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Merge Healthcare opens its code

Merge Healthcare, a company that seems to be back on its feet after an accounting scandal, a trip through bankruptcy and a change of management, is opening up some of its proprietary code for outside development. The Milwaukee-based company announced today that it has released several SDKs for imaging technologies, including x-ray and tumor tracking.

Speaking of tracking, many of you probably are wondering where I’ve been. Yes, I was away on a semi-vacation for about eight days, though I was working while I was gone. I’ve been doing most of my commentary of late at FierceMobileHealthcare and FierceEMR. I hope not to neglect this blog as much in the future, but we’ll see.

August 5, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.


I’ve just read open-source advocate Fred Trotter’s blog post regarding the meeting the open-source community had with the Certification Commission for Healthcare Information Technology at HIMSS09. (CCHIT recorded the session and posted the audio and presentation slides here.)

Trotter says he was authorized by some of his colleagues to “go nuclear” and perhaps launch an alternative EHR certification program if CCHIT didn’t listen to their concerns. That was not necessary, he says, because the commission Chairman Mark Leavitt and Director Dennis Wilson gave them a fair hearing and agreed to consider the impact of CCHIT rules on developers of free and open-source software.

The most serious problem for open source seems to be that the true cost of certification is not the actual testing and maintenance fees, but the expense of continually updating products to meet standards that get more stringent each year. Since the whole idea behind open-source is to share code rather than protect it with licensing fees, the first FOSS developer to build to CCHIT standards will effectively be paying the bulk of the certification cost, while competitors will benefit from that investment when the first company releases its source code.

Trotter explains: “Under the current certification model I could wait for ClearHealth Inc. to figure out how to pass the current CCHIT tests, and then republish the changes to the current ClearHealth codebase required to pass CCHIT. ThenI could apply for CCHIT certification with my friendly fork of ClearHealth…. So I would be getting a certification for about 1/10th the price that ClearHealth pays.”

Thus, there is a definite disincentive for ClearHealth to spend big bucks—Trotter estimates $300,000 a year—on creating a product that will pass CCHIT testing.

Some of the comments that follow Trotter’s report then veer into uncharted territory, namely the prospect of self-certification. Since CCHIT makes its testing requirements public, there are those that suggest small vendors should get together and run their own testing program, following CCHIT protocols.

I’m sure there are some small EHR vendors out there telling their customers that their products are just as good as anything that has passed CCHIT testing, but I wonder about both liability and copyright issues. One commenter, Tim Cook, suggests that CCHIT should put together a self-certification affidavit that companies can sign to make sure CCHIT is not held liable for any software faults or resulting medical errors.

This makes me wonder several things:

  • Would CCHIT even consider this if it became clear that someone was starting a competing certification program?
  • Would more than a fringe group of the EHR customers—hospitals, physician practices and other care providers—want the risk that comes with using a “self-certified” product?
  • How much money would vendors save anyway if they’re still updating their products to meet the same standards? Granted, they wouldn’t be paying the testing fees, but the consensus seems to be that the real cost of certification is in the development, not the actual testing.
  • And, of course, the biggest question remains, will non-certified EHRs still be eligible for stimulus money?

April 19, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Surrealism at HIMSS

CHICAGO—This picture is on display at the HIMSS conference booth of OpenVista developer Medsphere Systems.

Cerner doesn’t seem to be making many friends here by deciding to skip the exhibition, but still.

April 6, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Attention CCHIT critics

Dear Calvin Jablonski, Rocky Ostrand, Maggiemae Ph.D., or whatever your real name(s) is/are,

As I mentioned a couple of days ago, Mark Leavitt, M.D., Ph.D., chairman of the Certification Commission for Healthcare Information Technology, that organization you love to hate, has agreed to meet with the free and open-source software development community during next month’s HIMSS conference.

