From Up to You: "Re: Scott Wallace. From a magazine: Wallace said he will continue to work in the area of healthcare IT at, ’something really exciting, but I’m not quite ready to announce it yet. I’ve got another six weeks of really intensive work before I can announce it.’" NAHIT seems to want to reinvent itself following (and may related to) his departure. So, where’s he going?
From Tree Adams: "Re: RHIOs in Europe. Points worth mentioning: (1) Taxpayer money and government are the only available sources of funding and administration in a cradle-to-grave welfare state; (2) Might it be easier to introduce a single, electronic solution within an existing nationalized bureaucracy when compared to our disparate, private organizations?; (3) Is it theoretically easier to finance and implement technology when the populations in question are so small (less than 10 million)? But go ahead and keep comparing them to our model."
From The PACS Designer: "Re: Philips acquisitions. TPD is impressed by the recent acquisitions of Emergin, Visicu, Respironics, and Tomcat With the addition of these four, it appears a move by Philips toward the center of the IT process in the enterprise. The mini-EMR mentioned in my HIStalk interview may have to be revised to a main player in the EMR competition!"
Listening: new B52s, the first album with all four members in 16 years. If you liked Cosmic Thing, this is for you - the always-cute, beehived Kate and Cindy still sound young when they soar on the harmonies. Bet they’d play a mean HIStalk party next HIMSS.
A reader pointed out that the Rumor Report button wasn’t working all of a sudden, so I made a new one and moved the form to a new page. It now loads instantly and takes you back to the "new" HIStalk page. So, send me a rumor.
Why Epic is so expensive: take a virtual drive through its new campus Google Street View (the car-mounted 3D camera thing). Nice buildings surrounded by endless muddy fields, but it probably looks better now (or will by summer).
Cool booklet: Steve Bennett, VP of Snelling Executive Search and Chuck Christian, CIO of Good Samaritan Hospital have published 101 Healthcare IT Marketing Ideas and sent me a copy (I had mentioned their quest for reader ideas, although I don’t know if they received any). Item #38: "Station the Help Desk in the cafeteria for a day." Fun. Some of my smarter IT management ideas have involved internal marketing, so I can vouch for these 101 as useful for ensuring IT department visibility and CIO job security. I don’t know how you can get your copy, but I expect the Snelling folks can hook you up.
Execs may like the Allscripts-Misys merger idea, but the sales natives are apparently restless. Resumes from both companies are hitting the street in great numbers, a recruiter tells me.
Your federal tax dollars at waste: a for-profit hospital in New Jersey gets $500K for PACS upgrades. The hospital won’t peg a completion date until it can take another lap around the trough for more federal money. A real estate development company bought the bankrupt hospital in October. Maybe New Jersey has hospitals that aren’t bankrupt, under investigation, or both, but those aren’t making the papers.
A bunch of New York RHIOs gets $105 million in grants.
I mentioned that AT&T’s booth at HIMSS was busy, with a lot of potential partners sidling up as well. If you wonder what the company’s healthcare strategy is, check out my HIStech Report interview (just posted).
A demonstration project says its "best practices" processes reduced medication administration errors by 56%, but of course leaves off the most important stat: how many of those would have caused patient harm? Most people miss the point that a "medication error" is usually something as benign as not being given your daily 8 a.m. laxative until 8:30. Fixing that doesn’t do … well, you know.
More jobs: Account Executive (NC), Revenue Cycle and Operations (MA), Healthcare IT Project Manager (FL), RVP Sales (Western US), Information Security Manager (CA), MUMPS/Cache’ Software engineer (VA), Epic/Bridges Senior Integration Analyst (MA).
Deborah Moore, a former RN and CEO of Accustat EMR of of Myrtle Beach, SC, is named as state Small Business Person of the Year (I assume it’s the business that’s small and not her).
LSU wants a $250 per semester tuition increase on top of $43 million extra it’s getting from the state. They plan to spend $20 million for a new hospital EMR system.
I was looking for a lesser-known EMR vendor and found them on the list of 321 covered by EHR Scope. I didn’t realize there were so many.
