From Bruce Teeler: “Re: MGMA. Does anyone have any feedback on this organisation? They claim 21k members, which doesn’t seem like a lot to me.” MGMA is the defacto member organization for physician practice management. 21,000 members sounds like a lot to me (I don’t recall how many HIMSS has, but I bet MGMA is nearly as large.) If anyone has first-hand experience with MGMA or its conference, feel free to provide an opinion and I’ll run it here.
From Neal’s Pizza Guy: “Re: Cerner. Rumours abound that Fujitsu is pulling out of the NHS contract, leaving Cerner in a prime contractor role for the Southern Cluster of England. Townsend has been spending a lot of time in the UK to negotiate, along with Neal, who presented how they would take on a cluster direct. Get the pizza ready!!!!” Speaking of pies and Neal, I’ll be opening up the HISsies nominations very shortly. If you’re new here, you can check out the writeups for 2005, 2006, and 2007. Neal’s a three-peater for The Pie, of course, the most recognized subset (and least desirable) of the HISsies awards. So if you’ve been anxious for this year’s round, I’ll say just this: tick-tock. Billy “Biff” Jutjaw is getting fitted for a new tux for the ceremony since he’s put on a few pounds since the last one, so I hear.
From EX-Xtenity: “Re: layoffs. It seems that one of the only certain things in this industry is that there will be layoffs. My heartfelt condolences to those who were recently laid off during this time of year. You might want to consider pulling together as a group for the purpose of networking. Best of luck to you all from someone who has been there a few times.” Agreed. It’s not much consolation while the wound is still fresh, but I’ve known a bunch of people who were laid off and nearly all of them ended up better off because of it. The companies doing the deed don’t usually fare so well (how talented are executives who can’t plan far enough ahead to dump payroll expense sometime other than November or after December knowing how bad that makes them look?) It’s a good reminder that, despite feel-good HR talk about being a “valued associate,” we’re all expendable horseflesh. I’m not against that concept at all since it’s a two-way street in our capitalist society, but sometimes companies say one thing and behave entirely differently and I’ve got a problem with that. I’ve laid off a bunch of people in my time and didn’t like it one bit (like a death camp guard, the clueless commandants didn’t exactly give me a choice). One thing I’ve learned: a company that’s laid people off more than once is entirely likely to do it again, meaning think twice before taking a job there no matter how superior you believe your skills are. Those laid off aren’t necessarily the least-capable employees, just the easiest targets because of their assignments or lack of political connections. There but for the grace of God go you.
From Matchless: “Re: St. Joe’s. I don’t think you published this, but St. Joe’s in Atlanta has to pay the government $26m for overbilling Medicare. Case workers of the world unite!” Link. The most interesting part of the story: a nurse whistleblower gets $5 million for documenting that the hospital billed outpatient and observation services as inpatients. Sweet.
From TheCoolerKing: “Re: [British EMR vendor]. Fired their SVP of Sales last week. It took over two years to find him and he is gone in less than a year. 50% of plan will do that to you.” I expunged the company’s name because that would single out a guy who’s out of work (if the rumor is true, anyway). Those who care will easily figure it out. Hint: it’s not Misys.
From Malvern: “Re: selling patient data. The desire to keep patient data confidential is understandable, but we tend to forget what is known about each of us who uses a credit card, takes out a loan, or swipes the grocery store tag to get the store discounts. When you ask the credit report companies what they know about most of us, there is not a whole lot that escapes the electronic eye.” True, although they need to know lots of stuff to gauge your credit risk and there’s no morally acceptable equivalent in the healthcare insurance business. Maybe that in itself is illogical: other insurances are priced by risk (living in a flood zone, driving like a maniac, skydiving, etc.) but health insurance is supposed to be blind to higher-risk purchasers with no cost adjustment for risk factors. If we were designing the concept from scratch, I don’t think we’d come up with today’s system of voluntary participation and employer-based signup.
