.

News 8/31/07

From Captain Grammar: “Re: spelling. I find it disturbing that an industry as small as ours can’t agree on how to spell our name. Is it ‘healthcare’ or ‘health care’?” I use the former, but as a staunchly traditionalist grammarian, I really should insist on separate words. Opinions?

Practice Fusion, the “free if you’ll look at Google ads” EMR, announces that it will put Healthline’s medical search toolbar on its application. It’s probably a good match – Healthline is a “free if you’ll look at Google ads” medical search engine. I’m really not getting the business model. Will doctors really click on ads for stuff related to the condition of the patients they’re treating? Would you want to see a doctor that has to Google your condition?

Speaking of which, my idea of giving away a free EMR by jamming drug company ads in the faces of doctors is too late. Amplus HealthNet has what it calls an EHR (not likely) that offers on-screen drug company logos. “Every time a physician clicks on brand content, payment to that pharmaceutical brand occurs. For a brand manager, physician-initiated contact indicates a strong possibility that s/he is preparing to prescribe a product. ROI thus becomes needs-driven, highly- focused and target-specific. Better yet, this occurs at a much lower fraction of cost than traditional journal ads.” Damned annoying Flash and stock music site, I’ll say. I’m guessing its “EHR” solution is a lightweight. And I still refuse to call products EHRs unless the vendor can prove that it’s not just an EMR renamed to seem cooler (none have so far).

And speaking of free EMRs, RemedyMD is making its EZ Office suite free. I interviewed CEO Gary Kennedy in April, getting some good business lessons in running a healthcare IT company in the process.

A RICO lawsuit against McKesson for its alleged involvement in inflating published benchmark drug costs via First DataBank is certified as class action.

The local paper runs a story on Canada’s new Brampton Civic Hospital and its technology, including a picture of William Osler CIO Judy Middleton.

A ValueAct Capital partner ups his stake in Misys PLC to nearly 14%.

Modern Healthcare names its 100 most powerful people in healthcare. Sure, it’s just way to get the attention of readers too distracted to read anything substantial and instead lure them with pictures and cute graphics (I’m thinking about doing an HIStalk “100 Biggest Idiots in Healthcare IT”). Privacy fanatic Deborah Peel is #4, Newt Gingrich is #25, McKesson CEO John Hammergren is #38, Kaiser’s George Halvorson is #60, Suzanne Delbanco is myteriously #69 (parting gift?), CCHIT’s Mark Leavitt is #79, and HIMSS’ Steve Lieber is #100. I’ll move my hopes to next year.

I’ve never heard of oncology practice systems vendor Rabbit Healthcare Systems (TX), but if they’re being honest about increasing last year’s $165K revenue to $750K this year, somebody must have. Rabbit’s revenues are multiplying! (sorry).

August will set another record for HIStalk visits and the millionth one will drop by in October or so. Thank you for reading and thanks to the sponsors who make it possible. If you’re a Brev+IT newsletter reader and like it, drop me a line with a comment or two that I can use for pitching it to those who don’t read (what?) Several folks are surprised that it isn’t just an HIStalk rehash – it’s got more background and opinion that I’ve got space for here. The five biggest stories in the most recent issue involve Epic, Siemens, iSoft, Cisco, and at #1 … well, you should really sign up.

The Johnstown paper writes an article about now-independent hospital Windber Medical Center (still working on that interview with CEO Nick). An early challenge: a $3.5 million computer system replacement for what Conemaugh was providing. One of these days I need to get back up that way, if for no other reason to eat at my old favorite Oakhurst Tea Room just down the road.

CompuGroup has pulled out, so iSoft goes to IBA. For now. I mentioned a fact no one else has observed: private equity firm General Atlantic has a stake in both CompuGroup and iSoft.

Speaking of private equity companies, the 20 highest-paid private equity fund managers in the US average $658 million in compensation (and that was in 2006). I’m guessing some exceeded $1 billion a year in compensation, making outrageous CEO salaries seem paltry by comparison. I suppose they’re worth it if they provide big returns to investors, but that means investors lost that huge skim. They’re like Milliken’s junk bond kings – livin’ large now, but subject to investor fear of unregulated markets.

An Indian outsourcing firm buys medical billing company MedAssist Holding (KY) for $330 million. They like that BPO business overseas.

