Quest Diagnostics Restructuring and Will Cut 400 to 600 Jobs by End of 2013

Here’s some additional job losses and I swear we may be up for a short while and then more cuts come along.  This is a small cut over all when you figure they have over 40,000 employees but nobody wants to lose a job for sure and Quest has automated a lot of their work flows and the article states these are mostly in a layer of management they will be eliminating.  Where does Quest get most of their revenue, diagnostic information.  They also just hired someone from Pfizer to lead up their commercial business area.  The two individuals in charge of the health information unit will leave by the end of this year as well as the departments heads from HR and their insurance division so it kind of looks like these are the department that will largely fall under their reconstruction efforts.  BD

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MADISON, N.J. (AP) — Medical laboratory operator Quest Diagnostics Inc. said Thursday it will cut 400 to 600 management positions and reorganize its business.

Quest will eliminate three layers of management and reorganize into two business units, diagnostic information services and diagnostic solutions.

It expects to save $65 million a year from the changes. The company has around 42,000 employees. Quest expects to take $15 million to $20 million in charges associated with the restructuring and job cuts.

http://www.businessweek.com/ap/2012-10-11/quest-diagnostics-cutting-400-to-600-jobs

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Walmart Becomes the Next Employer to Negotiate Surgical Procedures Direct With Major Medical Centers, Just Need More Employees Covered

A while back Lowes was one of the first to negotiate with the Cleveland Clinic followed by Pepsico and now we have Walmart. If you have read the news of late Walmart employees are striking for better healthcare benefits, even though they are not union, but making a statement.

Johns Hopkins and PepsiCo Sign a Contract To Allow Employees and Their Dependents To Have Certain Surgical Procedures Performed At the Medical Center in Maryland

Employees must be healthy enough to travel but as this reads there’s no out of pocket expenditures for them to pay.  This agreement covers some additional items that were not mentioned in the Lowes or Pepsico agreements; however it’s been over a year and perhaps their agreements have expanded.  Transplant surgeries will all be performed at the Mayo Clinic.  The full press release can be read here.  Now all Walmart needs is more employees covered as many are part time and do not work enough hours to qualify for health insurance coverage.  Not all but some part time employees qualify for health insurance and that’s still the big problem is getting more covered.  BD

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Walmart employees will now be able to get heart, spine and transplant surgeries at six of the nation's most prestigious hospitals at no cost, the world's largest retailer announced Thursday.

Under what Walmart calls the "Centers of Excellence" program, employees and dependents enrolled in the company's health benefits won't pay out-of-pocket for medical care or related travel when they receive complex, expensive procedures including open-heart surgery, spinal fusion and organ transplants at select facilities. The Mayo Clinic in Rochester, Minn., the Cleveland Clinic in Ohio and the Geisinger Medical Center in Danville, Pa., are among the health systems participating in the program.

Walmart employees who undergo surgery at one of the six selected medical centers will save between $5,000 and $12,000 because they'll be exempt from health insurance deductibles and cost-sharing payments, Walmart spokesman Randy Hargrove said. Workers will gain access to the new benefit at the beginning of 2013.

http://www.huffingtonpost.com/2012/10/11/walmart-surgery-workers_n_1958673.html?ncid=edlinkusaolp00000003&ir=Money

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Continuum Health Partners Collaborates With Caradigm to Implement Innovative IT to Improve Care Coordination and Patient Experience

The group of teaching hospitals will be implementing Caradigm eHealth solution solutions to improve care coordination across the health system. The ED physicians will have access to patient data stored in systems across the four hospitals, including lab results, radiology reports, discharge summaries, and patient history.  Amalga, eHealth Information Exchange and Vergence are what Caradigm currently offers and I would believe this to be an Amalga or an eHealth installation as I believe all of their hospitals are working on a Cerner system.  BD

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Press Release: 

NEW YORK and BELLEVUE, Wash., Oct. 10, 2012 /PRNewswire/ -- Recently named one of the 2012 "Most Wired" healthcare systems in the United States according to a nationwide survey,^* Continuum Health Partners Inc. has implemented new information technology (IT) solutions from Caradigm to help improve care coordination across healthcare facilities and keep patients well and at home.

Continuum Health Partners comprises five distinguished voluntary teaching hospitals including Beth Israel Medical Center, Roosevelt Hospital, St. Luke's Hospital and the New York Eye and Ear Infirmary. Caradigm is a joint venture formed by GE Healthcare and Microsoft Corp. in June 2012.

 

"We're excited to partner with Caradigm to empower our physicians and patients with information they can use to make the best decisions," said Mark Moroses, senior vice president and chief information officer for Continuum. "Opening up access to patient data allows us to orchestrate the treatment of the people we serve across the care continuum and ultimately help them lead healthier lives."

 

To better support team-based care for patients, Continuum Health Partners has deployed Caradigm eHealth solutions designed to enable physicians to collaborate with each other and with patients more easily through the secure exchange of clinical data.

