Monday Morning Update 11/5/07

From Matthew Holt: "Re: millionth visitor. Inga, I wish I was as clever as you thought I am! I'm just feeling guilty that I'm speding too much time working and not enough flying my  paraglider. BTW why doesn't Mr HIStalk make his Sitemeter logs public?" Easy answer on Sitemeter: I'm trying to stay anonymous and Sitemeter would display my IP address, location, and (if I got on from work), my employer to the world. That actually happened once before (a vendor told my former employer) and I'd rather not deal with that again. I can't imagine what's in there that would interest anyone since it barely interests me, other than to see who's linking to HIStalk.

From hit-investor: "Re: athenahealth. Guess the street liked ATHN's earnings as it popped almost 11% on Friday to a 52-week high. Folks like their recurring rev model and SaaS network approach compared to Allscripts and Nextgen, which do not have a network strategy - hence lower valuation, not to mention these guys keep missing their numbers." I must be jaded by Google since I thought a 33% revenue rise was just OK. But, they're making money out of the gate and that's unusual. I can see why the model of making money only as a small percentage of what your customers get is attractive (why would anyone cancel?) It's certainly refreshing to see that instead of the usual "give us $20 million and we'll send you some CDs" approach. I think the message is that a company willing to go on the hook with their customer for the expected benefits can do very well. But, athena's system is plug and play and creates benefits automatically, while most hospital systems contribute only maybe 10% to the expected outcome (process change drives the rest). Think of it as HIT insurance: with traditional systems, your deductible is very high. The value of the shares Jonathan Bush still owns: $36 million.

From Lazlo Hollyfield: "Re: MGMA. The vendor hall was pretty sparse (tumbleweeds last Sunday and late Tuesday afternoon) and heard some grumblings from the vendors about it. Nowhere near the level of HIMSS. Seems that vendors had to do their work ahead of the show. Two positives, though. The leads are usually high quality and legit. Plus, a bunch of vendors mentioned that it great a great opportunity to concentrate on B2B relationships and see if there was anything really innovative. The conference attendees are mostly physician practice executives, but I didn't see a bunch of practice executives who were MDs. Mostly business people. Seem much more savvy than your typical physician practices, though. They have already installed an EMR or are in the process of installing an EMR. Interested in a few topics educational topics and mainly socializing. Biggest themes I heard repeatedly mentioned and discussed: real-time claims, P4P, Medicare cuts, and patient-centered practice." Thanks for the report. I always wondered why doctors don't get someone else to manage their practices (other than their wives or mistresses, anyway) because they're usually terrible businesspeople, despite their own flattering self-assessment. By the way, I'll be posting my interview with "house call doctor" Jay Parkinson in a day or two. He has no office, no staff, no equipment, and takes minimal insurance, but he's doing very well and enjoying his practice. He's fun, and about to become a TV personality, as you'll read shortly.

From Kip Wilson: "Re: Sunquest anonymous customer. The name is anonymous because this client does not allow their name to be used in public press releases. This client is in a big city in a rust belt state on one of the Great Lakes. Sunquest people tell me that they researched Cerner, Eclipsys, Epic, etc., and that these firms sometimes have press releases without company names, too." It makes a crappy press release no matter who else is doing it. It just looks desperate to announce a sale in which the customer refuses to be named (how do we know it's legit? how impressed should we be without having any details) Maybe they should include the CIO's picture with a bag over his or her head.

From Frank Poggio: "Re: how to market IT internally. 1) stop pushing technology; 2) stop pushing departments to a 'single' solution and focus on their needs first, IT's second; 3) get out into the departments and learn/understand their issues; 4) then, propose solutions, not technology; 5) if they don't 'see' the solution as you do ... go back to #2."

From Isabelle Hammond: "Re: terms. Any comments on the recently announced project funded by the Office of the National Coordinator to create consensus definitions for the terms  EHR, EMR, PHR, HIE, and RHIO? Think it's needed, or just nonsense? I've already heard that some folks at HL7 aren't pleased about it." Seems like a harmless waste of taxpayer dollars, I guess. While we jaw about the differences between EMR/EHR and HIE/RHIO on HIStalk, is anyone really all that confused, to the point of "impeding progress" as ONCHIT's Karen Bell suggests? Is that why RHIOs (or is it HIEs?) are failing?

Speaking of NAHIT's terminology project, the press release itself is loaded with business-babble BS (not a good sign for a terminology project announcement). My Bullfighter software summarized as follows: "Diagnosis: You overwhelmingly embrace obfuscation and don't want the reader to understand anything you have to say. Your writing lavishes a preponderance of dependent clauses and compound negatives upon the reader, whose cognitive load not infrequently exceeds the purported benefit of the substance of the article. Syntax incorporates numerous collections of items juxtaposed or in series that demand persistence and not a little unqualified expertise on the part of all intended recipients of the author's communications. In fact, such machinations inevitably prove detrimental to comprehension and sabotage the imparting of any and all knowledge. Your condition is irreversible." NAHIT's marketing person is running the project and an outside group is providing "collaboration tools and services" (guess e-mail and the telephone can't meet the demanding needs). Apparently, defining five ubiquitous terms is a daunting challenge.