Healthcare FOSS guru Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., are leading the event, Monday, April 6, at 2 p.m. in Room 10d at the Hyatt Regency McCormick Place at 22nd Street and South King Drive in Chicago. Trotter called the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,”, but I imagine they intend for things to be civil.

That doesn’t have to be the case. Calvin, Rocky, Maggiemae and your ilk, you are hereby (unofficially) invited to join the festivities and create some fireworks. Unmask yourself or selves and make it more like Luke and Leia finding out the true identity of Darth Vader. Or are you not the evil one? Here’s your chance to prove it.

We await your reply.


The Health IT Media and Blogging Communities

UPDATE 1 a.m. CDT: I just received an e-mail from Trotter informing me that two CCHIT sessions will be Webcast:

Date: Monday, April 6, 2009

Room 10d, Hyatt McCormick Conference Center, Chicago

Session #1 1:00 – 2:00 PM CDT

Interoperability 09 and Beyond: a look at CCHIT’s roadmap for the future

Session #2 2:00 – 3:00 PM CDT

Open Source Forum: a dialogue on certification for open source EHRs

Here is the link to register for the webinar:

After registering you will receive a confirmation email containing
information about joining the webinar. We will also be recording
these sessions, and plan to make the media files available on the web
for later downloads.

You have no excuse to miss it now.

March 26, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More CCHIT news

I may be inviting some more venomous comments with this post, but here goes anyway. The Certification Commission for Healthcare Information Technology (CCHIT) announced Monday that the federal economic stimulus legislation has caused the commission to move up its “advanced technology” certification programs for clinical decision support, interoperability, quality and security to 2010 instead of 2011. Because of this new development, CCHIT has pushed back its annual volunteer recruitment period to March 26 through April 20.

Meanwhile, CCHIT Chairman Mark Leavitt, M.D., Ph.D., has agreed to meet with some of its harshest critics, namely open-source software developers, in a session at next month’s HIMSS conference. The meeting, led by Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., is scheduled for Monday, April 6, at 2 p.m. in Room 10d of the Hyatt Regency McCormick Place in Chicago. Trotter, who calls the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,” has more details here.

March 24, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Benefit album for health IT. No, really.

Remember a few months back how I said health IT needed a rock star? I didn’t mean it literally.

Grammy-winning Senegalese musician Youssou N’Dour is spearheading a charity album to benefit and raise awareness for the IntraHealth OPEN initiative to help bring open-source health IT to health workers across Africa. Also participating are rap star Nas, singer-songwriter Duncan Sheik and a real, live rock star, R.E.M. guitarist Peter Buck.

The album, “OPEN Remix,” features N’Dour’s 2007 song, “Wake Up (It’s Africa Calling),” which originally was a duet with Neneh Cherry, plus remixes of that song by Nas, Sheik, Buck and other artists. The downloads are free via Rhapsody, iLike and Amazon MP3, but you can donate to the cause through those sites.

Indaba Music, a social networking site for musicians, will have a worldwide remix contest starting in April.

According to an e-mail from IntraHealth’s publicist, “IntraHealth has been collaborating with African governments and private institutions to design and apply open source solutions to strengthen their ability to use health information for strategic health policy and planning. Using mobile phones, PDAs and taking advantage of growing connectivity across Africa, the initiative aims to increase fluency in open source systems and help support a new generation of eHealth workers, technology professionals and national leaders in Africa who understand, customize and apply open technologies to improve health.”

This sounds a lot like what the OpenMRS and Partners In Health folks are working on, and a lot like what I heard at the Making the eHealth Connection conferences in Italy last summer. Funny how there seems to be more organization around e-health in Africa than in the U.S.

February 16, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Catching up

I’m slowly recovering from a tragic last few days, in which the Chicago Cubs, the best team in the National League this season, failed to show up for their three playoff games. I was among the more than 42,000–a number that surely had to violate some section of the fire code–jammed into Wrigley Field for Game 2 on Thursday night to watch a stinker for the ages. I suppose this doesn’t hurt as much as 2003, but maybe it will when it sinks in.