 

Using eHealth Community Desktop, a Web-based clinical portal, emergency department physicians can rapidly access and view patient history, discharge summaries, lab results, radiology reports and other patient data stored in multiple disparate IT systems across the four hospitals. This data is integrated by the eHealth Information Exchange, a secure, standards-based technology infrastructure that uses a patient-matching system and document repository to enable the exchange of clinical data from any system.

 

On this eHealth foundation, Continuum Health Partners has implemented shared treatment plans to enable physicians to better coordinate the care of patients with complex or chronic conditions such as diabetes or heart disease. Continuum Health Partners also has activated a notification system that alerts providers when there is any new information about their patients added to the eHealth Information Exchange, offering opportunities to coordinate care with other physicians.

 

"Having immediate access to a patient's medical history is critical to navigating the optimal course of care, especially in emergency situations," said Dr. Gregg Husk, Continuum's chief medical information officer and chairman of the Department of Emergency Medicine at Beth Israel Medical Center, one of Continuum's flagship hospitals. "Information can make an impact on the medications and tests we administer and also help us put patients on the best path forward for ongoing treatment with a primary care provider."

 

"Continuum Health Partners shares our vision of connected health communities," said Michael Simpson, CEO of Caradigm. "The ability to exchange and analyze clinical data across care settings is fundamental to improving the quality of patient care and reducing costs. We look forward to seeing the impact of Caradigm solutions on Continuum Health Partners' processes and on the lives of the people they serve."

Future capabilities currently planned by Continuum Health Partners include implementing a patient portal that allows patients to receive and store copies of their personal health histories and hospital visits.

 

About Continuum Health Partners
Continuum Health Partners, with an annual operating budget of over $3 billion, was created in January 1997 as the parent company for the partnership between five distinguished voluntary hospitals: Beth Israel Medical Center-Milton and Carroll Petrie Division, Beth Israel Brooklyn, St. Luke's Hospital, Roosevelt Hospital and New York Eye & Ear Infirmary.

The Continuum network also encompasses ambulatory health centers and group and private practice settings throughout the New York metropolitan region. Continuum operates more than 2,700 certified beds; provides for over 650,000 days of inpatient care and over 1.3 million outpatient visits; has more than 4,500 affiliated physicians; and a work force of over 15,500 individuals, making it the sixth largest private employer in the New York metropolitan region. Additional information about Continuum is available at www.chpnyc.org.

 

About Caradigm
Formed by GE Healthcare and Microsoft Corp. in June 2012, Caradigm is a 50–50 joint venture focused on enabling health systems and payers to drive continuous improvements in care. Caradigm software helps healthcare professionals across care settings to use data to gain critical insights, collaborate with each other and with patients, and to develop and implement innovative care solutions. Amalga, eHealth Information Exchange and Vergence — and applications built by partners to extend these products — give clinicians, administrators and finance teams timely access to key information, helping them to take steps to solve some of healthcare's biggest challenges, including chronic disease management, preventable hospital readmissions and hospital acquired conditions, and to advance integrated, accountable care. Caradigm is headquartered in Bellevue, Wash. For more information about the company, visit http://www.caradigm.com.

 

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The Prescription Auto-Refills Still Out There With CVS and Others as Pay for Performance Efforts Ramp Up at US Corporate Retail Pharmacies To Meet Quotas and Make Those Profit Numbers for the Shareholders

The LA Times has been doing a good job following up on this situation and I see it in Twitter all the time with pharmacists saying this happens a lot too.  We all know that pay for performance exists in the drug stores and some of what it is trying to accomplish is not bad and some of it creates data for sale as retail pharmacies make big money there, like Walgreens that made short of $800 million on selling data only so you could bet CVS is up there too.  Below is the first article on this topic from a few months ago.  Once the refill algorithm is set in place several things take place after that and items as such are making it difficult for consumers. 

The Automatic Prescription Refill Algorithm Causing Havoc at CVS When Not Personally Authorized By the Patient–Attack of the Killer Algorithms Chapter 40

This issue has to do with pharmacists putting prescriptions in for auto refills.  The Times has internal documents that show “refill quotas”   Corporate wise they say there are no quotas but pharmacists say it does play out on their evaluations.  CVS did  not want to respond.  There are emails from managers supervising pharmacists tell them about meeting their quotas.  This is typical whenever sales are being pushed, I had it from my manager when I was in sales but that was my job, a little different from being a pharmacist filling prescriptions.  The pharmacists don’t want to do this, and customers don’t want it but it’s the old game.  The insurance company gets billed when the prescription is filled, not when the patient picks it up.  The insurer is supposed to be refunded if this happens.  If a customer goes elsewhere to another drug store they can’t get it for around 2 weeks until it gets out of the system.  The insurer is not a victim here as they work with drug chains to set a lot of this up.  How can this be audited is one of the questions asked?  No wonder our premium are so high. 