From Gunsmoke: "Re: Perot layoffs. To be accurate, Perot Systems did announce 650 layoffs in their press release: 'These actions will include the termination of employment of approximately 650 associates.' The number 425 is also mentioned later inthe release as being 'beneficial to future earnings.' I'm not sure what that says about the other 225!"

People keep writing about Misys Connect without understanding what it is. It's not an EMR, a practice managment system, a portal, or anything that would interest a physician. It's a connectivity tool that uses the federated model (you decide with whom to share your practice's data). What a doctor would need to use it: (1) an EMR (big hurdle right there); (2) an interest in sharing information with somebody else, like a hospital (maybe an even bigger hurdle); (3) technical resources to get it connected, especially if your EMR isn't Misys (Misys hopes to profit from either the resources or the Misys EMR option). Also what it isn't: likely to spur EMR adoption.

Booked my HIMSS hotel this week. I'll say one thing about Orlando: hotels are cheap. I've also got a potential sponsor for some kind of HIStalk reader event, details not yet determined. It never occurred to me that someone might want to help out, so I appreciate that and I hope it works out. I've also received some good PR ideas, some involving strippers (those suggestions always catch my eye).

I'm still playing Love's live "Forever Changes" concert album nearly constantly. Want to see the 58-year-old Arthur Lee (now deceased) rocking a festival crowd in Europe with his 36-year-old music? I've played it at least 100 times and I'm still amazed.

A JAMA reader editorial called "The GAAP in Quality Measurement and Reporting" says that standards for quality reporting need to be better defined since public reporting puts money on the line (and therefore encourages favorable self-interpretation). Also mentioned: some widely used measures don't correlate well with outcomes, checking a box that smoking cessation counseling was done says little about its quality or impact, and having an order for DVT prophylaxis isn't the same as knowing it was actually given every day. Thanks to CMIO Mike for sending it my way.

The set of TV's Grey's Anatomy now features Epic Systems, which provided screen shots for the show's hospital computers. 

A New York health official says EMR systems, including CCHIT-certified ones, are missing four features needed for population-based health: structured data collection, the ability to create registry lists, built-in quality measurement, and decision support tools. It says it's working with its unnamed vendor (eClinicalWorks) to implement those features.

Virtua Healthcare (NJ) claims its planned $500 million medical campus will transform healthcare. Mostly it sounded like tablet PCs, cameras in rooms, and patient records access. Half a billion dollars for 368 beds is quite a Taj Mahospital, but after all, they had to have a hotel and conference center. GE's providing the IT, which apparently caused doctors to get giddy with anticipation for all the time they'll save (we'll check back later).

Siemens is restructuring worldwide, with thousands of layoffs coming. You're too late if you didn't already get your bribe.

A New Zealand hospital loses everything on its storage area network when two disks fail.

Odd lawsuit: a dentist's drill bit breaks off during a tooth extraction. He tries to pull it out, but pushes it through the patient's sinus and lodges it near her eye. The patient claims he told her she would sneeze it out eventually, but then told her to go the ER. The woman claims the dentist was dancing to the song "Car Wash" that playing on the radio at the time.

Philips will sell its 70% stake in transcription company MedQuist, for which it paid $1.2 billion in 2000 (now worth about 75% less). Philips has figured out how to make millions in healthcare IT: start with billions and wait for the accounting scandal. You know Nuance will be all over that one.

E-mail me.

Inga's Update

Misys’ Center for Community Health Leadership selected Tampa Bay for a $3 million software grant. The grant will be used to accelerate EHR adoption.

Speaking of Misys, their top guy Vern Davenport is quoted in Health Data Management as saying building community connectivity before most physician groups have implemented EHRs “is solving the wrong problem.” Now we know why Misys is giving away Connect! I guess Vern realized the reason no one was buying Connect was because communities didn’t any doctors for connecting. So, why not give away a product that doesn’t solve the right problem?

Boston-area Healthcare South selects Nightingale for their EMR/PM ASP solution. Healthcare South is a 45-provider group practice and over the next 2-1/2 years will pay $475K, plus training and implementation costs.

Eclipsys Sunrise Clinical Manager and Sunrise Pharmacy are up and running at Trinitas Hospital in Elizabeth, NJ. Trinitas is using Eclipsys’ remote hosting services to process more than 6,500 orders daily.

Summa Health Care is also operational on Eclipsys Clinical Manager and Knowledge-Based CPOE. Summa claims more than 95% physician adoption after four weeks of use. Summa has also collected some interesting before and after stats, both clinical and financial.

Third quarter results for Eclipsys: revenues up 11.5% over Q3 2006. Net income was $8.9 million or $.17/share compared to $5.6 million and $.11/share last year.