From Bill Bandolero: “Re: Second Life. Patients are using it, clinicians are exploring it, and educational institutions are setting up shop.” Bill sent a link to a site he maintains that has a lot of links to Second Life healthcare sites, but he asked to stay anonymous, so just Google “second life healthcare” and you’ll find stuff.
From PNeddy: “Re: Second Life. Maybe Mr. HIStalk should open a shop in this neighborhood.” Link. Government agencies, including NASA, NIH, NLM, and CDC, are using Second Life for meetings and eventually for widespread communication. “Not far from Meteora is Health Info Island, a medical library and virtual hospital initially funded with a $40,000 National Library of Medicine (NLM) grant to a group called Library Alliance in Illinois to provide consumer health information services in virtual worlds. There are three buildings on the island, said NLM technical information specialist Laura Bartlett, a consumer health library, a medical library and a health and wellness center. Over time, the project will provide training programs, outreach to virtual medical communities, consumer health resources and one-on-one support to Second Life residents.” I’m always up for cool stuff, but I’m light on available time. If anyone can explain what I could do there and what it would take to hook me up, let me know.
From Dan: “Re: Rumor Report. Why does the rumor report redirect to the old HIStalk instead of HIStalk 2? Just curious.” You’ve reminded me that I need to fix that sometime. I’d already created the button and the Web form and just didn’t have time to change it over for the new site. It works great, so I placed it low on my to-do list. You would be amazed at how nice it is to have a secure Rumor Report form that requires Captcha verification to keep the spambots out, plus allows attachments. Before, I was getting dozens to hundreds of spam messages a day. Now, it’s zero. Your rumors and news tips reach me unmolested.
From Maria Cortez: “Re: HIPAA. I’ve heard a lot of dumb things justified by HIPAA, but yesterday I heard one of the best. Our local medicaid HMO has started a ‘high risk diabetic outreach’ program, where they send patients forms to bring to their MDs to fill out. The forms have no pre-printed information and all look the same, so if you see three patients the same day from the same plan, you have no idea which form belongs to which patient (I handwrote their names and MRNs to remind myself). When I inquired as to why they don’t just pre-print patient information on the form (since it’s obviously printed on the envelope they send it in), their response was that if someone else in the household opened the envelope (addressed to the patient), and read the pre-printed form, it would be a privacy violation. I then asked them why anyone’s name is ever printed on a health insurance form/bill/EOB, but they didn’t have a good answer.” Wasn’t this the kind of overzealous interpretation that scared us about HIPAA in the first place? We like the “minimally compliant” approach.
From Charlene O’Donahue: “Re: PHRs. Here’s a new Wharton article.” Link. It’s a good overview for non-HIT people, but I’m surprised that it missed health record banks completely. I’d also question one conclusion that says PHRs could be a bridge between EMRs. I just don’t see that happening.
From The PACS Designer: “Re: ZOHO. TPD has been experimenting with an office software application that is Web-based. It’s called ZOHO and mimics Office. It also provides downloads for Windows, Internet Explorer, and Firefox to link to your system files for transferring online work. It would be good for mobile users when they want to do quick transfers to their home or work based records or files. You can also share records online with others using this application.” I’ve heard great things about Zoho DB and Reports (online forms and databases) and it also has a project management application. The more I play around with stuff like this, the more it feels like the old days when networks were catching on, but many people were still stuck on unattached PCs. I’m using Google Apps so I can access HIStalk documents at work (you didn’t hear me say that) and Inga and I are coordinating some of the HIStech Report stuff on Google’s shared calendar. Plus, I do all e-mail on Gmail and Yahoo Mail. Without all those apps, the PC seems kind of isolated, sitting there running boring stuff off its local drive.
I’m excited to announce HealthcareITJobs.com, something I’ve been working on in partnership with healthcare media publisher Gente Corporation. People have been telling me for years that I should start a first-class HIT career resource center and I’m confident this will be it. Here’s how it came about: first, I was planning to just buy some cheap Internet script and throw something up. Second, as I reconsidered whether that would really meet my standards, I thought about signing on with one of the online job services, but realized it would be cluttered with non-healthcare IT jobs and all kinds of junk that I couldn’t control. Then, I linked up with Gente and it just clicked. This isn’t Monster or Careerbuilder – our career center is dedicated to healthcare IT pros and employeers seeking exceptional candidates. No blind ads, no clutter, no lightweight software. We’re running a world-class job board application and have a team of real people operating it (one of whom you know – me!) The jobs are right there to see on the main page without any “register first” BS. I had my checklist of the ideal job board and we’ve hit every item.
Here are some things you can do with HealthcareITJobs.com. First, click on over and sign up for weekly job alerts. Click around, check out the first group of posted jobs, and register as a job seeker or employer. If you’re an employer, here’s a deal for you: we’re offering free job postings through January, so give us a try. We’re also offering banner advertising with a 10% discount for our loyal HIStalk sponsors. Remember what I said about real people? Here’s one: Gwen Darling. She’s the expert who will be happy to help you with your job postings or advertising needs. I’ve put a link to the site to your right and, as soon as I get a few minutes, I’ll be listing some of the hot jobs right here in HIStalk. I know some of you are unhappy with your situation or have been downsized, so we’re going to do our best to give you some fresh job options for 2008.
And, as I need to say often, thank you sincerely for supporting HIStalk and related projects. It’s not about fame or money (I’m anonymous and a working stiff, after all). I do this because I need something creative to do after a long day at work and I have few other interests or talents. It’s immensely gratifying that you read, interact, and educate through this vehicle. Thank you.
Crescendoplayer sent over some speculation that’s juicy, although certainly not verified. He tells me that a certain software vendor executive, who I’ll refer to as Juan Garcia, is a former military strike leader who ran anti-drug missions in South America with the CIA. Says that exec is being courted by GE Healthcare to be CEO, although he already passed on a CTO offer from them last year. Other companies supposedly interested in his leadership: Microsoft, McKesson, and IBA. I’m cutting back on the details since I don’t have first-hand knowledge, but it’s a fun story if nothing more.