Here’s a good example of where United pays pharmacists pay for performance money for those pharmacists that sign up consumers with the YMCA and other United plans, so maybe all these programs as they build and multiply are having a little conflict.  And again there’s the issue of making  money with data for sale too with not only prescription data but they have the capability to look at what else you purchase in the store as well, so are you getting insulin prescriptions and then buying a bunch of candy for one example?  They are all using predictive analytics these days everywhere they can. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Here’s another situation I wrote about a while back with the strips for my mother’s diabetes machine and we had quite the time once the pharmacists told her she needed to check 3 times a day and had conversations both with her doctor and Health-Net, her Part D provider who agreed 2 times a day was fine as she’s been doing it that way for around 20 years.  The problem was the extra shipments of strips that were auto refilled and shipped. 

My mother gets her diabetes strips from Walgreens who also called her.  Again as I mentioned above she’s been a diabetic for years and does her testing as she should, and does it twice a day, but the pharmacy said she needs to do it 3 times a day.  The pharmacy also said they had her next prescription ready for her too.  To this she said, hold off as I am getting too much and I don’t want to have too much on hand that might expire before I can use it.

Walgreens was basing their prescription refills and her needs on 3 times a day when in fact she does it twice a day.  They finally worked with her to let Mom get her own refills “when she needs them” but the caller on the phone was adamant about doing her readings 3 times a day.

Translation: Mom is messing up the automated system her by doing it twice a day instead of 3 times a day I think <grin>. 

They may or may not have a parameter that can be added for twice a day, either that or it requires someone in a supervisory position to make that change or a programmer to add it as a selected choice for the patient based on communications.   I realize working with data how automation is set into motion based on parameters

Compliance Police Out In Force for Seniors–Health Plans and Drug Stores Making Phone Calls-Business Models & Caller Behavior Sucks -A Result of Pay for Performance Efforts?

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Has your pharmacy ever refilled a prescription for you without your authorization?

Some customers of CVS have been complaining that that has happened to them.

Consumer columnist David Lazarus and Business Editor Marla Dickerson discuss the complaints, which Lazarus has written about in a series of stories in the Los Angeles Times.

CVS acknowledged the legitimacy of the emails but said the unauthorized refills were limited to about 50 East Coast pharmacists and that the supervisor involved wasn't following company policy

http://www.latimes.com/business/money/la-fi-mo-video-chat-customers-complain-about-cvs-20121009,0,2419922.story

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AllScripts Files Complaint With Review Board At Health and Hospitals Corporation Protesting Award of Contract to Epic Medical Records For New York City’s Public Hospital System

Last week I said “aren’t these insurance contracts a bitch” and it looks like now it’s bleeding over to sizeable medical record contracts.  The Allscripts situation certainly is getting interesting and catching a lot of press coverage.  It all began at the end of the first quarter when the projected sales numbers were not pleasing to shareholders and for good reason.  We all read about complexities with IT infrastructure systems and Allscripts is living it.  The average person has no clue today on the amount of time and code that it takes as things have changed from a few years ago when we used to be able to run out to the “code kitchen” and whip up a recipe for what someone had envisioned, not so today as there’s more code to work with other code and you have to depend on their code to be good.  Everyone does their best but bugs live. 

Class Action Lawsuit Filed Against Allscripts For Misleading Investors With Merging Data Systems–Too Much Code and Not Enough Time – Attack of the Killer Algorithms Chapter 30

Merging and integrating the Eclipsys system is a big project even though both Allscripts and Eclipsys use Microsoft technologies.   There’s a lot of neat dot net features in Eclipsys to work with and again it was not the same group of developers writing both systems, so now with a new group it’s time to take it apart and dig in to some code and you always find stuff to be rewritten, etc. which nobody’s fault, but it just needs updating sometimes to work with current day technologies.  I go back a ways with some of this and Misys was around with the “My Way” system which is now part of Allscripts and users are going to be able to upgrade to the latest system from the original system which was also grown by acquisitions, which when things were simpler was not a bad way to grow…now with complexities…better look at the code first and what other technologies it needs to work with. 

Misys Sells Allscripts Shares to Enable Eclipsys Merger – Medical Records

So one difference between Epic and Allscripts is that Epic has built their system in house and is not a combination of code technologies which does have some advantages and they are constantly updating as is every system but when it’s under one roof, well that does help a bit.  Allscripts has also turned to Microsoft as what better choice than to go to the owner of the technologies that were used to build both systems.  I said too that the Caradigm company, which is the combined Microsoft and GE company could be a place to go as well for help and who knows maybe they would be interested to have a medical records system to work with Amalga, which is now over there.  If you have one in house it makes it easier to test and work with Amalga with integration processes and I understand Amalga may have a cloud functionality soon too. 

Allscripts Turns to Microsoft To Expand Their Application Development

Now we also have this Allscripts challenge in the news the last couple of days to encourage folks to write apps to integrate with the system so you do have to say there’s no stone unturned here.  In addition with Citibank looking for private equity offerings for them, you can bet the PE firms are going to want to know the status of their code too..it just is what it is. 