From Billie Jean Queen: “Re: mining EMR data. Issues include: disparate standards across specialties and vendors; HIPAA and patient consent information, which requires metadata; control of the repository and how it will be secured, since search engine technology is so good that re-identification of patients is frighteningly easy; and getting enough data to make it useful for research (how BP was collected, for example: sitting, standing, etc. and most EHRs don’t capture that). The most useful thing that could be done would be to get device vendors to output all the information about how a signal was collected, such as device name, parameters for the study, methods used, software version, patient ID, etc. and automatically put that in the EHR in a standard form.”
A Washington Post article describes the software-driven ED turnaround at Inova Fair Oaks, with sophisticated applications forming the cornerstone of Inova’s plan to integrate its six Washington-area hospital EDs and several more freestanding emergency centers. GWU Hospital is also mentioned. The software isn’t mentioned by name, but a little Googling turns up that it’s Picis ED PulseCheck at both places.
Housekeeping reminders: you can sign up to your right for electronic updates when I write something new or for the Brev+IT weekly newsletter. New interviews are coming soon to HIStech Report, whose interviews delve deeper into vendors and their products (it will swell right before HIMSS). HIStalk Forum gives you a place to start discussions or participate in them — we’re planning to open up a Best Practices section there with an assigned focus area every couple of weeks for tip-sharing (grateful kudos for Noteworthy Medical Systems for sponsoring HIStalk Forum). There’s a site-specific Google Search box to your right, the first place I look when someone asks a question about a company or person since it covers 4 1/2 years of HIStalk. Lastly, please take minute to read and click those sponsor ads to your left and text ads to your right since they make HIStalk possible (and free).
A group of Paris hospitals withdraws its $110 million contract for patient systems development, awarded to GE and other companies, because the companies struggled to define their proposal. The tender has been reopened and a local paper says Capgemini and McKesson will probably jump back into the bidding.
Jobs: Medical Knowledge Engineer, Clinical Content Production Manager, Corporate Manager of Clinical Applications, Project Manager.
Barring last-minute voter fraud or eBay-type sniping, it looks like Sumter Regional Hospital will win an MRI machine from Siemens. The hospital has accumulated 244,000 votes, far ahead of #2 Grant Regional Health Center with 151,000.
Odd story: the Fiju hospital trust is running its own IT system after its vendor failed to meet its needs. The vendor’s owner is a businessman wanted for questioning over an alleged assassination plot.
Varian Medical Systems completes its acquisition of a radiology equipment distributor in China. Maybe I should study the Chinese HIT market since everybody seems to be looking there for growth unattainable elsewhere.
Idiotic hospital lawsuit: Wisconsin’s governor takes $200 million from the state’s medical malpractice fund to balance the budget. A patient is suing St. Luke’s Hospital for a medication error that occurred before state pain and suffering caps were enacted, with a potentially huge payoff on the line. The state’s medical society has filed a counter claim against the hospital to make them pay their own damages, claiming the hospital’s employee training is inadequate. The state’s hospital association, as you might expect, begs to differ, saying St. Luke’s should be covered by the malpractice fund because that’s why it was created in the first place. Now the medical society is suing the governor. An epidemic of lawyer paper cuts and 30-hour billing days is next.
Healthcare spending in California’s prison system has doubled in two years. Prisoner count is up 8% since 2003, but the budget increased 79% to $8.5 billion and expected to exceed $10 billion next year. The state faces a $14 billion budget shortfall, which surprises no one in the 49 other states who find it hard to suppress a guffaw. Surely The Terminator will blow away the deficit and save El Lay.
Interesting: an electronic stethoscope under development will use onboard Linux despite perceptions that it will make FDA approval difficult.
athenahealth’s IPO was the ninth best of 2007, one of 10 that doubled their IPO price. Implantable RFID chip maker VeriChip was the worst IPO of the year, down nearly 62% from $6.50 to $2.49.
I hope you’re enjoying the holiday. Shockingly, it’s just nine weeks or so until HIMSS. Save the early evening of Monday, February 25th if you’re headed to Orlando. That’s all I’m saying for now.
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Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in December 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
I’d never heard of the Clinical Data Interchange Standards Consortium (CDISC) until last week. That’s when that group announced the kickoff of a new interoperability project, this one involving linking EMR systems to the information systems of clinical investigators who are performing drug or disease research. The audience might be researchers, the Centers for Disease Control and Prevention, or registries for patients or disease. The IHE is involved in the testing and will demonstrate the results at the HIMSS conference.