Will Weider sent over to a link to a story about athenahealth’s Jonathan Bush and his participation on a PBS program that took non-athletes and trained them to run the Boston Marathon. JB’s Marathon Diary is a fun read, although a little sad because he was going through a divorce at the time. “Well, my friend Pierre, who knew about the project, said I should. I was in a very suggestible place. [laughs] If someone told me to join the Moonies, I think I’d probably be a member right now. I was in, you know, a difficult place personally. And there was something reassuring about joining a group to do something healthy for me. Forced health, forced purging of all kinds. I think that was the main motivation. Pierre also told me I needed to meet girls and that there would be all these girls in the marathon. [laughs]“ Will is unhappy that Jonathan finished in 3:52. “I trained much longer for my marathon and ran much slower. I now officially despise him. I am pretty sure that I will never buy anything from athenahealth. Perhaps I will add a question to my RFIs about the marathon times of their executives that I can use as a filtering criteria.” I e-mailed Will back: “I like the idea of showing preference to vendors whose executives are less athletic. I’m also on record as preferring those that are less attractive, less wealthy, and less intelligent. I have enough insecurities without realizing that some vendor sales VP is better than me in every important category!” To which Will replied, “Exactly. It is not a new concept. Everyone understands ‘client golf.’ We are just extending it a little.”
A bad smell forces the evacuation of one of McKesson’s Georgia offices. Any witty punchlines are up to you.
Industry regular Steve Roberts signs on with HealthPort as COO. He’s done stints at SDS, GE Healthcare, Allscripts, and McKesson.
An analyst thinks Emageon’s share price drop could attract merger or buyout offers.
Sunquest announces a sale to TriCore Reference Laboratories.
Embarrassing: surgeons at Rhode Island Hospital operate on the wrong side of a woman’s brain when a surgeon “misremembered” the CAT scan, the third such occurrence at the hospital so far this year. The state fined the hospital $50,000.
Somerset Pediatric Group (NJ) picks Sage Intergy.
South Florida has an epidemic of upper-middle class families, including their kids, who are hooked on prescription drugs willingly doled out by shady doctors operating from roadside pain management clinics. One such doctor had his medical license revoked and is working in a gas station while we waits to be tried for prescription drug trafficking, which could put him away for up to 75 years. “We wanted our market share … we didn’t wanna lose a patient.”
Greg Larkin MD, formerly of Eli Lilly, is named CMO of the Indiana Health Information Exchange.
Strange hospital lawsuit: a Chinese hospital insists on getting the husband’s signature on a surgical consent form before doing a C-section on his wife. He refuses at the last minute and the woman dies. Her mother is suing the husband and the hospital. The hospital says they coudn’t do anything without approval, although a legal expert says hospitals have the right to save a patient but are sometimes sued for doing so without the paperwork.
E-mail me.
Inga’s Update
From Dr. John J. Ryan, Founder, President and CEO, The Int’l. Assoc. of Dental and Medical Disciplines: “Inga, I am writing to tell you that we have no sponsors at the current time. Our organization is trying to remain financially independent for as long as we can. Though things may change at some point, we are giving the growing bundle of perks to attract educators and health care practitioners to share our mission of combining dental and medical under one umbrella to better treat every patient as a whole person. It is important for us to combine all disciplines to communicate on behalf of the best possible care and the IT giveaways can facilitate that. The Web Site, Hosting, and Email service is for every member, the IBM Thinkpads, however, are a limited number, for now. With members joining our group we can better build our donated services health care base and better help us can to find dental or medical donated care for such a person in need.” Dr. Ryan also mentioned they are looking for administrative volunteers to help find care for the uninsured.
Athenahealth is purchasing a 130,000 square foot office facility on 53 acres in Belfast, ME. The center will serve as a second operational service site
Sage reports its total revenues were up 24% over the previous year, though the healthcare group saw just 1% growth.
Overheard: Big Brother is watching over sales reps at a certain vendor. Supposedly sales folks at this company are upset over a new policy that requires them to keep up to schedules in Outlook. Seems like management could find better ways to help salespeople sell then by micro-managing their calendars. Not to mention that if someone is producing, what difference does it make if they take an afternoon off to golf? And if they aren’t selling, why keep them around?
Delaware Health Net selects Allscripts HealthMatics Office for its 20-doctor, six-location network of community health centers.
Norman Physician Hospital Organization purchases eClinicalWorks for its 31 affiliated practices and 100 physicians.
Carestream Health and IBM announce plans to integrate Carestream’s radiology solutions and IBM’s Lotus Sametime software to facilitate rapid communication, including instant messaging and VoIP operations.
Visage Imaging will integrate Nuance’s Commissure RadWhere into its PACS and image interpretation software.
The Brooklyn Hospital Center, Brooklyn, NY will implement Eclipsys’ Sunrise Clinical Manager at its 463-bed facility.
A Korean quarry worker dies after his cell phone battery explodes. Fortunately, the phone is only sold in Korea.
E-mail Inga.
From Bignurse: “Re: chart errors. The article about the doctors finding incorrect information in their own medical charts reminded me of a ‘new paradigm’ for charting that I saw a few years ago in which the doctor-chart-patient are in a triangle, with doctor and patient sitting side-by-side and looking at the chart (an EMR) together. It makes perfect sense and would prevent incidents of ‘wrong patient, wrong chart’ as described in the article, but when I used to describe the ‘new paradigm for charting’ during EMR training sessions, people looked at me like I had three heads. It is anathema for medical folks to imagine letting patients see—much less contribute to – their own medical records.” Maybe we need an evaluative tool to determine just how capable and interested people are in participating in their own care. Otherwise, we just treat them equally like dull fools, at least unless the family intervenes. And I truly believe the days of “don’t worry your pretty little head about your records – that’s my job” are over. No one’s too scared to speak up any more. I say if you want to stroll around to the doctor’s side of the PC or hold out your hand for the chart when he or she’s done writing in it to take your own look, then that’s your right as a paying patient, no different than you’d expect than when dealing with a mechanic or plumber (although since doctors work on patients, not cars, they can’t put out those phony “insurance doesn’t allow customers in the garage” signs to keep pests from bothering the help).