Caradigm–New Name for New Microsoft GE Healthcare Company

So coming back around we have this complaint filed and the folks at the New York hospital system don’t seem to feel comfortable with the pricing estimates Allscripts gave and executives from the hospital seem to indicate this claim is a stall in hoping they can get some PE money in the meantime.  The Hospital corporation said the Epic contract would cost $303 million and the Allscripts was $299 million and there was no or little support figured in with Allscripts and we all know you need that.  The CEO of Allscripts also pointed a finger and said that the Epic system was more expensive to maintain since it is based in a revised version of MUMPS and not Microsoft.  They all need attention and support today so that part is not a real argument any more.  This may very well be a stall tactic but with the way the company is currently under the magnifying glass it’s kind of hard to hide out if so. 

It sounds like the hospital system is on solid ground in knowing what they need though, and was not comfortable.  In the meantime we can wait and see what happens and if Allscripts gets all their code in place.  Again that is a big job combining two major systems and as I sad back a few months ago there was too much code and not enough time at the end of the first quarter when sales projections were added in for value. 

So hey, next time you hear some politician talking about completely repealing Obamacare think of this situation only a whole lot worse as there's not enough money, engineers or time to re-write an entire US Medicare/healthcare system from the ground up and realize you have been “algo duped” by a politician as at best such a huge project would take at least 7 years, so get in to some math here.  It could be so big that the US would have to outsource the coding to both India and China <grin>.    BD

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One of the country’s largest providers of electronic medical records has lodged a complaint against New York City’s public hospital system for awarding a $303 million contract to a rival.

The company, Allscripts, lost its bid last month to replace the public hospital system’s fragmented and antiquated medical-records system with an integrated system that would link 11 public hospitals, 70 clinics, thousands of doctors and more than one million patients and allow them to communicate with one another.

The contract went instead to Epic Systems Corporation, Allscripts’s chief rival for the highly competitive medical-records business. The industry is getting a huge lift from billions of dollars in federal stimulus money to help health care providers share medical records.

But Alan Aviles, president of the corporation, said on Tuesday that Allscripts’s cost analysis was false and unrealistic. He said that the corporation’s choice, made after considering nine vendors over four years, had been validated in the last few months as Allscripts experienced management and financial problems.

The hospitals corporation said it would cost almost as much to upgrade its existing electronic-records system, which goes back 20 years, as it would to build a new system. The net difference, according to corporation documents, was just $157 million, which would be largely paid for by federal funds, estimated at $125 million.

http://www.nytimes.com/2012/10/10/nyregion/allscripts-protests-epics-bid-for-electronic-medical-records.html?smid=tw-nytimeshealth&seid=auto&_r=0

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Cerner Connects EHR Technologies with CareFusion Medical Technologies Who Just Purchased Intermed Respiratory Care In Brazil This Week

CareFusion recently purchased Intermed in Brazil who makes and supplies ventilator devices used in hospitals in Brazil and in Latin America.  CareFusion earlier this year was in the news with web site issues and malware that crept in there and this is not unique as we all have to watch anymore.  The news today is with Cerner connecting to an automated medication system with their medical records. 

To connect to the medical records system,Cerner Millennium, the CareAware iBus will be the key and they received the clearance from the FDA back in January of 2010.  This technology helps create the “smart room” and below are a few other descriptions of the entire CareAware system. 

The Pyxis MedStation from CareFusion is an automated medication management system using bar code scanning to make sure the patient is getting the correct medications delivered.  Doctors and nurses will be able to see what medications are available and the system also checks for potential dangerous drug interactions and of course it’s loaded with analytics as is every software/hardware device we see today. 

Cerner Receives FDA Clearance for CareAware iBus to Connect Devices and EHR Systems

In addition CareFusion has worked with several other large medical device companies as you can read below.  With the Cerner EHR it appears this is just one of many devices that may ultimately connect to the medical records system as time moves forward as we are not only integrating medical records systems, but also the software and devices that send information as well.  This is new and is just rolling out  so I’m sure there will be more news and reviews on how it works with clinicians and their opinions as time moves forward.  BD 

CareFusion, Cisco and Medtronic to Collaborate With West Wireless Health Institute on Technology – Additional Grants Awarded From Philanthropists Gary and Mary West

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SAN DIEGO, Oct. 4, 2012 /PRNewswire/ -- CareFusion and Cerner today announced the implementation of interconnected systems that share data for enhanced medication management at Penn State Milton S. Hershey Medical Center, a leading U.S. teaching and research hospital and designated Magnet institution.

The new offering from CareFusion and Cerner, currently in limited commercial release, enables data sharing and centralizes clinical information between the Pyxis MedStation(®) 4000 system automated medication dispensing technology and the Cerner Millennium® electronic health record (EHR) system, via Cerner's CareAware iBus(TM) integrated device connectivity architecture.