Strange hospital lawsuit: Dongwoo Chang, a UC Davis neurosurgeon, accuses his supervisor Jan Paul Muizelaar of incompetence and practicing illegally. UCD suspends Chang citing his high complication rate and being a general pain in the ass. Chang is suing UCD’s top physician officers, saying he was fired in retaliation and that his own death rate and number of malpractice suits is zero, compared to Muizelaar’s high numbers of each. Makes you feel real good about needing trauma work done there.
HHS launches a hospital comparison site that includes process of care measures and patient survey results (when available). I doubt most patients would understand the clinical measures (although they can review bathroom cleanliness and noise), but providers might find competitive bragging rights therein. Unmotivated newspaper reporters are already crafting stories around how the local hospitals did, I’ve noticed.
Sad: a man whose mother died at Doctors Hospital (GA) in 2004 after what he believed was substandard care returns to the ICU armed to the teeth, killing a nurse, a secretary, and a bystander. I’m scared to say it out loud, but I’m surprised that it doesn’t happen more often with all the wackos that pass through hospital doors.
The charitable foundation started by IDX co-founder Bob Hoehl donates $1 million to a Vermont literacy organization.
Vermont Information Technology Leaders changes its mind - it now backs a surcharge on medical claims to pay for physician EMRs. Getting doctors to use them wasn’t mentioned.
Oracle’s Larry Ellison is bonkers, but smart: he successfully challenges the tax valuation of his $200 million Japanese-themed estate, arguing that Larryland is so bizarre that it’s worth a lot less than he paid. Result: he’ll pay taxes on only $65 million, earning him a $3 million refund.
ZDNet says Janet Dillione, CEO of Siemens Medical Solutions,was the smartest person at HIMSS, apparently because the reporter thought she looked a little like Hillary Clinton and because of her daringly insightful predictions such as "PHRs will be popular" and "Healthcare IT needs to change." ZDNet fawns over Soarian, apparently unaware that nobody’s buying it.
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Thoughts from the HIStalk 2008 Reader Survey
Thanks to those to responded. Inga and I pored over your survey submissions endlessly, so your time was well spent.
Not surprising: about 4% of readers are CEOs and 4% are CIOs, not much different than last year. As to the degree that HIStalk influences your perception of products and companies, 8.7% said none, 68.6% said some, 22.7% said a lot. The most popular HIStalk elements (in order) are news, rumors, and humor.
Surprising: to the true/false question of whether reading about a company in HIStalk raises interest or appreciation for those companies, 80.3% said yes (that’s a lot). Best of all, to the question of whether reading HIStalk helped you do your job better in the past year, 75.4% said yes (a 10% jump from last year). I don’t know of any organizations or publications that can claim that strong of an endorsement, so that’s pretty darned cool.
The comments were nearly universally complimentary (thanks for that). Some specific themes I teased out: you would like to see more interviews with non-CEO/CIO types, such as clinicians and non-hospital IT leaders (we’ll work on that). You’d like to see more activity in HIStalk Discussion (so would I.) You suggested a raffle or other incentive for readers who recommend new HIStalk readers (good idea). You suggested changing the sponsor ads (smaller, simpler, different layout) which we will review with the sponsors since they’re the ones keeping the virtual presses running. You asked me to highlight small, innovative vendors who might not make your radar otherwise, another good idea (if you know one or are one, check in).
You also gave us a couple of great ideas for major, separate offerings that we may do if I can figure out how create extra hours in the day. Since I work full time, I’m close to maxing out at maybe 90 hours a week, so maybe it’s time to hire more helpers or something. The ideas were good and have been suggested before, so I’m confident they would be successful.
Inga’s Update
Cerner is participating in a community outreach program that will bring in 45 Kansas City area high school students for half their school day. The curriculum will focus on teaching students the skills necessary to succeed in the workforce, particularly team work and problem solving. Good stuff.
The chairman, CEO, and CFO of Misys show enough confidence in the company’s direction to pull out their checkbooks and make substantial purchases of additional shares.
