News 11/16/07

From HIT Insider: "Re: Sutter. Haven't seen this article on Sutter Health wasting millions on its Epic installation yet." Link. Sutter's original estimate to install Epic in six hospitals: $150 million. Current estimate: $500 million and going up. Nearly $100 million for one hospital? Says they learned from Kaiser's mistakes.

Mr. HIStalk's universal rules for big EMR rollouts:

1. Your hospital will pledge to make major processes changes, vowing to "do it right" unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won't use it like you think, if at all, because hospitals are one of few organizations left that doctors can say 'no' to.

4. You'll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor's exaggeration first sees the harsh light of day in some analyst's cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You'll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor's 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You'll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you'll refused to apply them because you're scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

From Dastwood Biouf: "Re: AMIA. AMIA's annual meeting wrapped up this week in Chicago. It had over 2,000 attendees. AMIA still has a reputation for being full of pointy-headed navel-gazers more concerned with abstract topics than solving real-life issues in health care. If that was ever true, it’s certainly not now. The academic rigor is definitely there, but the focus is on everything from dealing with vendors to doing clinical decision support in distributed health information networks. Other highlights were a demonstration of context-sensitive “infobuttons” linking from EHRs to knowledge resources like UpToDate using the new HL7 Infobutton standard and a discussion of privacy policies around RHIOs. Oh, and also an announcement and panel discussion about AMIA’s latest initiative: establishing Applied Clinical Informatics as a formal medical specialty. Good stuff all around. AMIA is a great organization that deserves to have a higher profile than it does." I've started to join a few times, but I always balk at the $250 a year. That darned HIMSS has set the bar high by selling out to Diamond Members, thus keeping dues for the little people low in the process. AMIA's still worth it, I think, so I may pony up.

From Tom C. "Re: Eclipsys. Cardinal Health may buy Eclipsys. Cardinal likes the way McKesson is leveraging the old HBOC division." Bet they liked it even better back in 1999, when their arch-competitor took it in the shorts as the HBOC house of cards finally collapsed, wiping out $9 billion of market equity in one exciting day and forcing the writedown of hundreds of millions of dollars worth of fictional accounting.

From PoBoy: "Re: Healthvision sales price. Quovadx determined fair market value is $7.42M. After payment of @ $4.87M of Healthvision's indebtedness (primarily to VHA and a bank) and @ $1.23M of transaction expenses in connection with the merger, the remaining net equity value of Healthvision is @ $1.32M. Healthvision's Series E Preferred Stockholder was entitled to receive the entire net equity. None of the other stockholders were entitled to receive any proceeds." I assume General Atlantic was the stockholder, but I was too lazy to look it up. And to think that, according to Scott Decker, it had a value of between $1 and $2 billion back in the dot-com days. Like he said in my interview, too bad they didn't go public quickly then.





Pictures of Kiowa County Hospital in Greensburg, KS from May 4, 2007, from a presentation by administrator Mary Sweet. 68 employees lost their homes. That bottom picture is of HIM, yet 95% of the paper records were saved because a cement wall fell on them and protected them. Her tips: have a plan to bring in storage pods if needed, make sure the building code footprint is current, use employee picture IDs with an extra copy kept at home, develop plans to save vital items, have contracts in place for temporary buildings and bathroom facilities, make sure patient beds fit in the elevator, and don't keep your backup tape across town - the tornado's 200+ mph winds destroyed 95% of the town and the tapes, too. Pictures of the town are here. Ten people were killed. Sad.

Was I the only one who didn't notice that consulting outfit Kurt Salmon Associates sold out to a UK consulting company last month for $125 million?

I got wrapped up watching Eric Fishman's videos showing Dragon NaturallySpeaking working with several EMR products in several specialties. Though the speech recognition part is cool and it's clear that it works really well (you actually see the narrator's voice dictating and running the app), I liked being able to see someone actually going through eClinicalWorks, e-MDs, etc. so I could see what their screens looked like. Putting those out there was pure genius - seeing speech recognition driving the screens is fun.

I'm hearing that Dairyland laid off around 30 people this past Monday, with developers, architects, and PMs the hardest hit. This could be like a sports trivia question: what CEO laid off dozens of people at two different companies in the same year? (answer: James Burgess, 2007: Mediware and Dairyland).

The Healthcare IT Transition Group guys amuse me yet again (no, they're not a sponsor - I just think they're funny). Marty covers the CCS conference from Beverly Hills. In a wickedly funny summary, he postulates that Canadians live longer because all meat keeps better in the freezer, describes Eclipsys CEO Andy Eckert as "... like the guy in high school who was both valedictorian and captain of the football team. The kind of guy who you just couldn't help liking, even as he drove off with your girlfriend in his red Camaro.", and Jonathan Bush as Alex P. Keaton with ADHD and a software company ("he chewed up the scenery like William Shatner on steroids.")