I’m not usually interested in this sort of project. I’ve seen first-hand what an insurmountable effort it can be just to get hospital systems to swap clinical data across the hall, much less with national third parties. Still, this is an exciting indicator of how quickly the now-common idea of interoperability has taken hold. If nothing else, RHIOs have made hospitals think about the value of their patient information and how to exchange it in a standard electronic format.
Getting and keeping drugs and devices on the market is expensive and information-intensive. Several small, highly profitable companies have sprung up to help enlist patients in studies, to do the rigorous paperwork required, and to design research methodologies. Their key commodity is information.
Hospitals have patient information that’s available nowhere else, the kind that arouses researchers and manufacturers with far deeper pockets. Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.
Let’s say your hospital implements a well-integrated, information-rich EMR system that can easily tie together everything about patients from medical history to demographics to procedure history. Suppose you add genomic data to the mix, storing information about family history, lifestyle, and a longitudinal history of disease, treatment, and outcomes. All of that could be used to the advantage of your own patients and institutions, but it has an equally high value to those third parties trying to assemble or execute big research projects.
Drug companies and device manufacturers need the data that lives in your clinical systems. How else will they be available to target research to a very narrow range of patient types, maybe even those with a specific genomic profile? It could help them identify appropriate research subjects, design post-marketing surveillance, study population-based outcomes, and catalog adverse events. The information you provide could either be de-identified or made available only if individual patients opt in. The benefit to patients is access to a wider variety of treatments and protocols, most likely free to them if tied to a research project.
You wouldn’t just give that information away, of course. Hospital information is far deeper and more detailed than what’s available from any other source, with a wide scale to match. All you need is sophisticated EMR functionality and a relentless push to get every scrap of clinical information codified, categorized, and cross-referenced.
In the movie Wall Street, Gordon Gekko says, “The most valuable commodity I know of is information.” That is true of clinical data, especially when those who value it can afford to pay. Just don’t sign away too cheaply the rights to your treasure trove of data, even if the interested customer is a RHIO or third party data vendor.
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From Orthopod666: “Re: selling patient data. This is from an interview with the CEO of the AMGA regarding the AMGA/Anceta National Collaborative Data Warehouse, which provides groups with access to comparative healthcare data. ‘The revenue for the company (Anceta) will come from making the totally identified, HIPAA-compliant data available to third parties.’ If this is true, how can they possibly be HIPAA compliant?” Link. Other references to Anceta indicate that the data in the Collaborative Data Warehouse is de-identified, so I assume the reporter misquoted her source (her freelance articles elsewhere cover everything from beauty academies to LCD projectors to real estate, so she may have been in over her head, but surely the editor should have caught that goof).
From Former Medseek Employee: “Re: Medseek layoffs. Yes, it’s true. I was one of the chosen few who got the boot a week before Christmas. I believe there were 30+ employees shown the door. Cash flow was stated as the problem. Mike Drake is out too. The rumor mill has it that egineering folks are not happy in Jackson with losing their leader. Many are are ready to leave, which will only put Medseek in more dire straits.” Maybe you’ll get separation counseling from Chief Strategy Office Gale Wilson-Steele in the form of a free pass to her upcoming lecture called “Promote the Best, Improve the Rest: The Power of Positive Reinforcement.” Feeling better now?
From MedSlease: “Re: Medseek. Mr. HIStalk, you are a good judge of character and hit the nail on the head. Do you remember? Mr. Grehalva has been shaking the clients’ hands and working his free hand to pass out pink slips yesterday, five days before Christmas. There have been some very talented, seasoned people let go, including an older employee on medical leave whose wife is in intensive care with a brain hemorrhage. Merry Christmas, Medseek, and a Happy Lay Off. May 2008 bring you all that you deserve.” The reader is referring to this mention. Layoffs are part of corporate culture, unfortunately, and not entirely unsavory provided that: (1) companies don’t overhire and then correct their own excesses by downsizing; (2) the decision of who gets let go is made fairly; (3) executives share the pain by reducing their own compensation or benefits; (4) volunteers are first solicited to leave before axing those who don’t want to go; (5) separated employees are treated fairly and professionally without the usual security guard escort BS; (6) executives realize that layoffs are their failing, not those of the employees involved, and take appropriate actions to either improve their own skills or find better managers to replace them; (7) layoff decisions are a rare exception and not a routine management tool; (8) management is open about why the actions were taken and what they plan to do to avoid it in the future; (9) management doesn’t expect the shell-shocked survivors to cheerfully work extra hard to make up for the loss of downsized employees; and (10) employees aren’t singled out just because the company has at some point in the past decided to pay them higher salaries.