Bart Ponze, director of computer services for LSU Health Sciences Center, has died of cancer. Condolences.

If you’re an Epic Systems customer, here’s what those high prices provide: a $100 million learning center seating 5,300. Some say it looks like a horseshoe, but to me, it’s either a question mark or dollar sign (both appropriate). Note the Godcam-view company logo on the roof. Maybe Judy should have made the “most powerful” list. (Thanks to Romeo for the link. Photo from builder J.P. Cullen & Sons, Inc.)

I’m here.

Inga’s Update

I was thrilled to get an e-mail yesterday from Ralph Nader!! I knew that HIStalk had wide readership, but never imagined that folks I have actually seen on TV would be reading. Anyway, his email was not that nice (he called my postings “average”) but he did have an interesting comment about the Misys/iMedica partnership:

“My dear … If you had bothered to research anything about iMedica and its offerings, you would have the answers to yours (and others) questions about “Why iMedica”. The Mysis sales guys (and gals) should be dancing in the streets!”

(See what I mean about it not being that nice, especially since I did say some good things about iMedica? Now that I think about it, I wonder if this guy really is Ralph Nader. I mean, he had a grammatical error and even spelled Misys wrong. What does “dear” Ralph know – he has lost the presidential election, like five times hasn’t he?)

A consultant who was not claiming some phony name also sent me a note about iMedica/Misys. He indicated that iMedica had been losing money and needed to raise capital, thus, from a cash infusion standpoint, the arrangement is beneficial to iMedica. However, beyond that, he did not see much advantage of the partnership for either vendor since they sell similar products. “I think it makes them both look desperate, especially Misys. You have to give credit to Nissenbaum (iMedica’s CEO) for making one of his competitors resell his software for agreeing to refer his clients to only a segment of what Misys offer, such as their EDI services. How would you react to a Misys sales rep that has been touting their wares, now coming at you with one of their competitor’s applications? What about all the small practices who just purchased Misys? Why would they go through a reseller when they can go direct to iMedica? I also suspect that the Misys field reps will be disenchanted with having something else to promote. I suspect they will devote a sales force that will only focus on the small practices, similar to how GE uses their VARs.”

Yet another e-mail this week came from Obiwan Kenobe (by the way, keep all that sweet e-mail coming … I get so excited to hear from you all!) Obiwan thought I was “absolutely correct” in my comments about what really matters when it comes to enjoying your job. “You took the words right out of my mouth. Having been a sales person in this business a long time, you are absolutely correct in your statement. I have worked at a number of well-known and not so well-known companies. I am having an incredible time and success and much, if not all of it, directly relates to the things you mentioned that really matters.” Obiwan also mentioned he worked for HIStalk sponsor SCI (and I really don’t think he was trying to give them an extra plug, or even suck up to his bosses – I think he just really likes his job.) “I have never worked for such a fine company as SCI. I have a simple philosophy – it starts at the top! I believe many organizations and the people who work there reflect the attitude of their CEO and senior level management. It all starts with John Holton, our CEO, and filters down.”

I played “Heart Full of Black” (by Burning Brides) on Guitar Hero for the first time today (Xbox360, for those of you not into such toys.) Gosh I was good. I am thinking if this gig with Mr. H doesn’t work out, I may look into some of those Guitar Hero contests and start a new career.

Microsoft’s Azyxxi announces a new contract with Novant Health, a North Carolina-based healthcare system that includes eight hospitals, two nursing homes, and an 800-physician medical group.

Inga’s waiting.

News 8/29/07

From The PACS Designer: “Re: middleware. TPD has commented on service-oriented architecture in the past and wanted to expand on it since it’s the ‘middleware’ software concept that employs SOA. Middleware is a term for software applications that allow various software programs to communicate with each other. Many HIStalk interviewees have discussed middleware. Since it is a fairly new concept, not much has been published about it, even though it’s growing rapidly according to Oracle, which recently stated that it is now a billion-dollar business for them. With the diverse environment within healthcare practices, it sounds like SOA middleware is the concept to bring healthcare new efficiencies for daily  activities that wasn’t available in the past. Oracle Magazine had an article about middleware in their July-August 2007 edition titled ‘Hands-free Management’.”