Interoperability between systems allows caregivers to use Cerner Millennium to remotely track drug availability and select medications for removal from the Pyxis MedStation system. These features help improve efficiency in medication dispensing and administration and save nurses time previously spent looking for medications.

http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner-Corporation-CareFusion-And-Cerner-Connect-Technology-And-Data-To-Help-Improve-Medication-Sa-15253332/

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First Ever Crowd Funded IPO–$1 Million in Pledges For a Medical Device Delivering Non-Invasive Weight Loss Cellulite Removal Procedures, FDA and CE Marked

As the article mentions it is now in the quiet period and the name cannot be divulged.  IPO Village was the portal that handled the crowd funding. The company is not a start up and has been around for 6 years so I am guessing the IPO and crowd funding purpose was to ready the company for the IPO.  The SEC has to give their stamp of approval all who signed up will receive their notice that the offering is is open for investment.  The company’s product uses ultra sound technologies for cellulite removal and I can almost bet if I searched a bit it’s probably on this blog:) 

If you want to read more about the company there’s a lot to read up on  and it gives you just about everything about the product except the name at the IPO Village website.  This is a good example though of crowd funding for companies that are established and need to raise money as it’s not just limited to a start up.  BD

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What is unexpected is that the crowd funding model is being used for an SEC qualified IPO for the issuance of stock.  IPO Village will establish customer accounts with offering companies that will enable account holders to bid for IPO shares, with the priority order established by the order of funds deposited.

As mentioned previously, the first IPO Village enabled account has received $1 million in deposits from investors that want to be in line to bid for shares of the first ever crowd funded IPO.  The deposits are held at the IPO issuing company and are submitted through the company's website, accessed through IPO Village acting as a portal.  The name of the company going public is not revealed to the general public at this point because of SEC restrictions.  Obviously the name of the company is revealed to individuals who apply to make a deposit.

The company has developed patented solutions for non-invasive cosmetic weight-loss procedures. The company's technology is FDA-cleared and CE Medical Marked. It has been on the market for more than 6 years and is franchised in 13 countries with 130 installations and growing. 

(IPO Village is unable to name the company as it is currently in an SEC "Quiet Period".)

The IPO Village business model is much different than the traditional way that IPOs have operated.  And the difference starts with the fact that IPO Village is a not-for-profit operation.  It operates as a portal and information site.  There is no underwriting, there are no brokers and there are no investment bankers' fees.  The portal establishes a direct contact between the company going public and the registered members who wish to buy the IPO.

http://econintersect.com/b2evolution/blog1.php/2012/10/04/first-ever-crowd-funded-ipo

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Genetic Blood Test To Identify the Most Aggressive Prostate Cancers Being Tested in the UK– Research on Why Some Cancer Tumors Are Aggressive While Others Are Not And Help Identify Patient Risk

Researchers were able to test and find patients with the “gad”gene signature and compared it to those without and those that did not have it survived 21 months versus those who did have it to where survival was around 9 months.  It’s called a six gene test and could help establish high and low risk groups of patients.  This helps with the type of treatment of course and it helps with studying the role of the immune systems to see how a cancerous tumor behaves.  This was a group of 70 men and further studies are needed to see if the same results are played out again. 

I just recently posted about a new blood test in the works for a “liquid biopsy” with the ClearCell System so if both of these types of tests were combined it certainly is going to be a much better experience for the patient and give more definitive results.  BD

Cambridge Consultants Develops A Liquid Biopsy Test Without the Procedure–Only Blood Test Required

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The test, which looks at the signature pattern of genes switched on and off in blood cells triggered by the tumour, can sort the "tigers" from the "pussycats"  .

London's Institute of Cancer Research trialled the test in 94 patients.

The findings are published in the Lancet Oncology medical journal.

Prostate cancer is a very diverse disease - some people live with it for years without symptoms, but for others it can be aggressive and life-threatening.

Experts hope that ultimately the barcode blood test could be used to make a more accurate estimation.

In the study, the scientists were able to split the patients into four groups based on the results of the barcode test. One of these groups fared far worse, surviving for significantly less time than the other patients.

Patients with this "bad" gene signature survived for an average of nine months compared with 21 months for those without it.

US researchers at the Dana-Faber Cancer Institute and the Memorial Sloan-Kettering Cancer Centre have also been testing a similar prostate cancer blood test

http://www.bbc.co.uk/news/health-19873166#?utm_source=twitterfeed&utm_medium=twitter

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Buy or Build, or the Best of Both Worlds–Dr. Edmund Billings from Medsphere, OpenVista EHR

If you are not aware of Medsphere, they have been around for a while and created OpenVista, using the VA Vista Medical Record system and customized it for commercial use. I have talked about their software a few times here and a while back even had their demo loaded on my tablet to test and play around with. In this discussion Dr. Billings talks about the advantages of such a system versus a full commercial install or the ability to mix and match.

Lutheran Medical Center Goes Live with OpenVista Electronic Health Records In New York and 2 More In New Jersey Up Next

One installation was back in 2008 and was one of the fastest installs only to have the hospital close down due to lack of money and Century City is on the outskirts of Beverly Hills pretty much. 