From Hamilton Swan: “Re: Perot. Has Perot has adopted the IHE model for HIT standards, do they lean more toward the HL7 model, or are they agnostic?” I’ll ask for a lifeline on that one, if anyone knows.
From Gerry Fleck: “Re: reading list. I have found The Innovator’’s Solution a powerfully useful way of thinking about what it is that we healthcare informaticians are really trying to enable and why the incumbents can find it daunting.” OK, I was hooked by the opening sentence of the first Amazon review: “The first two chapters of this book are so well thought out and beautifully written that reading them literally made my muscles ache and toes curl.” I’ve placed my order. Thanks for the recommendation – book report to follow.
From Theodore Millbank III: “Re: hospital guards. Kaiser does not allow any armed guards for the ED or anywhere else for that matter. I really dislike this policy.” I’d be nervous, especially after dark. If you work for a trauma center or inner city hospital, you need a front door security guard and an real, uniformed cop in the ED, in my opinion. There’s nothing like a couple of stabbed gangbangers dripping blood in the ED who regain enough moxie to continue their knife-fight from their gurneys, sandwiching a 110-pound female nurse between them in the process. Current example: police dropped off a drunk man in a New York hospital ED, where he broke out of restraints at 4 in the morning and beat two nurses with them, threw a computer at another nurse, and wailed on security guards with computer cords. Sounds like an effective, if inappropriate, use of technology.
From Art Vandelay: “Re: remote monitoring. Monitoring technologies allow disease management with human interventions (i.e., people watching your data and running reports with automated alerts). These people will likely sit in other countries (The World is Flat) and use mobile broadband capabilities to work with our phones, watches, and other on-the-person devices. This could offer interesting alternatives for chronic condition management and surgical recovery, although the FDA 510K challenges could be interesting.” Art mentions Bill Crounse’s blog entry on mobile devices.
From Harlan Pepper: “Re: CIO Summit. The one being discussed is not affiliated with CIO magazine. They made their logo look just like the magazine’s.” I’ll be darned. Compare CIO Magazine’s logo to the Summit’s. That’s quite a coincidence. Harlan sent over a list of delegates who’ll be there, some of whom I know read HIStalk, so perhaps a critique will ensue.
Another sad news item involving a hospital IT leader. UPMC CIO Mark Hopkins died of cancer on November 13, the family announced yesterday. He was 47. Hopkins was named as one of ComputerWorld’s Premier 100 IT Leaders last year. He is survived by his wife Kimberly and two children. A memorial service will be held Saturday at noon at First Unitarian Church and a reception will follow at UPMC Shadyside’s Herberman Conference Center. In lieu of flowers, donations may be made to the Mark T. Hopkins Fund at the Baltimore Community Foundation.
Eric Rubino joins InfoLogix as COO. He was formerly COO of SAP Americas and Neoware.
Listening: Paramore, big-guitar chick rock. You have to like a song called “For a Pessimist, I’m Pretty Optimistic.”
Gaines Baty, president of recruiting firm and HIStalk supporter R. Gaines Baty Associates Inc., provides career guidance for employees of acquired companies in The Wall Street Journal.
Tom Visotsky, formerly of Concuity and 3M HIS, joins Medicare compliance and reimbursement solutions vendor CodeMap as EVP of business development.
A reader sent over John Glaser’s article in Harvard Business Review, a fictional case study in which an IDN’s CEO is asked to choose between a billion-dollar monolithic enterprise system and experimentation with service-oriented architecture. Without apparent irony, Kaiser CEO George Halvorson opines that the phony organization shouldn’t bet the farm on systems without a sound business case and that “extremely high levels of system availability are an absolute necessity.”
Reminder: Platinum Sponsor Picis is looking for topnotch talent, which I know is commonplace among HIStalk readers. Worth a look, I’d say.
Streamline Health’s Q3 numbers: revenue up 10%, EPS $0.00 vs. -$0.04.
A Tacoma Community College nursing professor uses the online world of Second Life to create ED simulation training. I tried Second Life once and was bored after a few minutes of fumbling around, but apparently it’s quite the hit, especially for nerds whose First Life isn’t what they’d hoped. If you’re a fan of it for medical or business reasons, feel free to send in a precis.
Health Data Services offers its FreeDOM PM/EMR at no charge to one- and two-doctor practices in Florida, the tenth state it serves. They make money from elective add-ons like claims processing, patient statements, support, and coding. Sounds like a good idea, although I know nothing about the product.
Cardinal Health recalls another model of its Alaris smart IV pump line, this time the biggie: the Medley, with 200,000 devices in the field.
Inga and I have been insanely busy lately with interviews, HIStech Report, and new and upgrading sponsors. If we’ve been inattentive to anyone who’s taken the time to e-mail, allow us to apologize and pledge to do better once we dig ourselves out from under the work we keep creating for ourselves. Here’s the lightning tour of reminders for the noobs: the Search function to your right covers the 4 1/2 years and millions of words of HIStalk, you can sign up for instant e-mail updates and the Brev+IT newsletter (current issue here) over there, and ping us if you’d like information about HIStech Report or sponsoring. The Rumor Report to your right is where you can tip us off to interesting news and rumors (you can even submit attachments and it’s anonymous, of course). Speaking of HIStech Report, I interviewed the guys from PringPierce Executive Search there, so check that out. In a day or two, I’ll also tell you about a new job service that I’m involved in that I think is pretty darned cool.
I wasn’t exaggerating on the “millions of words” above. So far this year, HIStalk is running well over 300,000 words, about six novels’ worth. That doesn’t count my editorializing, Brev+IT, HIStech Report, and so on. I knew I should have taken typing in high school.
Canadian physician EMR vendor Nightingale Informatix loses $1.4 million in Q2 on doubled revenue.
UPMC signs a seven-year, $70 million deal with Xerox for print and document management.
Atlanta’s Grady Hospital could close in the next few weeks, leaving the city’s poor with few options and Atlanta without a Level 1 trauma center. It’s running a $55 million deficit and needs $300 milllion in capital improvement. Its board wants local government to guarantee $200 million in new loans, although it’s a safe bet the money would never be paid back. In a sure sign of rational responsibility over the issue of privatization, community activists and showboating politicians scuffled with hospital security guards and were hauled off screaming in handcuffs, although in their defense the board did sound kind of high-handed in its decision-making.