From XSQ: “Re: Windber. A few weeks ago, Mr. HIStalk posted a blurb about the Windber Medical Center breaking away from the Conemaugh Health System (CHS). Intresting note on CHS that it’s Sidney Goldblatt’s (of Sunquest) home turf and he’s on the board. I agree Nick Jacobs from WMC would be a great interview.” You’ll be pleased to know that CEO Nick Jacobs has agreed to do an HIStalk interview, which I sought at your suggestion. We just have to work around our full-time jobs to find a time.

From Stan Saber: “Re: GE. Are you hearing anything from the GE user group meeting in Boston? Any promises of what’s coming from IHC?” I haven’t heard anything, so I’d appreciate an update from someone who went.

From Neeve deMick: “Re: wireless. Wireless comes up in every market survey as a key obstacle to EMR adoption. Hospitals spend millions on EMR/IT, then get limited or no return because of poor networks. Many EMR benefits are tied to point-of-care and network performance and reliability. COWs sit in the hallways and trench nurses deal with poor solutions while their ‘most wired’ CIOs do national IT speeches. No wonder there is a huge disconnect between dollars spent and user adoption and satisfaction.”

From Jeese: “Re: iMedica. You have mentioned several times that iMedica was started by former Millbrook execs. This is not the case. The former Millbrook execs came to iMedica after Millbrook was sold to GE around 2002-2003. The company was already up and running with a product. Most of the current senior management at iMedica is made up of former Millbrook execs.”

From Bumblebeast: “Re: QuadraMed. The Keith Hagen interview makes interesting reading in light of two happenings since then: (a) Quantim has lost its VP of product management and three product managers, and (b) with the Misys CPR acquisition, you have to believe that Affinity will be relegated to the dust bin, especially since Affinity and Quantim couldn’t be integrated as easily as Quantim and other clinical systems.”

From Portia Control: “Re: IBA. I hear that a juicy scandal will be coming out related to IBA and a deal in Thailand.”

Sorry if you got multiple copies of the e-mail update message about Misys today. The good news is that I had found (and hopefully fixed) a hopelessly obscure server problem that may have explained why some folks haven’t been getting the updates. If you’re a Unix geek, it involves changing the batch submission to a cron job to avoid auto-killing and restarting the Apache HTTP services that run the bulk mail script after memory consumption redlines.

Motorola is suing wireless network vendor Aruba Networks for patent infringement.

I mentioned in Brev+IT what sounds like to me a big waste of taxpayer dollars paid to SAIC for building and maintaining the DoD’s AHLTA system. Someone who should know e-mailed me that the original bid spec specifically said that the public domain VistA could not be used because the DoD was jealous. DoD reneged later, allowing SAIC to use the free VistA for its $1 billion bid, tweaking it enough to ensure highly lucrative annual maintenance. If you’ve got first-hand info, let me know. I hate $900 hammer guys.

Wake Forest Baptist University Hospital (NC) will roll out (no pun intended) a ton of products from EnovateIT: infection control keyboards and mice, barcode scanners, wall mounted articulating arms, CPU holders, and med carts. I’ve been to that hospital (872 beds!) and it’s as highly regarded as Wake Forest University, which has the med school there.

Bruce Friedman was especially pithy in his open letter to Siemens and Intel about their decision to get into the blood banking software business in Malaysia. “Developing a blood bank computer system for even a single small hospital is a project that will reduce grown men to tears … Simple computer errors in blood banking software can easily kill patients. Blood bank software is the only healthcare software that the FDA has chosen to regulate. This regulatory environment plus the complexity of the software has caused many of the U.S. vendors, previously active in this area, to defer to a small number of domain experts.” Soarian blood banking, anyone? Better re-check those bids.Picis hires two new SVPs for professional services and R&D.

The fired CFO of Mee Memorial Hospital (CA) is accused of setting up an automatic electronic payment on the hospital’s account to pay off his personal credit card each month. He’s charged with stealing $96,000, which included donations to his church.

This article definitely sounds like an Intel informercial disguised as news. It’s supposedly about nurses and IT, but it has a lot of background on bit player Intel, including talk about their nursing research and the Motion computing device.

Design Clinicals will integrate FDB’s medical knowledge base into its MedsTracker medication reconciliation software.