Century City Doctors Hospital Implement Enterprise-wide Clinical Application in Record Time - Open Vista (VA EHR)

Enjoy the article…as there are a lot of good points made pro and con.  BD

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When it comes to IT system decisions, healthcare organizations often ask a key question: Should we buy it or should we build it ourselves? Open source offers a new option to this traditionally binary decision. This option becomes more compelling when the open source solution is the most broadly deployed EHR in the world—the VistA system from the U.S. Department of Veterans Affairs (VA). Instead of Buy vs. Build, it’s the Best of Both.

Traditionally, organizations look at their new system requirements and weigh pros and cons as described below.

In

a Buy vs. Build decision, the key drivers are control and cost.  Do you have control over your system at a cost you can afford?  The decision calculus then shifts to ownership on two levels:  First, can we have true ownership of our solution and make it work ourselves?  Second, is the total cost of ownership economically sustainable?

Yes + Yes = “Best of Both

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Red Hat, the company that fundamentally changed the buy-versus-build mentality when it came to UNIX systems, provides a proof point outside of healthcare. Red Hat clients were looking to move away from legacy UNIX operating systems, which were tied to costly, difficult-to-maintain proprietary hardware.  Open-source Linux offered prospective customers a choice they could download and build on, but such a transition seemed too risky for most mainstream companies. Red Hat’s Enterprise Linux subscription minimized the perceived risk and affordably provided infrastructure management capabilities, toolsets and a proven implementation process.  Many organizations could have done it themselves, but at a higher total cost of ownership and with greater risk.  With Red Hat, they can still build on Linux but without the ongoing code maintenance.  There is a single point of accountability that knows their unique environment and facilitates integration and collaboration with other systems and vendors.  They don’t have to create their own software company internally—they don’t have to choose between Buy or Build.

In the electronic health record (EHR) market, even though an enterprise solution is not an operating system, the parallels are clear. Healthcare organizations use expensive and complex proprietary systems that are difficult to maintain.  The leading systems have prohibitive total costs of ownership. Ownership is undermined by vendor lock. The most important and valuable enhancements are held back for the next chargeable upgrade.  Lack of interoperability is a business model.

Just as Linux was to UNIX, so open-source VistA is an alternative to proprietary EHRs. The difference is that VistA is a proven enterprise solution—the most widely deployed and fully adopted EHR in the world with an open source solution stack that includes toolsets and configuration capabilities enabling an organization to truly own the solution and solve problems themselves.

A hospital can download VistA and build their own VistA-based system, as was recently described at Forbes.com.

Oroville Hospital (153 beds in California) is completing implementation of its EHR, a process that took three years and cost an estimated $10 million (including hardware)—probably half the price of a commercial EHR.

Oroville wanted total control, successful adoption and meaningful use, so they used an open source version of VistA to build their own system. They became their own software company, which means they retain absolute control over the incorporation of their own enhancements and those from the VA. But they also shoulder all the associated costs, with no opportunity to maximize economies of scale. What will their system cost over the next three years?

Because most organizations can’t or don’t want do it all themselves, but still want control, predictability and economic sustainability, OpenVista provides a “Best of Both” alternative to “Buy or Build”. For a hospital similar to Oroville, a subscription for the complete OpenVista solution and hardware would total approximately $4 million over 5 years.

An OpenVista subscription keeps the hospital up to date with enhancements from the VA, the Indian Health Service and other OpenVista facilities. It provides all the code management to keep the system in sync, with testing and certified quality of the client’s production environment. Based on knowledge transfer and true ownership, the OpenVista subscription model facilitates autonomy through “Superusers” capable of driving system change themselves. Designated 24×7 customer care provides backstop support, but hospitals are in control and remain independent.

The “Best of Both” means a hospital can truly own and control its system, and predict and manage costs.

http://blog.medsphere.com/buy-vs-build-or-the-best-of-both/#more-24

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Cambridge Consultants Develops A Liquid Biopsy Test Without the Procedure–Only Blood Test Required

Cambridge Consultants, is working with Singapore-based Clearbridge BioMedics on a new low cost, non-invasive system to improve cancer testing and diagnostics.   The ClearCell System finds circulating tumor cells that have attached to a cancerous tumor.  This got buried in my mailbox so I’m getting it out today.  I have written about several of the devices before that have been created by Cambridge and this time they are working with a company from Singapore.  Here’s a couple examples and they have also worked with Qualcomm.  The first device they created that got my attention was the blue tooth inhaler, something maybe that is still to come of age. 