A CDW Healthcare survey concludes that nurses understand the benefits of IT, but hate paper duplication, poorly designed systems, lack of input in selection and implementation decisions, and inadequate computer training. My experience validates every conclusion. Good work from a vendor you might not expect to care about such issues. You can download the report here.
E-mail me. It’s alway slow in December, so I can use good rumors, secrets, or thoughts.
Inga’s Update
Drs. DeBakey and Cooley have ended their 40 year feud. I never realized that the rift was over a stolen (artificial) heart. I guess at ages 99 and 87, they figured it was time to bury the scalpel. Heartwarming.
SCI announces that its Order Facilitator product won (warning: PDF) second place for “Best Technology Innovation for Continuum of Care” by Consumer Health World.
Fired Microsoft CIO Stuart L. Scott resurfaces as COO of Taylor, Bean & Whitaker Mortgage Corp. The company is based in Florida, but Scott is going to stay in Washington with his family (seven kids!)
Medsphere continues to add to their executive team. Former Athenahealth Chief Revenue Officer Rick Jung comes on board as Chief Marketing Officer. While he has an impressive resume, it looks like he has spent most of his time as a numbers guy. But, their new CMIO has spent most of his career with IT start-ups, so why not put a finance guy in the marketing role?
There is a new private investment firm focused on the healthcare. Cressey & Co. doesn’t have much of a web site up yet, but they do have former Senator Bill Frist as a partner.
I’ve read about the organization that is offering free IBM Thinkpads to attract doctors to their new association. The International Association of Dental and Medical Disciplines is offering this perk in addition to a free customized Web site, free Web site hosting, free email, and a free marketing package. The annual dues are $1899 and the perks about $5000. I looked all over the site for the catch (or at least an idea of who is providing the funding) but didn’t find any clues. Anyone know?
Hewlett Packard is giving the Lucile Packard Children’s Hospital $580K in HP equipment plus an additional $500K in cash for research.
E-mail Inga.
Photo: Hartford Courant
I was certain I knew Eric Rosow of Premise when he introduced himself as a new HIStalk sponsor, but I couldn’t place him. Finally, I remembered: I had seen his presentation at the 2002 HIMSS conference in Atlanta called “Real-time Executive Dashboards and Virtual Instrumentation: Solutions for Healthcare Systems”. It was one of a handful that I thought were interesting enough to cull out for further review, the idea that a feed of information and instrument sources could, like a car’s dashboard, provide an array of information needed to keep the vehicle operating efficiently and going in the right direction.
Patient throughput and its underlying components (patient assignment, bed managment, housekeeping, and patient transportation) have an enormous impact on hospitals that I’ve seen first-hand: ED waits, patient satisfaction, staff satisfaction, and even clinical outcomes (another great HIMSS presentation from years ago was from CareScience, which dealt with bed assignment and the clinical variation that occurs when nursing units get patients whose needs are vastly different from the average patient on that unit).
Hospitals need the kind of measurement and transparency that products like Premise’s can provide. Many (most?) of them have the expensive symptoms of poorly managed patient throughput. No wonder Premise has enjoyed growth of over 2,000% in five years.
Tell me about yourself and about Premise.
First, I have to say that I feel like I’m talking to an underground celebrity. I really love your blog. It’s just so refreshing and humorous and insightful and thought-provoking. It looks like at the rate you’re growing, it could blossom into a great vehicle for communication.
I’m a geek by definition, in some respects. I’m an engineer by training. I went to Trinity College here in Hartford, Connecticut. I majored in mechanical engineering and then got my Masters in biomedical engineering.
My Masters program had an internship, so not only did I get my degree in biomedical engineering, I also spent two full years at St. Francis Hospital and Medical Center in Hartford. That’s really where I fell in love with applied technology in healthcare. After graduating, I got to row with the US team for a couple of years, which was a great experience to see other parts of the world. I then went back to Trinity and taught for a year. It’s very true that you have to learn something to teach it.
After that, I joined Hartford Hospital as clinical engineer, where I was immersed in front lines of healthcare delivery and the role that technology can play in addressing those challenges. I did a 13-year stint at Hartford Hospital and was the director of biomedical engineering for the last seven. I served on the capital committee and was involved with the technology assessment of major projects, including enterprise-wide monitoring and re-engineering engagements.
It was the reengineering initiatives in late 1990s that led to the opportunity to develop what we now call our bed management platform. Hartford Hospital was faced with a number of challenges. A top initiative there was to find, build, or buy enabling technologies to help streamline capacity management/bed management. They had looked at different solutions on the market, but felt there was need for better communication and better integration of clinical information. That provided the opportunity to co-develop the Bed Management Dashboard.
I love the sport of rowing and helped started a rowing team in our town. Through that experience, I learned to value the passion, the teamwork, and the commitment that can come with a high-performing team. I think that experience fostered the entrepreneurial DNA that must have been in me. Or, the lack of a fear gene – I’m not really sure which [laughs] that resulted in us creating this crazy thing called Premise.
Premise is an interesting ride. It wasn’t just, “Let’s go off and create this thing called Premise.” It started out as two guys in the basement, myself and a long-time friend and colleague named Joe Adam. We met as high school lab partners. We were the yin and yang of complementary skill sets. In the early days, we were more of a consulting firm. Over time, we evolved to apply our applications to product-focused and decision support and business intelligence, ultimately to workflow applications. That was the next generation of Premise, in the late 90s, where we evolved from consulting and data acquisition and data presentation and focused on how we could apply those tools and visualization dashboard metaphors to really impact healthcare. For me as a biomedical engineer, it was such as great intersection of connecting devices and communications with workflow and safety and efficiency initiatives.
Hospitals used management engineers a lot a few years back to find and fix process problems. Did that work and are they using them enough today?
One of the ways I got engaged in developing the bed management dashboard was that I was one of first non-GE employees to go through GE’s Six Sixma quality training. Whether it’s management engineer or TQM or CQI or Six Sigma, I think the goal of trying to make informed decisions based on data and trends is what will always be required in healthcare, particularly given the challenges of aging nurses and baby boomers, the perfect storm that’s happening with capacity demand.