The chief of neurosurgery at Brigham and Women’s Hospital is accused of sexual discrimination in a lawsuit filed by a female surgeon who believes she was denied promotions in favor of male colleagues with less experience. Whether true or not, the chief definitely has odd taste in office decor and at a minimum has been accused of having a pretty annoying sense of humor. (I will leave my “men are pigs” comments to myself.)
MD Anderson is implementing MedAptus’s Facility Charge Capture and Infusion Services modules. Eight infusion centers will initially use the programs for reconciling the charge review, approval, and transmission processes.
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From Cherry Rojas: “Re: PHR fiasco. The State of Washington issued a $2 million dollar RFP for a demonstration project to link the EMS system in four counties to PHRs last fall. An out of state vendor won it December 12 using smart cards to verify patient ID and to hold their critical patient information, readable by portable reader. Two in-state consultants who wanted to sell the state proprietary software and (and who sat on the Health Information Infrastructure Advisory Board) got their legislators to cancel the RFP before the contract could be signed in February. SMART Association, the apparently successful vendor, had no idea it was an inside game. All references to the RFP have been pulled down from the DIS web site (but we have copies). How will we ever change healthcare if it’s just another inside game? Some DIS staffers were so upset that they were ready to quit.”
From Bruce: “Ars Technica, a popular tech news web site, has posted an interesting article on EHRs and PHR. Very high level, but it’s interesting to see this hit the mainstream tech community.” Link.
From Up to You: “Re: Scott Wallace stepping down as NAHIT CEO. This was WAY overdue.”
From Dutch Treat: “Re: PHR/EHR. EMC and InterSystems are testing the PHR/EHR waters in Northern Europe. IBM runs Denmark. Who’s next? Case in point: unlike RHIOs in in the USA, governance and funds make a difference in Euroland.” Link 1, Link 2.
From Art Vandelay: “Re: dumb EMRs. Many specialists using Epic find the EMR dumb until more configuration is done. This is always a tough position for hospitals or medical groups rolling out Epic. In the typical Epic EMR implementation, the first step is to focus on primary care in the ambulatory setting and hospitalists in the hospital setting. To make it more usable by the specialty physicians, a second round of tailoring then occurs. It is much easier for the implementation team to initially go with SmartText macros for notes and a few order sets for specialists. The team comes back again later with more focused templates for specialists. This causes many headaches in organizations without strong leadership, a large team, and good content management capabilities. By now, a couple of years have gone by and it is time for an upgrade, so progress may stall while the upgrade is tested. Still later comes the health maintenance reminders with the specialists saying, ‘WOW, you mean I get to use some of the discrete data I entered?’ Next, comes the focus on making sense of the order set and template proliferation. Few places take content management seriously and later have clean-up to do. It may or may not be time for another upgrade or the roll out of more specialty models. At last, many places then get to publishing queries in Clarity (data warehouse) for more advanced users to use in delivering care where some reminders may not exist. As with larger clinical systems, it is a toolkit. If the organization doesn’t have the right size team to match the hospital or clinic’s desire to implement and strong sponsorship to focus attention on the goals of the implementation, it is a rough uphill climb. It takes time, money, super-users, technology resources and a strong infrastructure to deliver the product. A place implementing an EMR can learn from Allina and Kaiser. Allina seems to have had great super user involvement. Kaiser has a content management discipline and content teams to quickly go area-by-area.”
I got an e-mail from Bryan Walser, MD, JD, CEO of Perlegen Sciences, Inc. about the company’s activities with the unnamed EMR vendor. Actually, it was the same “letter to the editor” sent to other publications, so I don’t see much point in running it here. I asked him for an interview and he declined. I’m mostly interested in the EMR vendor, of course, and I’m still trying to find out who it is.Design Clinicals has a new web site, I noticed.
Philips will buy Irish cardiology software vendor TOMCAT Systems. Lots of informatics activity in Ireland, it seems (field trip!)
Information Week digs around the Gnutella file-sharing network using LimeWire peer-to-peer software to see if business documents might actually be found there. Downloaded: banking passwords, credit card numbers, credit reports, tax returns, cell phone numbers of senators, meeting notes, and medical documents listing patient names with HIV status. The default setup of those P2P clients is often confusing about which PC folders you’ll be sharing with the world, so it’s likely that employees were so anxious to start downloading that they were sloppy in its setup.