From Dr. Elias Kuando: “Re: Medseek. First Healthvision, now Medseek. It would seem that a lot of these size HIT vendors keep getting it wrong. Healthvision was expected. They lacked focus. But Medseek? This one surprised me. In my contacts with them as both a partner and a customer using their product, I always had the impression they had it right. That the CEO has left either by design or request speaks volumes about the company’s stability or instability. We have had discussions with Geonetric, but felt they were too small to be considered a serious player. The impression we got from their demo and functionality was that they aspired to be Medseek someday. Given this recent news, I would rethink that position.”
The SEC creates a Web-based tool that allows comparing executive compensation at 500 big companies, although the only healthcare IT one I could find was GE.
I decided not to send a Brev+IT today since not much is going on. Next week.
Listening: Catatonia, witty Welsh (and disbanded) chick singin’ alternative rock. Also: new Nightwish, icy, cinematic, and operatic Finn prog metal.
James Pennington, former CIO at Blue Ridge Healthcare (NC), joins JPS Health Network (TX) in the same role.
University of Miami’s heart clinic will use Active Ink’s electronic forms software for patient check-in on tablet PCs.
Your federal tax dollars at work: bankrupt Bayonne Medical Center (NJ), soon to be sold off to a for-profit company, gets $487,000 for an EMR upgrade.
Philips hasn’t run out of acquisition money yet. The company announced Friday that it will buy sleep therapy products manufacturer Respironics for $5.1 billion in cash.
Merry Christmas (or its equivalent for whatever holiday you may be celebrating).
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Art Vandelay on Vendor Project Management
Many days, I feel like a boxing trainer looking at all kinds of boxers but not finding any with a solid one-two punch - a solid product with strong professional services. More and more, I have been focusing on the strength of the second punch - the vendor’s ability to provide technical assistance and manage a project. You have a real contender when you find one who can help with integration into our diverse environments.
The vendor’s ability to provide technical assistance includes application config., getting their product to work in our hardware environments and delivery of standard interfaces. As virtualization and monitoring ( e.g., response time, SNMP) become more prevalent, the vendors need to develop these skills. The challenges in the hardware environment are the lack of standards and number of varied products we all own. We now include information about these topics in our RFPs to set expectations with vendors.
Managing a project includes a flexible project plan and managing scope, issues and risks. Vendors need to leave appropriate “stubs” in the project plan where we can insert our tasks so that we have an integrated plan. This is always expected from our vendors answering RFPs.
Integration into our diverse environments involves more than just technology. It is about people, processes and other vendors’ technology as well in order to drive real workflow changes. As the number of broad independent consulting firms dwindle, the opportunity for vendors to step into this space will grow. I have yet to see the “heavyweight” vendors really grab this concept and run with it, directly, or through channel partnerships with others. Right now, we operate as our own integrator as the vendors really aren’t looking outside the domain of their products.
Inga Talks to a Former Meditech Director
I had the opportunity to talk to a former Meditech director recently. He had some interesting commentary about the company, its culture, technology, and people. Here are a few interesting tidbits.
Product development
I would say that a very wise move made six or seven years ago was to consolidate all development efforts throughout the company into one organization. Prior to that development had sprouted up and was going on in all different parts of the company. But when the product efforts were consolidated under Bob Gale, the process of developing products matured to the extent that now there are some really good processes in place that have much less in the way of redundancy and reinventing the wheel many times over and also for more rapidly deploying resources to customers.
