Monday Morning Update 10/16/05

From Matt Helm: "I am sure Halamka and Glaser are genuinely nice people and are very insightful. People are just reacting to the fact that their names are everywhere. Getting your name out in the press is a lot of work, it doesn't just happen. Have they hired PR firms? Don't get me wrong, I am a media hound too. But I am a distant third to those two. If I didn't have all of these hospitals, applications, employees and patients I could focus on becoming well known."

From West Coast Ron: "The new Eclipsys CEO is from Siemens." If you know who it is and want to spill the secret to me anonymously, you know who to contact. The earnings call is next Thursday, so maybe they're holding off until then (or just before, anyway.)

From Anonymous Reader: "I would add that EPIC is severely resource stretched from serving Kaiser AKA 'the client that built Judy's treehouse'… I think that they've hired every CS grad from UM and the surrounding five counties. Fulfilling promises to Kaiser is sucking away any resources that they would use to evolve their product line (and in my mind compete with Cerner in the long term)."

From Wheelybop: "Would like a little education on the medical banking concept - please ask readers for their 2 cents." I believe some readers have expertise in that area and I'll run something if they'll send it my way.

From Anonymous Reader II: "My take on RHIO's is that they should be the organic outgrowth of (existing community) disease registry, revenue cycle management and other projects. Build on existing data sharing and business relationships with both payers and providers…to solve shared problems. And incrementally grow on a project by project basis. Those on the sidelines will want to join if they see value (and low risk) in participating. I agree with Patterson that RHIOs will not materialize without active participation and investment by payers."

From Catch 22: "I am wondering if I am the only vendor that feels obligated (maybe even blackmailed) into attending HIMSS, despite the low value returned (leads per investment) because if we don't attend the prevailing rumor will be that our company is in 'trouble.' And Mr Blogger, at risk of sounding like a suck up, what would you do in my shoes?" I'm more of a guerrilla marketing kind of guy, so I agree that paying thousands of dollars (maybe your whole marketing budget, if you're a little guy) just to get your tiny patch of Siberia unloaded, erected, swept, and wired is absurd. You can't compete with the GEs of the world anyway. The whole "they're in trouble" thing came about a few years ago when SMS opted out of the HIMSS annual conference and gave only a terse, phony-sounding explanation. Not only did they get rapped by the rags, they were on the hook for the booth rent anyway because they'd already paid, so they didn't even save much money other than for staff travel. They should have made a scathing, heartfelt statement about how hypocritical it is to spend big bucks to court struggling, nonprofit hospitals who can't afford the allocated overhead from their vendors, but they apparently weren't smart enough to do that. I know other vendors who feel the same as you, but it's like nuclear disarmament: until all sides agree to stop, you may be at a disadvantage (perceived or real) if you do it unilaterally and the other guy takes shots at you. You could have your own bash offsite and invite all your current prospects and customers and provide transporation both ways. For the cost of a pathetic little unmemorable booth, you could show quite a few people a great time in a restaurant or bar. Or, as I always happily recommend, bring in D-list celebrities ("An Evening with Ron Palillo"), hookers ("Christi Canyon debates Mr. HIStalk on clinical integration,")  or ex-jocks ("Mr. Montana, can you make it out to my son?") However, HIMSS makes that hard because they (and your competitors) lock up many of the good venues. I'm really interested in this topic and I know many vendors (especially smaller ones) are, too, especially given the dearth of booth space in San Diego. Let me know what you think. Maybe we could get together and have an HIStalk Lollapalooza with all those weird bands I like. Ever see a CIO mosh?

From Anonymous Reader III: "Why can't giant companies put together better HIT than 2 docs, 5 developers, and a DBA? Big companies acquire small ones with (often unrealistic) expectations of short-term payoff. In order to convince their managers (who often know little or nothing about HIT) they have to make a business case for acquiring some HIT 'piece of the pie' that is better than, say, investing the money in new MRI machine features or a new line of light bulbs (or whatever).  Having accomplished this, it's all about reaping as-short-a-term-as-possible revenue from the acquisition. None of those above want to hear about integration beyond training the sales force on the new product and adding it to the marketing collateral. It will hurt margins. So the biggest companies have the least integrated product lines. It's not that they don't have the resources. It's that they're not willing to invest them strategically. The founders of the acquired company (and their IP, healthcare knowledge) leave, become cynical, or are marginalized. And the suite remains IOPO (Integrated on Powerpoint Only)."

