News 3/7/08

From Caryoutsider: "Re: Allscripts. What's going on? Stock keeps going down, down, down." Shares closed at $9.82 today, dropping the market cap to $553 million. You voted Allscripts Most Likely to Be Acquired in the HISsies, maybe showing some psychic ability if the trend continues (although I'd bet they would go private first). The PE's still at 31, so it's not necessarily cheap even at that low price. It was well over $25 a share in November. The old-line PM/EMR companies are getting pounded by eClinicalWorks and others like them (cheap and fast to implement) and Stark hasn't had the impact everyone expected (because free isn't cheap enough if a doctor doesn't want an EMR), so despite lots of interesting ideas and technologies and great leadership, they're playing on someone else's home field.

From Nasty Parts: "Re: Allscripts. I'm hearing a lot of news from a variety of sources regarding a potential acquisition of the Misys Ambulatory division by Allscripts. I've heard it from different high level sources which leads me to believe there is something afoot. Of course, with Allscripts stock under $10/share, I'd think *they* would me an attractive target right now." I heard that before, but it hasn't panned out yet. Allscripts needs to get its own house in order before buying the fixer-upper next door. Misys seems happy to sell relabeled iMedica, so I'm not sure they're looking for new worlds to conquer either. I can't what to hear what eCW's Girish Kumar has to say when I talk to him next week given how accurate his predictions two years ago were.

From Greg Tourniquet: "Re: CIS failures. AMIA keeps talking about the value of publishing CIS failures and lessons learned. There is a formal initiative that we can look forward to: A group of battle-scarred CMIOs is writing a book; they recently put out a request on their listserv for 'tales from the trenches.' This was the request: 'We are going to share our multidisciplinary IT stories in a book called 'Gain Wisdom From Failure - Lessons from HIT Projects that Missed their Marks'. I will ask the CMIO leading this effort if he wants input from our peeps." That's what the industry needs. That plus an assessment tool that I've advocated previously: a readiness checklist that would tell a hospital how high it should set its sights, i.e. if the culture and change management capability is primitive, don't run off and buy a $50 million clinical system - stick with ancillary department task automation, data analysis, and integration and call it a job well done. The money wasted by the hospital industry on ineffective IT implementations is embarrassing. It's not the vendors' fault - nobody made them buy - but they consistently underestimate the challenge despite ample available evidence. I'd buy that book.

From Mr. Underhill: "Re: discussion comments. I truly enjoy HIStalk. I don't think there's anything like in healthcare IT and your numbers and popularity just seem to keep climbing. One interesting observation, and you might agree, is that for all the site traffic, news, and rumours, it is predominantly you keeping us informed. What I'm saying is that with all that traffic there seem to be very few comments made in the discussion area.  It seems that so many people use it as a one-way communication tool. I'm as guilty as anybody, as I can't wait to read the latest edition when it arrives." That used to bug me, but I realize I'm the same way. Most of the time, I wouldn't want to interact either. I'd just want a quick read, summarized by someone who knows what's important, with a little humor and rumor to keep it interesting. I'm happy to get comments, but I don't count on them. Inga and I are flabbergasted at the number and quality of readers we have and we take our responsibility seriously. It's a lot harder than it looks, but a lot more fun, too. And yes, the visits are off the charts after HIMSS, I'm happy to say (thank you, Fake Ingas and sponsors).

From Mrs. Peele: "Re: ROI. I noticed the student looking for help with an ROI on an EMR. The HIMSS book, Medical Informatics: An executive primer, has a good intro to the technique for an ambulatory EHR in chapter 6." Thanks for that.

From The PACS Designer: "Re: Jott. TPD has found another new web-based tool that may be of value to mobile and other system users. It's called Jott and allows users to record voice messages that can be converted to text much like HIStalk sponsor Dragon Naturally Speaking. Jott converts your voice into e-mails, text messages, reminders, lists, and appointments." Link.

My annual reader survey is here if you'd care to opine.