McKesson Provider Technologies is criticized by the health department for moving quickly out of its Queensbury, NY building after an employee claimed to have Legionnaire's Disease. The health department says no one has reported the disease as the law requires, the landlord has been told nothing, and the health department said McKesson had been "less than forthcoming."

Former Duke University associate CIO Iain Sanderson is named CMIO at Health Sciences South Carolina.

EHRVA releases a free quick start guide for the Continuity of Care Document standard.

Misys tries to drum up some enthusiasm for the iMedica EMR it licensed. What it says: some resellers said they'd sell it and some MGMA attendees saw it demonstrated. Not well written: the headline is a dead giveaway for the commercial that follows and it lapses into the first person in the eighth paragraph as though some unseen press release god suddenly began speaking to you directly from your monitor. Bet they didn't feature as many compliments about the same system when iMedica was selling it against the old Misys warhorses (like this one, in which a practice paid over $150,000 to get five doctors on Misys).

Medsphere hires Edmund Billings, MD as CMO, who appears to have bailed out of medicine early in his career to start IT companies (like Oceania). I don't know that I'd have made him CMO, but maybe a marketing or development guy. He'll be a good asset to them nonetheless, I suspect.

Cardinal Health announces a 340B software package.

Ambulance chasers file a class action suit against FCG for taking $365 million in cash for the company. It's not enough, they say, despite the 30% premium to market price at the announcement. It was not mentioned whether they kept a straight face.

HIStech Report has caught the eye of a few companies and PR firms. I'm not making a pitch, but simply mentioning that companies who are interested in the pre-HIMSS period of January and February contact Inga stat because we're going to book it up fast, I think. We'll have a "Mr. HIStalk Goes to HIMSS" writeup that accompanies it, I think.

MediNotes says its small-practice EMR system interfaces with 76 practice management systems. My interview with CEO Don Schoen is here.

EnovateIT announces an agreement that gives Language Access Network the right to provide its two-way video system to EnovateIT's 1,100 hospital customers.

Pioneers Memorial Hospital (CA) chooses Optio's document-based EHR.

IBM will acquire Cognos for $4.9 billion in cash. Pretty much all of the BI companies have been swooped up except privately held SAS. They're probably next (Oracle?)

It's a holiday coming up, and one of few that somebody doesn't protest about. I've got planning to do (HISsies, the HIMSS get-together we're hoping to put on, and the announcement of a new service in the next handful of days). I'll still be writing here, of course, since that's what I do. If you're heading out of town, be safe and enjoy the time with your family and loved ones.

E-mail me.


Inga's Update

Larry: Regarding your comments on Allscripts third quarter projections and the question: Do you think the ambulatory market is slowing? I think that it has to do with Stark relaxation. My guess is that 1) physicians/groups are not buying as much because they are waiting to see if the hospitals will foot the bill and 2) hospitals/health systems take longer to make decisions and are still planning their strategies and budgets.

I think those are pretty good guesses. Hospitals establish strategies years in advance and many were not anticipating needing to have a strategy for offering EMR to community physicians. Those strategies and budgets are not created overnight.

A UMass Memorial Center doctor is arrested for soliciting sex, but claims he was just gathering information on STDs. No word if his wife bought that story.

La atención oradores españoles: Averigüe UnBuenDoctor.com, un nuevo sitio web del español Idioma que permite a usuarios a buscar para la información de asistencia sanitaria y recursos.

Chuck Noland and his buddy Wilson might have liked this. Telemedicine comes to Tristan da Cunha, a remote island 1,665 miles off Cape Town, South Africa. It is only accessible by boat and it takes a week to get there. But, thanks to IBM, UPMC, and Beacon Equity Partners, the island’s only physician can get advanced medical assistance when caring for the 270 residents. I am adding this one to my list of places Mr. H can send me for interviews (once he gets his $2 billion for going public.)

Speaking of UPMC, the Vatican blesses its merger with Mercy Hospital.

McKesson will provide PACS for 22 Shriners Hospitals for Children. I love the Shriners. Not only do they wear cool hats and get to ride funny bikes in parades, they provide free specialty pediatric care. Love it.

Virtual Radiologic Corporation, a provider of remote diagnostic image interpretation services raises $68 million for its IPO. Rob Kill, former Misys Physician Systems president, is Virtual’s president and COO. Bet he is happy how things turned out for him.

E-mail Inga.