Hospitals respect the science of management engineering in day-to-day operations, but saying and doing it are two different things. In our focus area of capacity management, there’s a huge opportunity where information technology can play a huge role in improving that. Specifically, in things that IT is really good at – providing transparency across the organization, analyzing variation, looking at historical trends like where are peak discharges and admissions by time of day, day of week, time of year – and most importantly, streamlining communication among stakeholders.
MRSA is an example of where, when we developed our application, it was really important from the get-go to provide that type of clinical information so that caregivers could take the precautions they needed to and not put patients at risk, particularly if they’re in a semi-private room.
How big a problem is patient throughput in hospitals?
It’s amazing to me how ubiqitious it is, not only in large hospitals, but small hospitals, and not only here in the US, but internationally. We’ve been fortunate to work with a lot of great thought-leading hospitals, places like Cleveland Clinic, Mass General, MD Anderson, and even recently at a kickoff for our first international application at Singapore General Hospital. Places like that who have lived through the SARS epidemic have an even greater appreciation for the challenges when it comes to emergency management. The day-to-day issues include ED wait times, the metrics around diversion, people who leave without treatment, satisfaction indicators, not only people coming from what we call portals of entry, like ED and ancillary areas, but are transfers from other hospitals.
The challenge I’ve seen is that ED backups or diversions and OR and PACU backups are symptoms of a much broader patient flow challenge. Studies have been done that show that ED wait time isn’t necessarily tied to volume or ED staffing, but the visibility of upstream bed capacity. That’s the challenge in hospitals from 100 to 1600 bed hospitals throughout the world. The opportunity to create virtual capacity by better utilization of existing beds is important, especially when we’re seeing bricks and mortar and cranes helping to build out capacity, but at a cost of half a million to a million dollars per bed, plus several years to do that. That’s the real benefit.
It’s looking at the right metrics. The bed turns in a year or in a given time period is a key operating metric that all hospitals need to monitor in real time to better manage their operation.
What are the symptoms that your hospital has a throughput problem and do executives recognize them?
Certainly diversion, excessive wait times in ED, people who leave without treatment, operating room cancellations or delays or backups in PACU. Corresponding derivative effects of that are upset physicians, caregivers, and surgeons who have to cancel or delay their cases due to lack of ICU or stepdown beds for patients to go to after the surgery. Also the challenge of what we call the shell game, where patients are placed on off-service units. An orthopedic patient who’s had their hip done that morning may go to a medical floor. That creates a whole host of challenges. Those units are not trained to manage an orthopedic patient and they are often placed in a temporary holding state. Medications and meals may play catch-up as the patient moves from one holding area to another. You create work for the organization because you’ve got a bed that was occupied that has to be cleaned and prepared for another patient to come in.
There’s great efficiency if you can get them to that right level of care the first time. We’ve seen hospitals that have done more than 40 intra-unit transfers per day. You’re just not getting the throughput you need because of poor visibility across the enterprise. In our experience, capacity management in many hospitals is reactive and decisions made round a diversion, cancellations, and delays are made without good, real-time information that can support these decisions. That’s the biggest value that Premise is focusing on – increasing that visibility and decision support.
Can throughput problems be fixed without an actively managed patient transportation program?
Clearly it’s a continuum. I’ll go on record as saying that you can’t fix throughput with any technology solution. It’s a holistic approach looking at as-is, the to-be state, gap analysis to configure a solution to manage that continuum. The way we look at it is that you’ve got a circle – a portal of entry, bed assignment, bed management. Then, you need the transportation on site to move the patient and/or assets and other equipment to their room and level of care. Communicating all the activities throughout the length of stay to discharge, when a housekeeping event occurs and the room and bed are cleaned. We were originally focused on clinically driven bed management and evolved to environmental service functionality. Our newest module, Transportation Dashboard, provides that visibility across the transportation team as well.
Are hospitals getting better at discharge planning?
I think they’ve had to. As more information becomes available, it becomes easier to plan. The challenge we’ve seen is this notion of hiding beds. People can only make decisions only based on timeliness and accuracy of the data they have. Patients may leave the hospital at 10 in the morning, but that event may not be broadly visible across the organization. If you’re looking only at one ADT system, it could appear that that patient is still up there occupying that bed. That’s the type of mis-information that can create a cascading effect of backups. That continues to be a challenge in terms of visibility in discharge planning and overall patient flow.
Hospitals often think that bed turnover is a housekeeping issue. Is it?
No, I absolutely don’t think so. I often think one of the most rewarding aspects of our solution and the clients we’ve worked with is vindicating and supporting what a great job the housekeeping departments actually do. Because housekeeping departments may not have all the tools and data to support the job they do, they can be the easiest to blame. By providing metrics such as response time to a cleaning request and bed turnaround time, and doing that both on a shift and employee basis, Premise can really empower an organization to see where the bottlenecks can be in their patient flow process. In general, they’re not with housekeeping.
Can census levels be predicted?
I think hospitals can predict some of them. Certainly if you’ve got scheduled procedures, you can see what’s coming up. You can look at histograms and historical trends and control charts of what patterns have been historically for different regions of the country. There is a growing capability with some of the business analytic tools to look at what patterns have been and to use that going forward.
Having been at Hartford Hospital on 9/11, a tragic day for this whole world, the ability to look at patients that were in the hospital that day … there were only three open beds that morning and calls were coming down from state and federal authorities. There were two questions: how many beds do you have available right now by type and how many can you have available in one, two, and three hours from now? Without technology to augment your hypothesis, it would be almost impossible for many hospitals to answer that question. Hartford was able to free up over 140 beds that day to make room for anticipated casualties from New York City, which tragically never came.
What’s the ROI on your products?
There are different pain points for different organizations. Many we’ve worked with have looked purely at their ability to increase admissions without increasing their bed compliment or increasing their staff. Going back to virtual capacity and making better use of the beds they have. Other ROI elements can tie in to reduction in diversion, reduction in OR delays and cancellations. We’ve developed quantitative and qualitative ROI metrics that may or may not apply to a particular hospital’s geography or challenges.