Cambridge Consultants and Sun Pharma Develop a High Performance Dry Powder Drug Inhaler for Use Beginning in 2011

 

The Minder Wireless Device Connects to Collect Patient Medical Data and Transmit Via Wireless Network to Medical Record Systems Via HL7 Standards

The device is called the ClearCell system and even at low concentration levels it is able to find stray cells in the bloodstream that have detached from the tumor. BD

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Press Release:

Cambridge, UK and MA – September 25, 2012 – Innovative technology design and development firm Cambridge Consultants is working with Singapore-based Clearbridge BioMedics on a groundbreaking device to improve cancer testing and research. The innovative second-generation ClearCell^TM System enables tumor cells to be retrieved and detected even faster, and potentially more accurately, from a simple blood sample – paving the way for a new generation of personalized cancer treatments and increasing the chance of saving lives^*.

 

There were an estimated 12.7 million new cancer cases diagnosed around the world in 2008 – the latest year for which figures are available – and 7.6 million deaths. The number of cases is expected to increase to 21 million by 2030. The spread of the disease around the body is the major cause of death from cancer^*. But the traditional diagnosis method of a tumor biopsy often involves invasive surgery and cannot easily detect whether the disease has spread.

 

Clearbridge BioMedics’s proprietary second-generation ClearCell^TM System is a new low-cost non-invasive ‘liquid biopsy’ that is drawing on the diagnostic device expertise of Cambridge Consultants – particularly in the fields of microfluidics and automation control – to give early warning of the spread of the disease. It detects circulating tumor cells (CTCs) in the bloodstream that have detached from a patient’s primary tumor – even at concentrations of as low as one in a billion blood cells.

 

Early detection of these CTCs can increase patients’ chances of survival – and tracking the cell count over time could help ensure treatment is more effective. The new testing device has also solved the technical challenge of retrieving the cells intact – offering detailed insight into the exact nature of the cancer and its unique characteristics, and so paving the way for a new generation of personalized cancer treatments to fit the needs of each patient’s unique tumor biology.

 

“It is a tribute to our world-leading track record in diagnostic device development that we have been approached from Singapore to help with this development work,” said Duncan Bishop, program director in the Medical Technology division of Cambridge Consultants. “We can also offer a complete end-to-end solution, including blood handling, rapid prototyping and manufacturing trial devices, which is invaluable to start-up companies.”

 

Clearbridge BioMedics is a spin-off from the National University of Singapore and the first member of the Clearbridge Accelerator technology incubator, which is supported by the Singapore government’s National Research Foundation and SPRING Singapore. Clearbridge BioMedics specializes in novel applications for cancer research and diagnostics, and has customers spanning Asia, Europe and North America.

 

Johnson Chen, managing partner of Clearbridge Accelerator, said: “The ClearCell^TM System from Clearbridge BioMedics is designed to resolve the current limitations of today’s technologies for detecting and isolating circulating tumor cells. It potentially represents the next generation of cancer screening, diagnosis, personalized medicine and treatment monitoring. The world-class diagnostic device expertise of Cambridge Consultants made it the clear winner when it came to selecting a development partner.”

 

^* World Health Organization fact sheet no 297, February 2012

 

Cambridge Consultants develops breakthrough products, creates and licenses intellectual property, and provides business consultancy in technology critical issues for clients worldwide. For 50 years, the company has been helping its clients turn business opportunities into commercial successes, whether they are launching first-to-market products, entering new markets or expanding existing markets through the introduction of new technologies. With a team of more than 360 staff, including scientists, mathematicians, engineers and designers, in offices in Cambridge (UK) and Boston (USA), Cambridge Consultants offers solutions across a diverse range of industries including medical technology, industrial and consumer products, transport, energy, cleantech and wireless communications. For more information visit: www.CambridgeConsultants.com 

 

Cambridge Consultants is part of Altran, a global leader in innovation and high-tech engineering consulting which supports companies in the creation and development of their new products and services. With a global network of 17,000 collaborators (including 15,000 consultants) throughout more than 20 countries, and 500 major clients, the Group reported sales of €1,420m in 2011. For more information visit: www.altran.com

 

Clearbridge BioMedics specializes in novel platforms with applications in oncology research and diagnostics. It is a National University of Singapore spin-off company that is committed to developing medical devices which will impact the world and revolutionize cancer diagnostics and patient care by leveraging groundbreaking technology from research partners. The ClearCell™ System comprises patent-pending CTChips®, which are microfluidic biochips able to effectively detect, isolate and retrieve wholly-intact circulating tumor cells (CTCs) from small quantities of patient blood samples. The isolated CTCs can then be stained directly on the CTChips® for identification and enumeration, or retrieved for further molecular analysis. Headquartered in Singapore, Clearbridge BioMedics currently has customers spanning Asia, Europe and North America. For more information visit www.clearbridgebiomedics.com

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Man Dies After Eating Cockroaches During a Contest at a Pet Store to Win a Python

This is sad but other participants did not get sick.  You could not pay me enough to eat roaches.  There’s women in the video eating them too.  A python snake is also something I would not get excited about either to win, but shortly after the contest ended he started feeling sick and I might add there were worms in the mix to eat at well.  After this I can bet it might be a while before such a contest is entertained again.  He was pronounced dead at the arrival to the hospital.  Midnight Madness sale was the come on to get customers in to participate.  It will be interesting to hear what the cause of death was and if the bug and worms were part of it.  BD 


The competition was organized by the Ben Siegel Reptiles store, and the winner was to get a python.