Alas, life goes on, and so does the backlog in my inbox. Baseball season may be nearing a close in Chicago (the White Sox are on the brink, but still alive), but the never-ending political season still has a month to go. It was brought to my attention recently that Hollywood may have anticipated the McCain-Obama matchup in a 2006 episode of The West Wing. The debate between Matthew Santos (Jimmy Smits) and Arnold Vinick (Alan Alda) even strikes a familiar chord.

A discussion of healthcare policy starts around 3:20.

Back in the real world, I’ve seen a bunch of commentaries of late on the health IT policies of the Obama and McCain campaigns, in part because I had to write summaries for both the Physician Office Technology Report of Part B News and for my British client, E-Health Insider. The most interesting analysis I’ve seen so far is from David Merritt, a longtime aide to Newt Gingrich who also is advising the McCain campaign. Despite this built-in bias, Merritt actually gives a mostly unbiased assessment of the plans. Mostly.

If you want to know more, check out the Kaiser Family Foundation’s health issues comparison tool on 15 areas of health policy, including IT.

I still think both candidates are really lacking in specificity when it comes to health IT. I am anxious to hear further details, though I don’t really expect to hear much before the actual election. More likely, the details will come when the new president names his secretary of Health and Human Services, and perhaps not until the full healthcare policy teams are in place.

Moving on, there’s a new professional certification program in health information exchange. It’s from the same people who developed programs to designate certified professionals in health information technology and certified professionals in electronic health records. I wrote about that in November 2004 and got one very pointed comment how certification courses like this were “a joke” because they convey a hoity-toity title after just a few days of training. Just like then, however, program has some highly respected names on its advisory board. Anyone know if this sort of thing is worth it?

While we’re talking about professional credentials, here’s a link to the newly redesigned EMR site (even though it defaults to a .net site). Now I have just set myself up for everyone with an IT-related Web site to demand a link. I’ve been good at ignoring e-mails in the past, and I can do it in the future.

I didn’t submit anything to the most recent Health Wonk Review, but host David Shafrin of the Healthcare Economist blog examines groups in need of bail-outs.

I figured it would be much ado about nothing when HIMSS circulated a letter it sent to Reps. Pete Stark (D-Calif.) and Dave Camp (R-Mich.) about the proposed “Health-e Information Technology Act of 2008.” Just a few weeks ago, I expressed my frustration with new legislation that stands almost zero chance of passing.

Apparently the response did strike a raw nerve with some people, including open-source advocate Fred Trotter, who accused HIMSS of being little more than a lobby group for vendors of proprietary systems. HIMSS subsequently published a “fact sheet” about its views on the Stark-Camp bill, including this statement: “HIMSS actively supports the industry’s exploration and utilization of open source software as one avenue for information technology solutions within the healthcare industry.”

Just how significant is this mini-spat anyway?

October 5, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Holy Grail’ in open source?

Open-source devotee Fred Trotter reports today that ClearHealth apparently has reached what he calls the “Holy Grail of open-source medical informatics”: a Web-based version of CPRS, the user interface for the Veterans Health Administration’s vaunted VistA system.

ClearHealth today has posted screen shots of the beta version of what it calls WebVista. I’m not a techie, I’m not well-versed in open source. Is this is a big deal? Someone please tell me.

Also, someone please tell ClearHealth that there has not been a “Veterans Administration” since 1989. It’s called the Department of Veterans Affairs.

August 7, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Dude, this sucks!

Paper medical records suck. You and I have known this for a long time. But it’s confirmed this month in “Wired,” which has a cover story called, “Why Things Suck! 33 Things That Drive Us Crazy.”

Among them is this entry:

Why Things Suck: Medical Records
By Erin Biba Email 01.18.08 | 6:00 PM

Most medical records are about as orderly as an ER on Saturday night. Because they’re mainly confined to paper, they can’t be easily transferred from one physician or hospital to another. And because they’re not subject to any standards (or even legibility requirements), they’re nearly impossible to compare and combine.