We’re seeing more and more organizations view patient flow as a strategy, not just a problem. It’s critical, it’s real time, it’s strategic. The ability to increase efficiency and therefore profitability is why inpatients are such a high profile. It also plays an important role in patient and staff satisfaction. Chief nursing officers and other leaders use tools that help manage beds and and patient flow as a recruiting tool that makes it a more desirable place to work. All the years I’ve worked with nurses and physicians, they want to do the best job possible and take care of patients like they’ve been trained to. When you have such a potentially out of control system with patients not appropriate for their population, that can create anxiety and risk. Getting the patient in the right bed the first time is critical.
What vendors are competitors to Premise and how would you compare your offerings to theirs?
Certainly the market continues to mature. The vendors we typically see are Tele-Tracking, who I have a lot of respect for; Navicare; Statcom as a pure play vendor as well; and certainly Awarix is a really impressive company and obviously McKesson thought so as well. Those are the pure play vendors we see most often. The large healthcare IT vendors have some functionally. We see ourselves as complimentary to them. We can work in concert with the big HIT or ADT vendors out there. It’s good for the market that we’re all raising the bar, all bringing features and functions to bear as strategy that allows hospitals to better utilize their beds.
In terms of differences, our architecture is open, flexible, based on industry standards. We’re a Microsoft technology platform. We’re unique in the clinical functionality we use to match the patient’s clinical attributes to their level of care. If a patient presents with chest pain and tuberculosis and MRSA, we might need to find a bed with a patient monitor and negative pressure capability in that room. We used to joke that if you have a Yankee fan and Red Sox fan, you may not want to put them in the same semi-private room during the playoffs.
There’s all kind of attributes that may not be readily apparent. Some hospitals have to track gang affiliations. You don’t want to put rival gang members in semi-private room. This ability to complement ADT demographic data with specific attributes, like monitoring infectious disease, is really important to optimize the patient flow experience.
We want to have a highly intuitive look and feel and an easy-to-use user experience. We have patent pending technology called our Intelligent Workflow Engine to optimize and load level how tasks are assigned, particularly in the area of bed turnover, environmental service/housekeeping, and transportation tasks.
I do think it’s not just about technology. You don’t just double click the install button and it’s done. We measure the as-is state and the to-be state based on desired outcomes, and then gap analysis. We bring subject matter experts, a number of clinicians who are nurses with backgrounds in clinical patient flow, project managers, and technical specialists to make sure that when we go live with client, we tune that application to align with their desired workflow. For that reason, our solution may not be right for everybody, but for those it is, it will fit like a glove when we’re done.
Deloitte recognized Premise for outstanding growth of nearly 2300% over five years, one notch behind Google. How did you create that growth and how do you manage it?
We’ve certainly been excited to have grown the way we have. We joke internally that we were right behind Google in terms of statistics, so we love that “lies, damned lies, and statistics.” [laughs] We have great people who have a lot of experience in building companies and also focusing on what’s important. Our goal isn’t to grow, it’s to have 100% referencability. People here are exceptionally passionate. We say we have a company, but we have a mission to make a meaningful difference in healthcare. Hiring the right leaders, the right skill sets and, most importantly, the right culture and chemistry is key to any high performing organization.
In some cases, we’ve been better served by hiring people from outside of our industry. We recently created a chief technology officer position and, after an extensive search, hired a person from the digital media space, somebody familiar with innovation, user experience, and time to market, unencumbered by the traditional healthcare IT world. That has been an advantage for us to innovate. We also made a decision, for the first time, to take on a round of investor money. Through that process, we’ve got a very strong board of directors and thought leaders who have been wonderful advisors and strategists and also mentors to me and other members of our team. One gentleman in particular, Joe Zaccagnino, was the former CEO of Yale New Haven Health. He brings a tremendous insight into the challenges going forward in hospital management and administration.
You said when you hired Craig Gavina as CTO that innovative consumer technologies have healthcare potential. What are some of them?
Certainly as we look at different forms by which information can be displayed. Form has to fit function. We don’t want to be too ahead of curve, but we want to be responsive to what’s out there. One thing we say here at Premise is NEHITO – nothing every happens in the office. We want to make sure we understand what is the most effective way to deliver information, through touch screen interfaces to PDAs to iPhones, as well as traditional vehicles.
The other thing that’s exciting to me as a biomedical engineer is the convergence of other medical devices and applications with patient flow. We have relationship with Stryker,where their next generation smart bed, or iBed as they’re calling it, can communicate bed parameters. For example, are the side rails up, are the brakes on, is the bed at a low height. That information can be critical to another hospital challenge, falls and fall risk and the ability to integrate that type of information into an application like our patient flow system. The same applies to scheduling and resource management. We have a history of form fitting function.
We do what’s right for the customer, and by having a lot of what I call Chuck Yeager accounts – hospitals that push the envelope of this company in a good way to make sure we’re thinking ahead but also grounding our thinking in what will work and what won’t. I know from my experience at Hartford Hospital that things that don’t work the first time often don’t get a second chance. Applications that are innovative and functional and, at the end of the day, will get used.
I love to read books and ideas from thought leaders. One of my favorite authors is Guy Kawasaki, who describes himself as Apple Computer’s evangineer, someone who wants to change the world and has the technical ability to do it. That’s what I see that at Premise. We’re excited to have this technical ability to influence how patients move through organization. We’ve had housekeepers come up to use with tears in their eyes and hugging us, thanking us for being able to show what a great job they do in helping that organization improve their patient flow.
Where does the company go next?
We see a tremendous challenge of continuing to focus and build on the base we have. The opportunity we have to extend into the ability to tie into other devices, staff scheduling, analytics – the market will see a lot more functionality on reporting and analytics. We will continue to be opportunistic as we see challenges and synergies that are presented. We don’t want to boil the ocean – we want to focus on what we do really well. We see the benefits and value of RFID technology.
At Singapore General, we’ll see the integration of advanced RFID technology into our patient flow platform. Technology that can not only show the location of a patient, of staff, or an asset, but also be able to measure physiological signals of those patients, like core body temperature. In Singapore, that can be a useful tool to for precursors or outbreaks of infection or disease states like SARS or avian flu.