Jobs: EMR Developer, Clinical Improvement Analyst, Meditech Clinical Consultants, Physician Liaison. There’s a ton of new jobs listed, I see, so take a look and sign up to get Gwen’s weekly job listing.
A few folks missed the HISsies cartoon, so I’m listing the winners below.
HIStalk readership will break another record this month. It’s nearly there already with four days left in March. Sitemeter projects 66,796 visits and 101,700 page views. Thanks to those who read, sponsor, e-mail me stuff, and spread the word among colleagues. It means a lot. I’ll have an update on the broad themes from the reader survey in a couple of days. One of them: everybody loves Inga (and rightly so).
New text ad to your right: InteGREAT Healthcare, which offers consulting services in the areas of application integration and interoperability.
California will delay for two years its plan to track prescription drugs to prevent counterfeiting, moving it back to January 1, 2011. Everybody in the drug supply chain said they wouldn’t be ready and would have to stop selling drugs in California (riiiiight). How about that nimble pharma industry, of which Pfizer says it will need 5-7 years just to put serial numbers on its products, even though it’s already doing that for some of its high-profit drugs like Viagra?
Allscripts files a new 8-K that describes the mechanics of its proposed merger with Misys Healthcare. It says the per-share value to MDRX shareholders is $14.30 to $16.20, an 85% premium to the share price the day before the announcement. Shares closed today at $9.06 if you want in.
Cerner shares hit a 52-week low today. Share in athenahealth are dropping, too, and PSS sold some of its pre-IPO stake Wednesday. Nothing’s going to do consistently well in this market, of course.
Former Harvard Vanguard CIO Tom Congoran will fill in as CFO of Massachusetts practice group Atrius Health, which has cleaned house on its executive team after parting ways with former CEO Debra Geihsler.
Harvey Picker, founder of the Picker Institute that promotes measurement of the way patients experience healthcare, has died at 92.
Cambridge Consultants says its Vena single-chip platform can allow medical devices to transmit data wirelessly for less than $10.
RemedyMD will integrate the disease models and biospecimen management system of GulfStream Bioinformatics Corp. into its Investigate research software.
The all-lower-case api software (annoying, yes?) acquires EPEPCS, a tool that estimates required nursing hours and skill mix.
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Inga’s Update
Dr. Deborah Peel’s Patient Privacy Rights organization has posted a summary outlining each remaining presidential candidate’s stand on patient privacy. It’s worth a read if the topic concerns you.
Mediware announces that its blood management software systems are ready to accommodate ISBT 128 labeling.
Oshsner Health System is implementing new DocuSys technology for pre and post surgical care. The solutions will be used across Oschner’s 28 operating room and 15 other anesthetizing locations.
Some not-so-good news for McKesson. A US District court certifies a $7 billion nationwide class-action lawsuit against McKesson on behalf of consumers and third-party payers. It has the potential to be the third largest class action suit in the US. It charges McKesson engaged in a scheme to fraudulently inflate the price of more than 400 prescription drugs.
While it’s unlikely to cover the extra $7 billion, McKesson is partnering with Clorox to develop and promote disinfection protocols for mobile equipment and handheld devices.
Nebraska’s Great Plains Regional Medical Center selects Eclipsys Sunrise Clinical Essential for EMR and medication management. They’ll add additional Sunrise products after Essentials is deployed.
Thank you Wheaties Gal for sending me this link for an inspiring new bingo game. “This does not have to do with big mergers or company layoffs- has to do more with passing time in those boring IT meetings where they think nothing of rattling off acronyms and trying to put together sentences around the latest business buzzwords. Here is a site that you can print out ‘B-S Bingo’ cards. I think you would have to be careful not to yell out (like the girl in the TV commercial). Some meetings I have been in lately, I could get a cover-all in 30 minutes- or less.” I am on the same page as you on this, Wheaties Gal. Going forward, for all mission critical enterprises Mr. H and I will simply set our goals, leverage our resources, and just get it done.