Improving the system is possible, but it would take the cooperation of a bunch of interest groups that have no interest in working together. The Health Insurance Portability and Accountability Act, passed by the federal government in 1996, was supposed to fix things, but massive lobbying turned it into porridge. For example, HIPAA lets states make their own rules; now some states say doctors should keep records for 20 years, some for two.

You’d think electronic records would solve the problem, but no. Because the software vendors selling electronic record-keeping systems are competing, their systems are proprietary and incompatible. Oddly, that’s OK with many physicians. Another name for an all-knowing, all-seeing, all-compatible electronic system is database, and physicians don’t want people mining theirs — not because of patient-privacy concerns, but because the info could be used for doctor-on-doctor performance stats. Plus, docs already hate filling out charts; you think they want to learn data entry?

A fix may be on the way. Google and Microsoft are both working on software that will appeal to physicians and patients alike. (Kind of gives new meaning to “blue screen of death,” don’t it?) But a word of advice: Pressure your docs into accepting a more transparent system. If you don’t understand your chart, ask. You want some surgeon to cut the wrong leg off of you someday?

So finally a publication that fancies itself as cutting-edge gets it. Are Microsoft and Google the fix? Well, that remains to be seen. Last week, Microsoft re-branded its healthcare products as Amalga, replacing the Azyxxi and Hospital 2000 names. Today, the Redmond Empire announced plans to publish the source code for HealthVault XML interface protocols and other open-source projects.

HealthVault chief architect Sean Nolan explains the open-source initiative on his blog. Michael Zimmer, the 2007-08 Microsoft Resident Fellow at Yale Law School’s Information Society Project talks about some of the privacy issues HealthVault is trying to address on his blog today, while open-source guru and Microsoft critic Fred Trotter cautiously lauds Zimmer for a fair assessment of the issues.

As for Google, CEO Eric Schmidt is delivering a keynote at next week’s HIMSS conference, and actually is holding a 30-minute press conference afterwards. The Internet search giant also is throwing a cocktail party next Tuesday, with the theme, “Home is Where the Heart Is.” The invite says, “Come meet the health team at Google and learn more about what we’re working on.” About all I expect to learn from the secretive company is who actually works for Google (I know a couple of people already) and whether the bartender can mix a dry vodka martini.

Back to the “Wired” spread. Medical records are not the only “things that suck” in healthcare. The list also includes prescription drugs, hearing aids, infertility treatments and knees and backs, not to mention the all-encompassing science itself.

I can’t say for certain that personal health records suck, but that could be an addition to the list if someone doesn’t figure out a way to make someone other than health plans use them. You may recall that back in December I declared a personal moratorium on PHR stories until I saw proof that doctors and patients were actually using PHRs in any sort of volume.

After I got a pitch from one payer-owned PHR vendor on Jan. 29, I wrote back with a terse, “I’m not doing any more PHR stories until someone shows me evidence that more than a handful of patients and doctors are actually using the things.” I’m still awaiting a response.

February 20, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Let’s be candid

BILOXI, Miss.—I was about to post a rant about the PR reps still bugging me about setting up HIMSS meetings just a couple of days before the conference starts, as if I have time left on my schedule to sneak in a couple of hours of sleep, much less write my stories (you know, the stuff that pays for my trip). Then I got an e-mail from open-source software guru Fred Trotter (and yes, I know he doesn’t care for the phrase, “open source”) that he won an auction over at HISTalk to have a chat with Jonathan Bush, the very outspoken and usually highly entertaining CEO of athenahealth. That got me to thinking that I’ve got a theme to blog about: candid chat about health IT.

Trotter asked me—and probably some other bloggers—to link to this post on LinuxMedNews, where he asks readers to suggest questions to pose to Bush. OK, consider it done.