A psych patient in physical restraints breaks loose from an orderly and gouges out his own eyes before the orderly can restrain him again. The patient’s guardian is suing for over $10 million. The hospital then billed him for the $2.2 million in care it delivered, which the plaintiff’s attorney calls “mean-spirited”. Only in hospitals is trying to collect what’s owed you considered to be a heinous insult, although granted the ridiculous prices charged to private pay patients almost put me on the patient’s side.

Congratulations to HIStalk reader Ed Marx, formerly CIO of Cleveland’s University Hospitals, just named today as SVP/CIO of Texas Health Resources. That’s where David Muntz was until a year ago when he left for Baylor. I like to think that Ed’s HIStalk-gained knowledge got him the new gig, but that’s a bit presumptious.

I’m here.

Inga’s Update

I loved the posting from Insider Outsider about loving his/her job. Made me wonder what readers believe are the best and worst jobs in this industry. My best job was probably a few years back when I got paid ridiculous sums of money to work trade shows and “demonstrate” software. I got to stay in great hotels, wear fabulous outfits, and always got offers for free dinners. There were some downsides, such as static cling and four-inch heels, but all in all, it was fun.

So, what makes a job “good?” I personally think company culture has a lot to do with it. As Insider Outsider said, more money could be made elsewhere, but it isn’t always about money. I think what really matters is working with people you like and respect, promoting a product or service that has value, and receiving a fair wage is worth more than being the best compensated programmer or salesperson or nurse in the industry.

The Professional Association of Health Care Office Management (PAHCOM) has negotiated a “discount” for members for athenahealth’s PM and EMR services. That part is not so interesting in and of itself, but I sure liked this quote from PAHCOM”s founder Richard Blanchette, a retired Lieutenant Commander in the US Navy’s Medical Department. “I would equate the operational capability of athenahealth to one that is so well coordinated that the U.S. Navy would be dutifully impressed.” (In layman’s terms, I think he was saying things were “ship shape” over at Jonathan Bush’s place).

Acer is buying Gateway Computers for $710 million. Does that mean all those cows will be put out to pasture?

MedAssets, Inc. has filed a $230 million IPO. MedAssets is an Alpharetta, GA-based provider of software to improve operating margin and cashflow for hospitals and health systems.

After all the weeks of rumors about Misys and who they may or may not purchase or partner with, it was interesting to hear that iMedica was the selected company. I have heard their product has a lot of functionality and offers all the bells and whistles that the Misys EMR product lacks (SQL, .net, and a single PM/EMR database.) It also sounds like an ASP offering is in the works as well. The announced plan is to offer the solution at the low end, where Misys EMR has had a hard time competing (due to price and dated technology). The biggest question I have is why would Misys announce this agreement today, while also stating in their press release that the “initial products, including ASP service offerings, will be announced this November?” It would seem to me that Misys is going to have a hard time selling too many systems – at least at the low end – until buyers see what the new offerings are all about. If I were a Misys salesperson I think I would be frustrated and wondering if the light at the end of the tunnel will ever come.

First Consulting Group wins a contract with NYC-based RHIO NYCLIX to build their RHIO infrastructure. FCG’s FristGateways technology will be used for the secure data exchange between provider organizations and the largest hospitals in Manhattan and the other boroughs. FCG will host the data.

A Moscow woman set fire to her ex-husband’s privates as he sat naked watching TV and drinking vodka last week (there’s a picture). While I don’t think it was a very nice thing to do (he claims it was “monstrously painful”) I don’t buy his story that he doesn’t know “what I did to deserve this.” Come on ladies, he “knows,” doesn’t he?

Inga’s waiting.

Misys Licenses Small Practice PM/EMR from iMedica

Misys Healthcare announced this morning that it will license practice management and electronic medical records products from iMedica. Misys will pay $8 million for minority ownership in iMedica plus $5 million in licensing fees. Misys will also get a seat on iMedica’s board of directors.

iMedica was founder by former Millbrook executives in 1998. Michael Nissenbaum is president and CEO.

New Misys-labeled product offerings, including an ASP product, will be announced in November. Misys CEO Mike Lawrie said the deal will allow the company to quickly market a small practice product, an area identified earlier as a weakness.