From Fish n' Chips: "It amazes me. Highly experienced LastWord/Carecast consultants (non-IDX) get sent back to the states in an effort to save a few 'bucks', meanwhile BT is looking at multi-millon pound fines."

Important tee shirt issue: several readers suggested having buttons made up instead. Reasons: (1) low cost means someone might be willing to hand them out free from their HIMSS booth; and (2) some companies have policies against wearing tee shirts but are OK with buttons. I like the idea ... do you? Would you wear a button, would anyone care if you did, or would I be wasting my money?

I've gotten a couple of comments over several months that the CIO salaries I run are too low. They come from the IRS Form 990s, but maybe hospitals have gotten wise to the management team's "dammit, the local paper printed all our salaries again" issue and put teams of intrepid, dashing CPAs on the task to hide the money as outside management fees or something. I worked in a hospital that ill-advisedly went to the public with hat in hand for ED funding, moaning that circumstances outside of their control (mostly legislative) made it imperative that all the surrounding counties pledge their dollars to keep it open (while internally, those with access to the books knew it was darned profitable as a service line.) The predictable result? The local paper printed the salaries of the CEO and several VPs on the front page, along with scathing editorials demanding that we open up our books to show them just how bad our self-proclaimed financial plight was (and why our airspace was dark with cranes adding fancy new buildings.) The veeps panicked and were sent out to meet with the peons (a rare event) for damage control, given that the ever-present unionization fear was at near-hysterical levels. The squirming VPs assured everyone in confidence that the paper was full of crap and that all of our execs were, in fact, nearly destitute and homeless, making laughably less than the amounts we filed on the IRS forms (how could that be?) Most common VP podium adlib: "I wish I made that much." What most employees thought: anyone who's that embarrassed by their salary must not be worth it. The next year, salaries got a lot lower, at least on the 990s.

Reader TV recommendation: My Name is Earl. I liked it pretty well, but need another ep or two to decide. My choice: the ever-hammy Bill Shatner in Boston Legal. They snuck in a Klingon joke last week, making it worth suffering from their intentionally goofy camera angles and rapid-fire cutting required to keep the MTV generation from tuning out.

Cerner will connect Millennium to the SureScripts e-prescribing network.

Interesting phenomenon: instead of making a diagnosis, doctors are wasting time "de-diagnosing" patients who study Internet sites and visit the office only to get the prescriptions they've decided they need. That's a good argument for evidence-based medicine and clinical content, since some stuff on the web is probably more current than the practice of many physicians (according to studies concluding that docs practice like they did right out of med school for most of their careers.) Maybe we need a new taxonomy of medical knowledge that can quickly be updated with singular facts obtained from medical literature with creative linkages. If you've ever looked through a medical article as a clinician, you're looking for the facts (and making an impression as to their probably validity, their applicability, and the ability to be generalized.)

Gerry Hogue, founder of oncology system vendor OpTx (acquired by Varian) is named VP of their former competitor IMPAC.

GE announces Q3 numbers. Revenue was up 9%, earnings up 15% to a record $4.7 billion. Healthcare orders were up 8%.

Blogs are good for personal therapy. Assume I need that kind of psychological benefit if I write something personal or off-topic. I get e-mails containing polite recommendations (appreciated) and nasty demands (ignored) on how I should write HIStalk. If you want a soulless, zipless read, there's plenty of snoozefest alternatives out there. Otherwise, what you get here is me being me. Maybe that's not for everyone.

An interesting article on healthcare costs in Vermont says it's tough to get consensus on cost-cutting when healthcare provides 10% of the state's jobs. "'For every job at the hospitals and related facilities, approximately one job is created in the state economy,' a report commissioned by the Vermont Association of Hospitals and Health Systems says. 'The people who work directly for the hospital receive paychecks, which they then use to purchase goods and services in the region's economy. This demand for goods and services, such as groceries, apparel, automobiles, appliances, and housing in turn, creates other employment in the region's economy and further stimulates economic activity.'"

An Illinois hospital and a former medical staff member are locked in a legal struggle. The plastic surgeon claims his privileges were revoked after he opened a competing cosmetic surgery practice. The hospital says he didn't provide the information they asked for. Strangely, the hospital hired an attorney best known for suing hospitals and physicians.

IDX founder Rich Tarrant officially announces his candidacy for US Senate from Vermont.

Zynx announces two new products: ZynxOrder for order set maintenance and ZynxEvidence for QI reference.

Could iSoft be brought in from the bullpen to bail out BT from their NHS delays?

News, rumors, and the like: e-mail me.