Orienting new employees to Meditech
The new employee orientation process is either two or three days and consolidates together a large group of people who all start at the same time. Everyone starts at the same time, and there is a certain bond that people have with that group that they started with. They get to know each other and I think that that method of bringing people on board is a good one in terms of not having to individually deal with so many people on common issues such as enrolling in health plans and understanding benefits and just general corporate culture pieces such as how you page people in buildings and so forth. And without that sort of centralized dissemination of the information you’d have all sorts of crazy things going on that would seem small but would make kind of a funny footprint over the whole organization.
Neil Pappalardo and whether he has a hands on or a delegating leadership style
Both – there are certain things he doesn’t get involved with day to day. He is very closely involved with the broad vision of where the company is going and the broad vision of the company’s financial direction but he is not one who would want to see every single detail of what is going on. He just wants to see if the broad vision is heading the way he has asked it to go. He has a very small number of people that report directly to him who would sort of fill him in whether or not we are moving in the direction he has asked for. He doesn’t have an office and sits out in the open in a workstation with other people. He goes right down in the cafeteria with everybody and just grabs his lunch. If you didn’t know who he was you wouldn’t know who he was (laughs) if you know what I mean. If someone didn’t point out that guy over there at that workstation is Neil, you would be likely to think that guy has been here awhile and looks a little older than everybody else. He has always made time for me.
Technology
The products are now developed in a much newer technology than MUMPS. The latest version of their products 6.0 client/server is written in a brand new technology developed by Meditech. Meditch develops the technology that is used to develop the applications and that has always been the case. MUMPS has not been used - I am not sure it was ever used to develop any Meditech products. A close cousin of that is named MIIS was the first language that any product developed by Meditch was written in. Over the years, that evolved into Magic, and Magic evolved into a Magic-based C/S. This newest technology is a brand new development environment that runs in Windows NT and but it also has ability to run in other environments as well because it relies minimally on the server side. They have applications that are used internally for administrative purposes that are running on Linux instead of NT just to give it a test and see how platform independent the technology can be. That is a newer product that is more of a staff scheduling kind of model that’s issued internally.
Why Meditech has been able to achieve such long-term success
Simply the fact the products do work. That is the key thing. It sounds almost like – why wouldn’t they work. You buy a car and expect to drive off the lot, not that they will have to tow it to your house and hopefully in a couple of months you can drive. I think because the products have been written to work together has been is a key to the success of their stability. They have never acquired other companies’ products and tried to put a portal or some kind of other face on top of that product and interface it behind the scenes. It’s true integration. The products were developed with the same technology under the same leadership and that really gives them true integration and not just the appearance of integration.
Meditech’s biggest challenges and opportunities going forward
I think continuing to retain good talent is going to be a critical piece for them. That is really what the company is built on. It’s human capital. You can be financially solid in many ways, but you have to be able to have the people who can carry out that vision and that plan. Another thing that will be a big challenge is getting customers moving forward on new technology. Magic is very solid and I know for a fact there is no plan to scale back or sunset Magic at all. Magic has been moving forward because there are so many clients on it. It would be very difficult from a logistical standpoint envision trying to get more than 1500 customers over to a brand new platform in a short amount of time. It would take a decade or more.
Whether Meditech will lose clients in the migration to newer technologies
I think the cost factor will be far too compelling to leave. And that people would benefit with staying with Meditech because it is only going to be a fraction of the cost to implement a newer technology then it would be to go out and license brand new software from a brand new vendor and do all the conversion. And who knows how much of the data would go with you and now more than ever be able to keep and maintain that data. Staying with Meditech would allow you to keep your historical data. They have migration plans in place that would allow customers a way to do that with minimal effort and maximum retention of historical data. That is an important thing I think to customers.
The biggest misconception about Meditech
That Meditech systems aren’t open. That is a long time fallacy that people have somewhere grasped onto. I think it is because it is not written in a language that they know, the assumption is it’s a closed system. The newer version, the 6.0 version of c/s, is even more open, even with data repository as one of the standard products that Meditech sells, which is a relational copy of their entire data set. That is about as open as you can get by today’s standards. And, even if you think about it, if the technology is different to write or to develop the product, it can be done in such a way that it will allow you to get at data you want to get at if you know the way to do it, and at the same time it can help protect your data from hackers and viruses and other malware that you want to keep away from the software. If you are running an application that is written in a technology that millions of people are familiar with, then millions of people would potentially know how to write something that would do harm, whereas with a Meditech environment you are not going to find that.