Who do you admire in the industry?
I think people like Michael McNeal, who I know you interviewed a while ago. What he’s doing with Emergin is really exciting, how he’s looking holistically across multiple vendors and providing that glue, middleware that can tie information and devices together to enable companies like Premise to add value quicker. Outside the industry, I really admire Steve Jobs and the elegance of what Apple has done and continues to do. I’m one of the heretics here at Premise that carries the iPhone and MacBook running Windows applications. I hold that as the standard to try for in terms of elegance, ease of use, and functionality.
Also, Bill and Melinda Gates and the incredible work their foundation is doing for global health with access to vaccines and drugs and research to develop health solutions that are affordable and practical. I’ve been an Apple evangelist since college, but I’ve always admired Bill’s ability to scale his vision and organization through the vehicle of Microsoft and especially the standards and rigor of the Gates Foundation. It has always been my goal to create social value through my profession and now through Premise. I’ve been in the healthcare profession my entire career because I can think of no better industry to devote one’s time and energy to. Their leadership by example has been a tremendous catalyst for others to contribute, like Warren Buffett, to such an important initiative — global health and the challenging inequities in the world.
Any other thoughts?
The patient flow is a strategy and looking at logistics and analytics is a platform to look at the core processes of delivery. That’s what we’re really focused on doing.
Our success to date has been a combination of our company’s humility. We don’t think we know it all, but we have have great advisors and customers to guide us through a dynamic market. I think it’s due to our passion, a desire to innovate, and our commitment to realizing that vision that has made this place, while at times challenging given the growth we’ve experienced, rewarding. Everybody who works here wakes up every morning excited about what we’re contributing to healthcare. It’s not for everyone, I wouldn’t want anything else. I’m really proud of this team. I don’t want to sound like an infomercial, but I really mean that. It’s a great experience we’re building on and I really appreciate the opportunity to talk with you and I appreciate all the great work you’re doing with your website.
A doctor I worked once with made a great analogy. Why do people buy drills? What they’re really buying is holes. I love that analogy. What is it you really do? What we really do is provide workflow automation, but what we really provide are analytics and real-time information. That’s what people need. We are never going to be a replacement, nor do we want to be, for the big HIT vendors. What we want to be is a decision support tool and real-time dashboard that can work in concert with ancillary systems to make the best, accurate, timely decisions so that the patient gets to the right place at the right time. That ties into patient safety and a whole host of other benefits.
From Jay G: “Re. CIO’s Healthcare CIO Summit. I got to attend the recent Scottsdale event. The resort location was quite impressive, but we didn’t have much time to enjoy the surroundings. The organizers had things scheduled from morning to evening, with roundtable presentations during lunch and vendor presentations during supper. Vendors reportedly paid over $30K to sponsor (which works out to ~$2,000 per 45-minute one-on-one session with a CIO). At that rate, the organizers were pretty aggressive about making sure that the guests got to their sessions. Vendors ranged from hardware (UPS) to implementation consultants. I heard positive comments from guests (’learned about a variety of solutions’) as well as negative comments (’waste of time’). Overall, it was an interesting example of how much vendors will pay for face time with a CIO.”
From CIO Guy: “Re: HBR. ave you seen the Case Study authored by Glaser in this month’s Harvard Business Review? It is a little quirky, but I think he did a good job overall. How did they choose the respondents?” I couldn’t find the article by searching on their site, but I like quirky.
From Former Misys Manager: “Re: Misys. Sunquest Announces New Investment and Market Focus for its Radiology Information System.” Link. Smart move. I expressed surprise that Misys sunsetted Flexirad and the PIM PACS broker in the first place. I expressed surprise once again when Sunquest re-emerged as a LIS-only vendor, having dumped rad, pharm, and clinical decision support apps along the way that were good, marginal, and immature but promising, respectively. The last radiology upgrade was in December 2006, so they can pick up the cycle pretty easily if they still have the right people. Their PE investors could consider acquisition targets that have complementary clinical offerings, like TheraDoc or E&C.
From The PACS Designer: “Re: what to read. TPD peruses the Ebling Library, Health Sciences Learning Center to find interesting reading material. Ebling is in Epicland at the University of Wisconsin-Madison, so it’s in the right location for healthcare research devotees although you need a UW-Madison ID to access the library remotely. There are over 1,900 biomedical and health sciences journals in the online library. If you find something good that HIStalk readers may benefit from, please post a comment so we all learn something new.” Link.
From Rich Kremsdorf: “Re: what to read. Here is a link to the reading list I maintain on my website. It was developed for MDs who find themselves in HIT leadership roles, but is more generally applicable.” Link.
From Duuude: “Re: informatics programs. I recommend UAB, which has done a good job of training eventual directors and CIOs in healthcare IT. It misses its founder, Merida Johns, but still does a good job.”
From The Shadow Chancellor: “Re: UK identity loss. This quote sums it up: ‘Let us be clear about the scale of this catastrophic mistake – the names, the addresses and the dates of birth of every child in the country are sitting on two computer discs that are apparently lost in the post, and the bank account details and National Insurance numbers of 10 million parents, guardians and carers have gone missing.” From this newspaper editorial: “Yet when asked if this fiasco effectively ends plans for identity cards, government ministers say no, still holding to a misplaced belief that ID cards will help make Britain safer. This is a contempt-ridden response. All politicians should be judged on their record. On anything to do with data and IT, this government has a woeful record, illustrated by the millions wasted on an NHS computer system that after years of consultancy fees still does less than a doctor with a notepad and a Biro. And the lessons learned here? There have been none. The plans for ID cards, with all the complexity of biometric data they are supposed to contain, are said to be still on course.” Biro is apparently Britspeak for a pen.
Tim Belec, VP of IT at Wheaton Franciscan Healthcare, was shot in the parking lot of the organization’s Glendale headquarters as he left work on Tuesday. A 17-year-old suspect approached Belec and robbed him of several items, then shot him twice in the chest with a .38 pistol. The 50-year-old Belec, a former police officer, gave authorities a description of the suspect and weapon, leading to his arrest. Belec was moved out of the ICU at Froedtert Hospital later in the week and no updates of his condition have been posted since, but he is expected to recover. Wheaton had recently increased security after vehicle break-ins and now plans to fence the property and hire additional security guards.