I'm a huge fan of Snag-It, which captures screen shots but does about a zillion other things for next to nothing. Their newsletter has an article on its use in radiology at Cincinnati Children's, where the rads use it to capture PACS images for PowerPoint and teaching files. I've only run across a handful of life-changing computer applications and Snag-It is definitely one of them (non-profits get a discount, by the way, and I'm not a compensated endorser since I bought my copy like everyone else).

The Healthcare IT Transition guys report that the HISsies cartoon has been downloaded over 1,400 times. Maybe next time we'll do a reality film a la Blair Witch Project, featuring some hospital people hopelessly lost in the HIMSS exhibit hall and stalked by a salesperson.

Speaking of the HITTGers, they videoed a Webinar they put on last fall that addressed "surprise" ROI that came about when implementing systems for patient safety. Per Marty, "We did a study of the literature and found scads of examples of HIT systems that paid for themselves. We only looked at provider-reported stories. If it even smelled like a vendor PR fish was hiding under the paper, we pitched it." Marty's offering our grad student Jerry Rivers a peek, so Jerry, e-mail Marty while he's feeling educationally benevolent.

Shares in athenahealth nosedive after the company announces Q4 numbers: revenue up 35%, EPS $0.06 vs. -$0.58,  beating analysts' estimates but not their expectations. The stock finished down 22.2% today. Ouch.

I always like the objective analysis of Vince Kuraitis, so I recommend his comparison between Google Health and HealthVault.

Joe Conn of Modern Healthcare writes about the Cerner HIMSS pullout, confirming from HIMSS that Cerner wanted to run what HIMSS CEO Steve Lieber admits would have been an "innovative" education program, but one he denied nonetheless because HIMSS policy doesn't allow vendors to hold events unless they exhibit. I know what Cerner was planning and it's a darned shame that HIMSS is so terrified of losing its boat show cash cow that it won't allow education as an alternative (check the schedule: you can go all day long, yet still only attend five hours or so of actual education because that interferes with forced trinket-harvesting and tire-kicking). HIMSS locks down the entire Convention Center ground zero - every meeting room in every hotel - using its Exhibitor Point system (warning: PDF) to ensure that financial homage is paid. It's entirely non-coincidental that there are 30 education sessions going at once, then suddenly a big block of empty time that compels you to Neon Gulch. At least it keeps the dues cheap.

Speaking of bad HIMSS decisions, how about that "Chicago next April" idea? I checked weather records for April 4, the opening day of the conference next year, at the 8 a.m. opening session time: 2007, 31 degrees and snow; 2006, 39 degrees and snow; 2005, 30 degrees and no snow; 2004, 23 degrees and no snow. I'm not sure who loves Chicago enough to look forward to that, but I suspect they already live in Wisconsin or Minnesota (or work in the Chicago headquarters of HIMSS). Coat check girls can't wait and neither can exhibitors, who hate to see a sunny, warm day because people don't hang around those mission-critical booths for hours at a time (say, you don't suppose that HIMSS would intentionally ... no, surely not).

I'm with Cerner on this one, but I still like the potshot Todd Cozzens of Picis took in Joe's article, speculating the same as I did earlier: "To me, it’s a sign that their growth in the U.S. market has tapped out; they don’t see a lot of green-field hospitals in the U.S. The fact that Neal is not being there and being in Europe means he’s run out of runway here." I think that's most likely true, still another reason to avoid selling your soul to Wall Street. It's tough to run an R&D intensive business that sells mostly to non-profits and still keep the money guys salivating.

Cerner will distribute cancer care guidelines from the National Comprehensive Cancer Network.

RemoteScan offers TWAIN-redirection software that allows scanning into a Citrix or WTS application.

David Brailer's private equity has quietly invested $100 million in healthcare companies, but says he's smarter than everyone else and won't share details. He's bringing in more state pension funds as investors. He's sounding kind of smug these days.

A New Zealand health board gives up trying to recover vital SAN backup data lost in an unspecified incident last year.

Larry Stofko, CIO of St. Joseph Health System (CA), whose wife is fighting cancer, provides a WSJ opinion on PHRs.