From Ralph Hinckley: “Re: outage. Any truth that Penrose St. Francis in Denver/Colorado Springs had a four-day Meditech outage? The story I hear is the Colorado Springs location had just gone live and the entire system went down for four days.” I hadn’t heard that, but perhaps someone will elucidate.
From Quilmes Boy: “Re: Medseek. Medseek reduced its workforce by approximately 20% on 12/19/07. From a company with about 140 employees, this is a significant cut which went wide and deep. The reason cited? Cash flow issues - plenty of AR but no cash coming in yet. Note that Mike Drake, CEO, resigned on the same day.” I saw no announcement, although another reader reported the same thing and Drake’s bio is gone from the exec page. If it’s true, giving employees the boot less than a week before Christmas definitely embodies suckitude (and implies desperation to get them off the books by year-end). Condolences to those alleged to have been affected (careful wording, you’ll note, since it’s just a rumor so far).
From HIT Insider: “Re: Eclipsys. Looks like the new Eclipsys management continues to move the company in the right direction with the sale of the CPM Resource Center. Smart move to keep the company’s focus on software and the integration of content and leave publishing headaches to someone else.” CPMRC was Bonnie Wesorick’s clinical content group out of Michigan, now dealt off to Elsevier for $25 million in cash. Eclipsys paid $5 million in 2004 plus up to $12.5 million more based on performance. ECLP will have to pay Elsevier for the content it distributes with Sunrise, but assuming that licensing cost isn’t too high, it sounds like the right move to sell it off and take the cash.
From Holiday Season: “Re: McKesson. Unless I missed it in one of your reports, I heard McKesson (IT business unit) let hundreds of people go. Does anyone know what is happening? Sales down? Revenue down? Competitors pinching in on the cherished customer base? Overburdened org structure finally catching up with them?” I reported a rumor from Keyser Size in November that up to 250 people had been let go, but I’ve seen no announcement.
From Dr. KillDare: “Re: Epic. There is some unverified noise rolling around that Epic is actually laying off some staff, apparently in Web development. Interesting, since the last noise heard about FTE levels there was about adding ‘200 employees a week’ and ‘the new campus is full’. I don’t believe in spreading wild rumors, but the source was reasonably solid. Any way to solidify or shoot this in the head?” The only one I know is if someone tells me, “Hey, I was one of them” and I haven’t heard that. What’s up with all the layoff rumors?
InBusiness runs a story on Epic called Epic’s workplace culture: IB Investigates the mystique. Epic doesn’t hire you without a 3.5 GPA or better, no matter how long you’ve been out of school, and the company believes in “hiring slow and firing fast.” Judy is “enigmatic” and the company is intensely private, stiffing the reporter’s request for assistance like it does nearly all of them (even Epic’s PR person doesn’t give quotes). Former employees complained about the flat management structure (huh?) and overly intrusive management style (free juice, but no free soda because the company has decided it isn’t good for you, and one guy claims the Internet is shut down during certain times of day). Hours are long and everybody’s supposed to follow Judy’s lack of work/life balance (a former employee says she resents sleep because she could be working). A former employee said employees would be snickering if the article concluded that working conditions are great, but another replied, “It’s because, for a lot of employees, this is their first job out of college. Why don’t you get a sucky job and find out what that’s like? Then there won’t be as much snickering … Epic is still kicking the competitors’ butts. They hire the right people and they know what they’re doing.”
Funny timing: Motley Fool adds Visicu to its list of cheap growth stocks on Wednesday, the day after Philips announced that it would acquire the company. They would have looked really smart if the piece had run closer to when it was written, presumably before the announcement.
TeraMedica announces a reseller deal with Dell.
Jobs: CIO (NC), Nursing Informatics Specialist (CA), Radiology Informatics (VA), Senior Network Engineer (CA), EMR/PM Sales Specialist (AZ). List your jobs free.