Bill Yasnoff sent over a link (warning: PDF) to a new report on health record banking called “Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered”, by The Information Technology and Innovation Foundation. I’m beginning to like the concept since it seems to address the major issues that are holding back information exchange (privacy concerns, technology challenges, business models).
I guessed wrong on the system used to inappropriately access celebrity medical records in New Zealand. Wrong Concerto – theirs was Orion Health’s Concerto portal. Makes sense since both are from New Zealand.
I haven’t heard a word about the recent Virtual HIMSS.
Everybody’s read the headlines by now: the newborn twins of actor Dennis Quaid are given heparin 10,000 units instead of 10 units at Cedars-Sinai. They got a quick PTT and protamine doses and will probably be OK. I’m betting it was the same problem that happened in Indianapolis before, where pharmacy technicians loaded the wrong vial into the Pyxis dispensing cabinet and nurses didn’t pay attention to the label on the otherwise nearly identical vials. Barcoding, people.
McKesson VP and former Per-Se chief accounting officer Richard Flynt joins Immucor as CFO.
Healthcare organizations in Maine get a $3 million FCC grant to bring in broadband connectivity.
Baxa signs on as the exclusive reseller of software from MedKeeper that tracks the preparation and delivery of drug doses packaged in the hospital pharmacy. Everybody involved in MedKeeper used to work for Micromedex.
A Berlin hospital is involved in testing a brain-computer interface that could help people who are paralyzed. It uses EEG signals to control a robotic arm, in essence making it a thought-controlled device.
UMass Med Center uses RFID to track stents and other devices via smart cabinets that inventory their contents and update them as items are removed.
A Michigan woman faces fraud charges for continuing to use employer-paid medical insurance for eight years after she was fired, running up $230,000 in expenses. She got on the county-paid BCBS plan, was fired after 10 days on the job, but kept getting new cards because the county screwed up.
The guy who started Hotmail and sold it to Microsoft for $400 million uses the money to launch a free, online semi-clone of Microsoft Office. That’s one irony; the other is that Microsoft itself set the legal precedent that may keep them from suing him over look and feel issues, from a 1994 ruling that Apple lost to Microsoft claiming that Mac graphics were copied for Windows. Trivia that I didn’t know until now: they guy came up with the name Hotmail as the sounding out of HTML. Great quote: “We are just a few years away from the end of the shrink-wrapped software business. By 2010, people will not be buying software.” I signed up for an invitation, so I’ll let you know.
The New York Times magazine has a fascinating look at how drug companies get private doctors to pimp their wares to colleagues. $500 for a one-hour lunch chat, luxurious “training” (i.e., brainwashing) that includes Broadway tickets and cash, and buddying-up with the local drug reps who grade their selling performance. Startling: 25% of US doctors get paychecks from drug companies for pushing their goods. “Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called ‘prescription data-mining,’ in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies.”
Doctors, when they are patients anyway, think doctors do a sloppy job with paper medical records. One doctor quoted had a cheek lump that went away, but his chart said he’d had a stroke.
Sumter Regional is doing great in the “Win an MRI” contest with 136,000 votes, well ahead of second place Lockport Memorial’s 73,000. But, voting runs through December 31, so they would appreciate some clicks, I’m sure. While you’re there, check out Othello Community Hospital’s (WA) “MR Chick Magnet”, which is pretty funny in the prevalent “we’re hayseeds” genre.
What HIT people are reading:
Redefining Healthcare
The New CIO Leader: Setting the Agenda and Delivering the Results
Crossing the Chasm
The Innovator’s Dilemma
How Doctors Think
E-mail me.
Art Vandelay on the Near-Term Vendor Frontier
We can see the intermediate strategy emerging for a number of vendors. Two strategies ago, vendors were working on a set of bolt-on applications targeted at work-queue and workflow enabling the old-and-tired applications in our environments. Some vendors elected to partner for bolt-ons, others elected to build them, and still others had a foot in both worlds. Representative strategies were to add billing and collection queues and registration and authorization queues for payer-rule intensive areas ( i.e., high-end diagnostics, surgeries). The next strategy was to provide visual workflow aids (i.e., bed boards) and visual integration of information (i.e., patient context enabling any best-of-breed applications in the environment, portals) as well as pursue the enhancement or re-architecture of general-use clinical systems ( i.e., systems supporting order entry, general documentation, not specific departments).
We are on the verge of another strategy shift, one back towards a focus on the functions enabling departments and the emergence of the next stage of integration with real-time location systems (RTLS). The major single-source clinical system vendors ( i.e., Cerner, Eclipsys, Epic) have poor capabilities that enable the workflows and effectiveness of “specific-use departments” or care delivery areas (i.e., cardiology, emergency department, lab, oncology, pharmacy, radiology, procedural medicine). As the deployments in the “general-use care delivery areas” ( i.e., ICUs, medical-surgical floors, ambulatory primary care) progress, the focus will turn back to the “specific-use departments” who “took one for the team” and are now swimming in the inefficiency of a single-source system. The single-source vendors can choose to address the issue and keep their customers happy and engaged, or they can continue to short-change these areas.
Vendors who short-changed these areas, or who can execute two major strategies concurrently, will likely focus on the acquisition of or partnering with vendors on RTLS. Health care, as an industry, is usually behind other major industries. Real-time feedback and visualization has been a focus of other industries for over 5 years now. We are just getting to this. The next stage of RTLS integration will involve the visualization of and enablement of tasks and workflows on a macro-basis, not just focused in a “specific-use department.” This next stage of integration will involve visualization of orders, pending activities ( i.e., documentation, medication administration, transport), patient health status and staff workload. Beyond this, I can see the systems evolving to show or predict the picture hours in advance to help sequence future tasks and determine if additional staff are needed.
On the far horizon is the reinvigoration of revenue cycle systems, it is inevitable as the disenchantment with the broad yet not deep clinical systems will grow and the economic situation in the country becomes more challenged. As always, the million-dollar question is, “Can vendors evolve or will there be more strange appendages and vestigial structures bolted-on to an inflexible architecture?”