Now, Broward Sheriff’s Office detectives are investigating the death.

The victim was identified as Edward Archbold.

Minutes after Friday night’s contest, according to a BSO spokeswoman, Archbold started feeling ill. He started regurgitating and later collapsed shortly after exiting the store.

http://gossipextra.com/2012/10/08/man-eat-cockroaches-dies-1896/

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United Healthcare Negotiated to Buy 90 Percent of the Largest Managed Care Provider in Brazil, Where Insurers Can Own Hospitals and Physician’s Practices

Update: You can read through here and see where the market value is over $4 billion for the Brazilian HMO. They have a lot of cash on hand due to people here in the US not going to the doctor. The deal was announced today, so is this a predictor of any type of medical tourism push in the future? That’s what I would ponder if down the road something along this line comes about since I don’t know if they get any hospitals in the deal or not. In the US the company has been duking it out with contracts, suing the DOD to get the big west coast Tri-Care contract and pretty much have an all out technology battle going with Blue Cross with a lot of subsidiary actions taking place.

Aren’t These Health Insurance Contracts a Bitch! - Battle of the Algorithms

Ok so let’s have a song…”Down in Brazil”…..BD

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Amil Participacoes SA (AMIL3), Brazil’s largest managed-health provider, is boosting revenue at five times the pace of its biggest U.S. peers, luring a bid from UnitedHealth Group Inc. (UNH) as growth at home slows.

UnitedHealth, the No. 1 U.S. health insurer, is negotiating to buy all or part of Rio de Janeiro-based Amil, which has a market value of 9.12 billion reais ($4.49 billion), according to people familiar with the matter, who asked not to be named because the talks are private. While Amil is talking to other suitors, UnitedHealth has emerged as the likely buyer and a deal may be announced as soon as this week, they said.

Brazil’s relatively strong private-health sector may be more enticing than other countries where governments place more control on the market, said Sheryl Skolnick, a CRT Capital Group analyst who follows UnitedHealth.

Brazil’s integrated-care model, where insurers also own hospitals and physicians’ practices, is another attraction, said the analyst, who is based in Stamford, Connecticut. Unlike in the U.S., where the two sides are often at odds, a blended system can lead to more coordinated care for patients and better cost controls, she said.

http://www.bloomberg.com/news/2012-10-08/amil-lures-unitedhealth-as-brazil-s-sales-outpace-u-s-.html?cmpid=yhoo

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Fungal Meningitis Cases up to 91 and 7 Deaths So Far

This story keeps getting worse and at least there’s a full on alert to try to identify any potential recipients of the spinal injection.  The product has a formal recall and what is really strange here with the compounding company is the fact that it was supplying a large supply of the drug in so many states as usually compounding companies are pretty much working in a local or one state area.  They seem to have the distribution of a mini drug company and there are drugs that are FDA approved that do the same thing, but guess what, they cost more so and from what I read it’s somewhat a substantial price break when ordering in quantity.  I read where the NECC website is now down as well.

Fungal Meningitis Infections Linked to Steroid Injections Manufactured by New England Compounding Center In Massachusetts

Now there are 91 reported cases and I hope we have reached the end of them as patients who received injections between July and September are being contacted.  Over 17,000 potentially tainted injections were shipped from the NECC lab.  BD 


The number of people sickened with fungal meningitis from tainted epidural steroid injections has now risen to 91 in nine states, including seven deaths, federal officials said Sunday, as investigators try to home in on the precise source of contamination at a compounding pharmacy tied to the widespread outbreak.

Investigators from the U.S. Food and Drug Administration and state officials are probing the Framingham, Mass., facility where the New England Compounding Center made the 17,676 potentially tainted steroid injections, which were then shipped to 75 clinics in 23 states, according to federal and state officials.

http://online.wsj.com/article/SB10000872396390444070104578042860922074782.html

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Jon Stewart and Bill O’Reilly–“The Rumble in the Air Conditioned Auditorium” – Big Healthcare Discussion at the End About A Single Payer System–Video

This is great and starts out funny.  I had no idea that Jon Stewart was only 5 foot 7 inches.  They start out on birth control…which of course is the “default” topic for the GOP when they have the urge to control something.  “BS Mountain, pretty funny from Stewart.  Killing Big Bird is not a solution he says and the discussion moves on to investing in PBS.  Stewart has no problem with being taller…love the solution.  I certainly found this debate more entertaining than any of the others out there:)  I think Stewart won this one and hats off to O’Reilly for his participation too.  Here’s the full show if you haven’t seen it.  BD

If you missed the trailers and previews, the links a below.

The Real Debate–Jon Stewart and Bill O’Reilly “The Rumble in the Air Conditioned Auditorium” Saturday October 6th at 8 PM Eastern Time

http://www.youtube.com/watch?v=A051B-uPopM

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