Save the date — January 16 — If you have strong feelings about the formal definition of five common HIT terms (EHR, EMR, PHR, HIE, and RHIO). NAHIT and BearingPoint will convene a three-hour forum in DC to gather public comments in what sounds like a wild melee of grammarian one-upmanship. Perhaps it’s a bad sign that NAHIT’s press release gave the last term as “Regional Health Information Network,” so maybe it’s forming a subcommittee to talk up RHINs (the love child of RHIOs and CHINs?) Or, maybe they’re slyly illustrating the point that definitions vary, justifying paying BearingPoint taxpayer dollars to settle the apparently contentious terminology issue, which ONCHIT says is the problem that’s causing all five initiatives to flounder (”Our hospital would be tickled to pay to join your unfunded and paralyzed data sharing project that mostly involves our hated competitors, if you’ll first be so kind as to Fedex over a definition of RHIO — or is it RHIN?”)
British government agencies take heat for security breaches, threatening the Department of Health with prosecution for future breaches like the one that exposed the personal information of those applying for medical residencies on a public website. The most heated information exposed seems to be sexual orientation and religious beliefs, begging the question: why were those applying asked about those topics in the first place?
A London hospital that offers a 40-minute 4D ultrasound for expectant mothers makes another option available: a high definition video download to a cell phone or iPod.
A NEJM study says that hospitalists don’t get patients out of the hospital any faster or cheaper than family doctors.
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Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in July 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
My colleague Ross Koppel, a sociologist and Penn professor, wrote an editorial in The American Journal of Managed Care (released today) titled “Defending Computerized Physician Order Entry From Its Supporters.” In it, he stresses that CPOE and clinical decision support systems (DSS) are separate systems, despite popular perception. Their implementation is often divergent and their benefits and shortcomings confused (or intentionally misrepresented).
Ross is right, and his sociologist’s view is important to our little world of geeks and IT-friendly doctors. We’re expecting a lot from immature CPOE and DSS systems that most hospital executives can’t define, even when they’re plunking down hard-earned capital dollars for them.
I should mention that Ross wrote another article awhile back that riled up vendors, consultants, and HIMSS, in which he described one hospital’s increased error rate with CPOE implementation, finding that his one, small discouraging word was met with choruses of indignation from the “CPOE is Nirvana” crowd.)
CPOE is a smart typewriter that, standing alone, has little ability to improve patient outcomes. It prevents transcription errors, although those seldom harm patients because they’re caught anyway. CPOE makes it easy to choose common order defaults instead of “winging it.” Beyond that, the benefits (both clinical and financial) come from DSS, not CPOE, even though the hospital executives signing a multi-million CPOE deal as their cornerstone of patient safety automation probably missed that point completely.
DSS systems are, unfortunately, mostly frightfully immature, even more so than CPOE. Early adopters share war stories of sky-is-falling alerting, inflexible third-party rules, the inability to customize and personalize, and performance-sapping rules engines incapable of delivering alerts of any more sophistication than the old hard-coded screen edits.
Still, the real problem is right down Ross’s alley. Hospitals usually buy CPOE and DSS because they’ve failed to control physician behavior otherwise, often euphemised as “reducing practice variation” or “practicing evidence-based medicine.” They want software to do the dirty work that they can’t or won’t: telling physicians that they’re wrong and forcing them to change. When docs don’t follow the new cookbook medicine rules any better than the old ones, CPOE and DSS get the blame and everyone involved in the project pretends to have been somewhere else when the vote was taken to buy it.
I’ve been involved in two CPOE/DSS implementations, both involving large IDNs and well-known vendors. In both cases, hospital administration ill-advisedly shot their patient safety technology wad on CPOE, confident that it would improve patient care better than any other investment. Physician adoption was universal in one, minimal in the other, but one element was common to both: 90% of the expected DSS benefit never materialized. The carefully but naively drawn up list of post-implementation metrics was hidden away once everyone realized that we hadn’t really changed anything of importance for our multi-million dollar investment. We had bought ourselves a smart typewriter.
No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines. But if your hospital has already spent a few million on CPOE and DSS thinking that was the case, you’ve learned that already.
Maybe the next generation of systems will offer value that physicians recognize. After all, they want the best outcomes for their patients, too. Where they disagree is that we have the answer right now with these first-generation CPOE and DSS applications.
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