FYI, the Bush bio that Trotter cites is accurate. Athenahealth boss Jonathan S. Bush is indeed a first cousin of the president. (His father, Jonathan J. Bush, is the brother of former President George H.W. Bush). One thing that’s not there is that Bush also is the brother of Billy Bush, co-anchor of celebrity dish-fest “Access Hollywood” and host of the new reality show, “Grease: You’re the One That I Want.” I believe Jonathan Bush also went to high school with Rep. Patrick Kennedy (D-R.I.), who, in case you were unaware, is a member of a pretty high-profile family with Democratic leanings.

None of those facts, of course, have any effect on the ability to run a healthcare software company, other than better access to well-heeled investors than most entrepreneurs. I’m not going to suggest any questions for Trotter to ask (OK, fine, he can have Bush call his brother to report the latest on Britney Spears’ meltdown if he wants) because I’m going to one-up Trotter. I’m putting a microphone in front of Bush for a podcast we’re going to record during HIMSS next week. So there!

I can’t give you a firm date for posting the podcast because it’s not the only one I have scheduled. Indeed, my schedule is beyond full at this point. But does that stop the PR people from e-mailing and calling even today to see if I want to meet with their clients? It’s almost as if they believe that what they’re selling is the most important thing going on at the world’s largest health IT conference.

And what earth-shattering news are they trying to sell me on as story fodder? OCR technology. A new vice president at a staffing company. And the pièce de résistance: an Israeli HMO with no U.S. customers cutting a deal with the government of Bulgaria. (Call me when an Israeli company sells something to the Iranian government.)

A voice mail I got about the Bulgaria story one ended with, “Have a good show.” Bad idea.

Yes, the vendor exhibition is a “show.” It’s a big show. It’s a great selling opportunity for the exhibitors and a veritable smorgasbord for anyone shopping for IT. The problem is, I ain’t shopping. For me, the annual HIMSS confab is not a show, but a conference. If I wanted a show, I’d go catch Julio Iglesias tonight and tomorrow at the rebuilt Beau Rivage casino a few miles down the beach from here.

OK, that’s a stretch. I’m actually waiting for the official announcement that The Police will play two dates at Wrigley Field this summer.

I do meet with vendors, this year more than last. I try to stay on top of trends and innovations in the marketplace. But I get my best stories from the users and thought leaders. You know, the speakers and session presenters. I love some of the pre-conference symposia for that very reason. That’s why I make it a rule not to schedule vendor meetings while the educational sessions are going on. I’m planning on cutting out of a vendor luncheon a few minutes early so as not to miss an early-afternoon presentation.

There’s also a good reason why I came down to the Gulf Coast today to follow up on some of the reporting I did last summer on the rebuilding of healthcare infrastructure after Hurricane Katrina. (Mea culpa: I never did put together the podcast I promised. I learned the hard way that editing audio is time-consuming, plus, the recordings weren’t all that great.)

As a bonus, I wasn’t home to receive the “have a good show” call. And it was 80 degrees when I left New Orleans this afternoon for the two-hour drive to Biloxi. It was not 80 degrees when I left my apartment in Chicago at 6:30 this morning. (What am I doing in Biloxi? Chasing stories others are not.)

But I digress.

Last year, I posted some other advice for PR representatives. OK, so it’s actually another unvarnished rant, on the overuse of essentially meaningless buzzwords in press releases. I have to say bravo to this year’s crop of press releases for being more descriptive.

Just so nobody gets the idea I scorn all things PR, here’s some good advice from Schwartz Communications about pitching journalists for HIMSS. Read these tips, learn them, use them.

Also, today is the 27th anniversary of one of the most memorable events of my childhood, not long before my 10th birthday: Team USA’s hockey victory over the Soviet Union at the 1980 Winter Olympics in Lake Placid. No, that was not the gold-medal game. The final victory came two days later vs. Finland. Rest in peace, Herb Brooks.

I digress again. It’s my blog and I’ll digress if I want to.

February 22, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.