Monday Morning Update 2/18/08

From TenaciousD: "Re: CHOP CIO. I hear the CIO leaving may be due to the Epic EMR implementation taking too long and supposedly going to the board for another $25-30 million to finish it. They signed with Epic in 2003 and have very little to show for it." Unverified. TD also says that he's hearing that Judy Faulkner is spending time in France wooing a potential global client for Epic.

From Steve Stifler: "Re: Microsoft Amalga. Here we go again ... Let's see, in my 30-plus years in HIS, we've had only a 'few' system vendors try this. NCR, Honeywell, DEC, Oracle, SAP, and, oh yes, IBM (several times, as I recall). Basically the hardware guys (now the op systems guys) come to the conclusion that the apps people do not know how to do it right, so we'll show 'em. Can Mr Softie succeed where these behemoths of their day could not? In my opinion, not likely. It takes a lot more to succeed than a big wallet and a big name. Maybe they are NOT shooting for the US market, but international, where HIT is far less mature (intractable?)"

From Jim Levenstein: "Re: Eclipsys earnings call. They mentioned Sunrise 5.0 and its integrated revenue cycle. Anybody have feedback on that release?"

Not HIT-related, but something cool I ran across: MightyJack, a tiny box with a USB plug on one end and a standard phone jack on the other. Unlimited calls to the US and Canada using a regular telephone run $20 a year ($40 for the first year including the box itself), including an answering service that works offline, an incoming number, and other goodies. Skype-killer, highly rated from what I saw. I was thinking about setting up one of my old PCs as a "phone server," just running a broadband connection, MightyJack, and a cordless telephone base. You roadies could take it along and save your cell minutes. I use a Skype-powered VoIP phone on my PC and laptop, which works fine, but unlimited calls run $36 a year, an inbound number is extra, and there's no offline answering capability.

A reader sent over a CPOE study on error reduction in response to my comment that clinical systems don't ever seem to reduce the cost of healthcare to patients. I don't doubt the study, but it wasn't as broad as I wanted. Hospitals always tout their IT, but never do a rigorous study to prove that systems (a) improve care, and by that I mean broad-based outcomes like mortality or quality of life measures, not just task improvement; or (b) truly save money to the point that the hospital passes those savings along to its customers (certainly many factors impact this, but why spend millions if you don't expect to save at least as much?) Anything else is nice, but secondary. Like those prognosticators who said we'd all be working five hours a week because PCs would make us so efficient, I'm not buying it in many cases (and it's not the vendors' fault: it's up to hospitals to buy the right ones and use them to get the job done). You wouldn't use a drug or medical device without clear-cut evidence of its effectiveness and benefits, but nobody expects that with IT because hospitals can't abide reproducible processes (except Licking Memorial Hospital, which earned ISO certification in 2005 - anyone know how that's worked for them?)

Right as I ranted above, I ran across this article (warning: PDF) that looked at mortality in ESRD patients pre- and post-EMR implementation, finding big reductions in mortality and cost at a dialysis unit affiliated with New York Presbyterian. Their system was Disease Manager Plus from MIQS. I need to study the article a bit more.

I can't explain who needs to know or why, but if you have a C-level contact for any potential big player PHR vendors, let me know.

E-mail me.


Sponsor Updates and Housekeeping

HIStech Report interviews: Design Clinicals,  EnovateIT, Healthia Consulting, McKesson Horizon Enterprise Visibility, PringPierce Executive Search, Sage Software, Stratus Technologies, The White Stone Group. You can download PDFs with full information from each interview. Also, seem my HIMSS page with reception info, giveaway locations, and writeups about companies that support HIStalk (or download a PDF to print and take along).

Jobs: Practice Director - McKesson Practice, Precision 2000 Support Analyst, Senior Consulting Manager, Network Analyst. One of our listing employers said they were inundated with responses to their HealthcareITJobs.com  listing, so we know folks are reading. Thanks.

Welcome to new HIStalk Platinum Sponsor Greenway Medical Technologies of Carrollton, GA, whose PrimeSuite EHR earned Best in KLAS 2007 for ambulatory EMR in 6-25 doc practices. It's also CCHIT certified through Ambulatory 2007. Other products include PrimePatient (patient portal), PrimeExchange (interoperability), PrimeResearch (clinical research networking), PrimeMobile (mobile desktop), PrimeARM (revenue cycle management), and extensive services and support. They must be doing something right since Q2 sales just announced were up 52% over 2007 and 83% over 2006. I notice they have lots of good Southerners on the management team, so I'd say drop by their HIMSS booth at least for some high-bandwidth conversation about barbeque or college football (Georgia vs. Georgia Tech or Auburn vs. Alabama should raise the intensity level). I love the South, so I may lead the discourse over sampler bowls of grits for you Yankees and Left Coasters. They're in Booth # 1263. Thanks to Greenway for supporting HIStalk and its readers.


Art Vandelay on "Buy and Develop"

Dale Sanders had post mentioning Northwestern's "buy and develop" strategy. I agree with this concept. It is a practical means of delivering a full solution when using a broad "big box" system (ex: Cerner, Epic) in a large organization. Any vendor has functional deficits. There are four ways of dealing with deficits – a manual workflow, suck it up and use the system, use a best-of-breed system, or develop a system in-house. For major deficits in an area, using best-of-breed systems is a common approach (for ex: surgery, ED). For minor functional deficits or cross-area workflows, in-house development appears to be on the rebound.

Examples of cross-area workflow issues include the management of clinical pathways or discharges from care settings. An example of a minor functional deficit is information exchange. To resolve these issues or deficits, organizations are turning to vendor's software development kits or web services. A very recent example of this is UPMC's Smart Room. UPMC has enabled a unique workflow by using multiple vendors' services and some custom development.

This type of in-house development has been common outside of health care for some time (for ex: with major ERP systems). The challenge is maintaining the integration as the systems evolve. I am optimistic that organizations will be open-minded about using development to address functional deficits and workflow issues.

Inga's Update

St. Francis Health Center, part of the Sisters of Charity of Leavenworth Health System, is implementing (warning: PDF) eWebHealth’s EHR.

HCA selects PatientKeeper’s integrated patient portal, which will  integrate with its Meditech systems plus a wide variety of others.

This article suggests that at least one major Mediware shareholder is using the board of directors to put the company up for sale. Apparently Cannell Capital, which owns almost 13% of the company, sent the board a letter illustrating how cheap the company was on both an absolute and relative basis.

Merge Technology announces its “rightsizing” initiative, which is just a fancy way of saying they are laying off about 160 people worldwide and not replacing another 20 who left due to attrition. Forty-five of the affected are in North America with the other 115 are offshore. The final "right size" for the workforce appears to be 440. The changes are expected to save Merge about $12 million this year. Merge is also closing its Burlington, MA office. I checked out the salaries of the top five execs for Merge and was pleased their total pay (at least in 2006) averaged a reasonable $238K. 

E-mail Inga.