That made me think of something someone told me once: why don't patient care systems store PHI in a database that requires an encrypted patient ID key to access? In other words, nothing in the database identifies the patient except a gibberish key that can be unlocked only by the application's front end. If you don't store identified data, you can't lose it. Today's systems were designed for access and not security, of course, but it doesn't seem that hard.

Midland Memorial Hospital (TX) hits HIMSS Analytics EHR Stage 6 on Medsphere OpenVista, one of only nine in the US. Like I've always said, it's not what you have, but how you use it. Dozens of millions vs. free - which is the bigger risk?

A private equity firm will buy Tunstall, a UK telehealth provider that's a member of the Continua Health Alliance, for just over $1 billion.

CompuGroup buys Fliegel Data, a German HIS vendor.

Axellis acquires three medical software vendors in oncology and cardiology: Innocure, Bluescope Medical Technologies, and Mailling Wright Products. Strangely enough, Axellis doesn't even have a web site yet.

Bizarre: the family of a 20-year-old model who died of a drug overdose in the apartment of her 40-year-old psychologist and lover is suing him. He's already been charged with manslaughter in her death, which was caused by her taking 100 times the normal dose of oxycodone. The psychologist, who specializes in treating drug abusers, was also charged with oxycodone trafficking and using other doctors' prescription pads to obtain drugs since psychologists can't usually prescribe.

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Housekeeping and Sponsor Updates

Bon Secours Health Systems (MD) attributes EnovateIT’s mobile solutions for helping improve patient safety across several of its hospitals.

Jobs: Sales Executive - GE Healthcare, Healthcare Technology Senior Specialist - American College of Cardiology, System Director of IS - Manatee Memorial Hospital, Epic Consultants - Vitalize Consulting Solutions. Those who sign up for weekly job alerts hear from the ab-fab Gwen, who writes a fun letter with each one.

Thanks to the companies that sponsor HIStalk. Please click their ads, consider them if you're in a buying mood, and tell them you appreciate it. I know some of them have a real challenge getting their corporate bean-counters to loosen the financial chastity belt to send money off to some anonymous guy's PayPal account, so give them credit for being cool enough to try. Some are large, some are small, all choose to support HIStalk because of you.


Inga's Update

Prior to HIMSS, I mentioned Beacon Partners was conducting a poll at HIMSS to determine which presidential candidate healthcare execs thought would best represent healthcare. Over 600 people participated in the survey and the majority indicated Hillary Clinton would be the biggest advocate for healthcare IT and would have the most impact on empowering providers to deliver the best possible healthcare through the use of healthcare IT. However, Clinton came in third after McCain and Obama when these same participants were asked which candidate they would vote for. While the Beacon folks said they found the results “fascinating,” my take is that even healthcare execs see the presidential race to be about more than just healthcare. (Kind of reminds me of the recent McKesson/Quadramed conversations over how you can lose even if you have a better product.)

I registered for all sorts of exciting prizes last week at HIMSS (iPods, Wii, etc.) and am now getting a bunch of e-mails back from those vendors. Unfortunately I didn’t win anything yet, but have learned a few things NOT to do when sending emails. For example, I got this email today: “We met at the HIMSS event in Orlando last week. You had stopped by [company’s] booth and we spoke. We were discussing your current IT environment and any current or planned applications development initiatives coming up in 2008.” Well, let it suffice to say that I didn’t mention HIStalk’s (or anyone else’s) current IT environment to this guy. Why send out a spamming e-mail that makes you and your company look amateurish? A simple, “thanks for stopping by” would be more appropriate.

BC/BS of Massachusetts announces physicians won’t be required to install EMRs in order to participate in its bonus programs, though health systems will be required to install CPOE by 2012. The insurer has determined that the financial benefits of an office-based EMR are not worth the costs, which usually take five to six years to recoup. CPOE has been shown to provide payback in about 26 months. Additionally, a recent study found that CPOE could prevent 55,000 medication errors in Massachusetts and provide annual savings of $170 million ($2.7 million per hospital.) It will be interesting to see if other insurers follow their lead. The study results also suggest physicians will continue to look for outside funding for EMR purchases since the ROI provides them with limited financial benefit.

E-mail Inga.