The Healthare Informatics 100 list of companies in Health IT is out. It’s fawned over with reverence by lots of companies on the list, and it even gets an encouraging nod from MrHISTalk—who’s usually a lot more sensible. Which is a pity because the list is basically rubbish, and not very helpful to the industry.

Who’s the biggest Health IT company, and #1 on their list? It’s Cardinal Health. Err, really? Well they may have $80–odd billion in revenue, but that’s because they sell lots of drugs wholesale. Even Healthcare Informatics realizes that and has a note saying “share of revenue from IT” and for Cardinal they say it’s 3%. Even that ($3ish billion) from sales in Health IT is a big number, although I think it’s stretching the definition to say that Cardinal has that amount in IT sales. And of course on that logic McKesson should be #2 on the list. But they only make it to #9, somehow down from #4 in 2006

Who’s next? #2 is SAIC. A big time defense contractor with lots of revenue ($8 bn)  from the taxpayer, but only 4% ($200m) in health care. Third and fourth are Henry Schein and CGI. Who? Exactly. (Henry Schein is a medium sized medical products distributor and CGI is a Canadian version of SAIC which bought mid-sized US based outsourcers AMS which had a decent health care business in 2004). Neither of them are real players in health care IT. Henry Schein claims less than $100m in health care IT sales.

#5 is Perot, which is probably in the right place, but #6 is SAS. Great company and all that but it’s probably not even the biggest business intelligence company in healthcare. By the time we get to #7, 8, 9 & 10–Agfa, Sage (ex-Emdeon/Medical Manager), McKesson Provider Technologies and Cerner, we’re now talking about real health care IT companies. Although again the Agfa & Sage rankings are way high as there’s lots of non-health care revenue in there too.

And then there’s a few small companies not on the list — and like in War Games what’s not on the list matters. One is called Siemens, another is GE, and a third is called Philips. Two of those are in the top 4 health IS companies by revenue, not to mention each of their PACS sales alone which probably exceed Agfa’s. For that matter if SAIC belongs on the list where is EDS, ACS, or CSC? (And I’m not talking about #88, an Ohio company with $18m in revenue called strangely enough “The CSC Group”). By the way GE used to be on the list at #1 before it bought IDX because the dummies at Healthcare Informatics used to count its medical imaging business as IT revenue. Now for some reason it’s disappeared.

Finally a bunch of consultants are on the list including some great niche firms like #79 ECG and #89 Healthia. But if they’re on the list where the heck is Deloitte, Accenture, IBM, PWC etc, etc.

So what does Healthcare Informatics, one of the “bibles” of health IT say to defend this schlock it puts out every year?

As you peruse our annual ranking, keep in mind that the data is self reported. As such we rely on the companies to report only healthcare IT-generated revenues and to do it accurately. Though not perfect we have faith that our survey provides a valuable resource to the industry. <SNIP> Some companies may have a significantly different ranking to previous years because in changes of how IT revenues were attributed or defined as a result of reorganization. And absent entirely are some large industry players due to limits on the granularity of the information they are willing to share.

So in other words we’re printing garbage, but it’s not our fault. For a start they know that they’re not ranking companies by their health IT revenue or else they wouldn’t have Cardinal #1, SAIC #2 or Henry Schein in there at all. So it would be easy for them to rank the order by reported health care IT revenue. Why they don’t do that I can’t fathom.

But that’s not the real problem. Do you think Forbes uses the “self-reported” approach when it’s putting out its list of the world’s richest people. Do you think that the Hong Kong shipping magnates, Colombian drug dealers and Arab princes and terrorists on their lists fax in a form detailing their net worth?

Exactly how hard would it be for Healthcare Informatics to make a couple of phone calls to Wall Street (which of course knows the real numbers), do a bit of real investigative work, talk to a few consultants and come up with a decent list. That would provide a real “resource to the industry”. But someone coming to try to figure out the real state of who’s big and who’s not in health care IT from this list would be hopelessly confused.

CODA: And if you’re searching for Healthcare Informatics online, good luck

There’s a whole lot of rubbish talked by various MDs quoted in an article in Modern Physician called PHR liability, data overload making docs a little queasy. Essentially they’re all saying that they’re gong to be overrun by patients with printouts of their PHRs and because they’ll miss something on page 97 they’ll get sued. And one MD in particular Joseph Heyman (with whom THCB has had its run-ins before) is quoted as saying

there is a risk of ‘garbage in, garbage out,’ and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient.”

It’s just the same as saying that if you give patients email access they’ll abuse it. Lots of doctors talked about that in the past. Several studies have shown it’s not true. You have to truck through a lot of rubbish in the article to get to someone who knows what he’s talking about. Luckily dog-owning Medem CEO Ed Fotsch does, and it’s worth reading:

Edward Fotsch, M.D., CEO of PHR-provider Medem, says that was something he rarely experienced during his years as an emergency medicine physician, ending in the early ’90s. “I saw 10,000 ER patients, and I can remember on one hand the number of patients who had any documented information when they came in,” he says. Fotsch says much of the confusion surrounding PHRs stems from a misunderstanding of what they are.“A disk with a mishmash of information is not a PHR, because I could call my dog a ‘Ferrari’ if I wanted to, but that doesn’t make him one,” Fotsch says. “A personal health record is, by definition, an online collection of structured data.” <SNIP>While agreeing that standards are needed, the AAFP’s Waldren disagrees that PHRs need to be Web-based. Although he thinks that Web-based models will eventually dominate the field, Waldren says there are desktop PHRs available “that are networkable.” But Fotsch wonders if the models mentioned by Waldren allow secured online communication between physicians and patients. Without that, Fotsch says a PHR is like an automated teller machine with no money in it that only allows you to check your balance. Fotsch says a PHR should resemble a continuity-of-care record or continuity-of-care document—two vetted and accepted formats for transmitting basic patient-care data. The PHRs should have defined fields where particular types of data should be entered and displayed, and they also should feature a secure e-mail connection between patient and physician. “There’s a structure around a personal health record,” Fotsch says. “So, if you say you accept a personal health record, you know what you’re accepting.”

So a structured useful PHR should be a good thing for doctors. And surprise surprise that’s what patients want to. So can we have a little less kvetching about this wave that‘s coming and a little more helping patients get these things?