Speaking of getting it done, I was making up some pretty charts for Mr. H showing the growth in readers over the last 18 months. The number of monthly visits has doubled during that time period, which is pretty darned impressive. So keep telling your friends because it sure seems to make Mr. H happy!
E-mail Inga.
HISsies 2008 Winners
Smartest vendor strategic move
athenahealth, for its initial public offering (IPO)
Stupidest vendor strategic move
Medseek, for laying off employees right before Christmas
Most impressive vendor sales deal
Epic, Cedars-Sinai
Best healthcare IT vendor
athenahealth
Worst healthcare IT vendor
Cerner
Best provider healthcare IT organization
MD Anderson
Vendor most likely to be acquired in 2008
Allscripts
HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
athenahealth
Most promising technology development
Software as a Service/Service Oriented Architecture
Most overrated technology
RHIOs
Biggest HIS-related news story of the year
athenahealth’s IPO
Best speaker you heard at a conference in 2007
Jonathan Bush
Most impressive vendor at the HIMSS Annual Conference in 2007
athenahealth
Most overused buzzword
Interoperability
Most effective CIO in a healthcare provider organization
Judy Middleton, William Osler Health Centre
HIS industry figure with whom you’d most like to have a few beers
Jonathan Bush, athenahealth
HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner
HIStalk Healthcare IT Industry Figure of the Year
Jonathan Bush, athenahealth
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 September 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Stanford Hospital last week joined the growing number of academic medical centers that prohibit their physicians from accepting gifts from drug company salespeople. The reps aren’t even allowed on campus, except by appointment to conduct product inservices.
Bravo to Stanford. Physicians think they’re too savvy to be influenced by free lunches, rounds of golf, or drug samples, but drug companies know better – subtle bribery works. If it didn’t, they’d stop. A $100 staff lunch influences even a $500K a year doctor whose prescriptions for one medical condition might generate thousands of dollars a week of business for the drug company.
I’ve taken my share of IT vendor goodies: junkets, executive dinners, trips on private jets, and one memorable evening spent in an internationally known billionaire’s back yard. Having thereby flouted the rules of propriety myself, I’m qualified to issue my first-ever standards of conduct for CIOs and other provider-side executives.
The most important fact is this: it doesn’t matter whether your acceptance of vendor swag is improper; it matters only that it might appear improper to an outsider, like the attorney of a bid-losing vendor who’s suing you for tortuous interference or the 60 Minutes camera crew accosting you on your way to drop the kids off at school.
It’s obvious, but if your organization is sending out RFIs or RFPs or is otherwise involved in system selection, accepting anything is unwise. Even speaking to vendor reps is not smart. Don’t let vendors provide free lunches or giveaways for employees attending demos. Vendors shouldn’t pay for your site visits – if you can afford their product, you can spend your organization’s own money on flights and hotels. Besides, spurned vendors aren’t nearly as chummy afterwards, I’ve found.
Otherwise, lunches are always OK, whether one-on-one or group. Stuff for the IT department is OK, like shirts, food brought in, or sports tickets. This is the IT version of the unrestricted grants that drug companies offer, where you accept small items without reciprocating and the chance of undue influence is minimal. Corporate ethics people are usually OK with this, as long as the gifts aren’t for the specific benefit of an individual.
On the other hand, it’s never OK to solicit stuff from a vendor: free software from the Microsoft rep, donations for a pet cause, money for a department party, or entry fees for a fundraiser. Vendor strong-arming is tacky.
I also don’t like the idea that vendors buy access by sponsoring conferences and giveaways for HIMSS and CHIME, but that’s apparently a hopeless cause. It looks like Halloween, except the trick-or-treaters are wearing suits or conscientiously casual golf apparel.
Spouse trips are out. So are ridiculously transparent junkets, phony advisory board conferences, honoraria, or a visit to the German countryside to see your future PACS system being assembled. It’s tempting when all your cross-town colleagues are lining up at the feed trough, but it’s still wrong, don’t you think?
Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels: with flattery, rapt listening, and a shower of baubles. You know what they really want. Surely your integrity is worth enough that you won’t sell it that cheaply, especially knowing that they won’t respect you in the morning.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
From Mitch Router: “Re: PatientsLikeMe. This really isn’t my bailiwick, but I thought your readers might be interested. It’s easy to see why doctors and researchers (in particular) would not like PatientsLikeMe.com. As a social network, great. But without scientific scrutiny collated anecdotal data may well be “interesting-in –> mathematical model + statistics –> garbage-out.” Link. An interesting New York Times article on PatientsLikeMe, where patients with a handful of specific conditions are posting detailed information about their treatments, right down to drug dosages correlated to their symptoms. It’s advertising-free, but hoping to sell information to drug companies (of course). The article has some interesting thoughts on the privacy implications of such a service and physician questions about having patients take actions based on what other patients report.
From The PACS Designer: “Re: creating your PHR. TPD has been a member of the ASTM International Healthcare Informatics E31 Committee for some time and worked with others to create the Continuity of Care Record or CCR. Now, anyone can create their own PHR using the CCR format by using the Consumer Empowerment National Demonstration website called CEND PHR, sponsored by the American Academy of Family Physicians Center for Health Information Technology. After you creating an ID and password, you will find the following categories available for inputting your health information: Personal, Emergency contact, Insurance, Primary physician, Problems, Medications, Allergies, Family history, and Social history. After completing entries into the PHR, you can save the file and then access your PHR Portable Document File (PDF) for local printing and also save an XML file to a storage location.” Link.
From Mrs. Brown’s Lovely Daughter: “Re: McKesson Paragon. It’s cleaning Meditech’s clock in a number of regions. Key replacement announcement pending”
From Bearly Stern: “Re: Allscripts-Misys. The amazing thing about the Allscripts-Misys merger is that it could have happened years ago. John McConnell repeatedly pitched the idea to Goldberg and Skelton, but they were so focused on becoming a mini-Cerner or Epic that they squandered $500M and a huge lead in the ambulatory space. Was there any real growth or value added to Misys from year 2000 onward? Leadership’s main ideas were cutting cost as a growth strategy and making it prohibitive for existing practice management clients to buy a non-Misys (read: workable) EMR. This while touting ‘interoperability’ in a failed strategy to connect the products of three business units.”
From Esther: “Re: data mining. I CANNOT confirm the vendor, but I can tell you, as an ex-[company] employee, that [company] is very interested in data mining of patient information. Prior to the opening of the [company] employee clinic, we were told at a town hall meeting that any lab work done in our clinic could and would be used for a DNA project [company] was working on. Trust me - you could hear a pin drop during that announcement. There was a lot of uneasiness expressed after the meeting, but as far as I know, no one ever took them to task on it. Those of us who were truly concerned made sure that we didn’t get any blood work done on the premises!” I expunged the company name since it’s a bit of a hot topic right now and I don’t want to cast any unearned aspersions, but you can probably figure out who she’s talking about. Unconfirmed and still waiting on the smoking gun. Possible clue: four million patients? That’s a big footprint. Maybe it’s a clearinghouse owned by an EMR vendor - the Perlegen press release didn’t say it was EMR data, only an EMR vendor, and it refers to an “information warehouse” that would imply either hosted systems or a transaction database. Hmm.
From Dutch Treat: “Re: data mining. What about this company helping the pharma sector?” Link. IntrinsiQQ LLC, the company behind web-based chemotherapy dosing system IntelliDose, didn’t rack up enough paid monthly subscribers, so it started selling de-identified information about drug usage to drug companies. At least the drug companies don’t have plans to re-identify data or contact patients. Still, patients not only have to trust a company with which they have no legal relationship, they probably don’t even know their data is being bought and sold. Somebody could start a nice little company testing and certifying de-identification processes.
From Larry Lonesome: “Re: development. I would be interested in the perspective of users/purchasers of clinical applications, as well as developers of these applications, regarding AJAX application development versus smart client versus any other relevant methodology. Do hospitals have a preferred technology platform? Is AJAX development robust enough to handle the heavy lifting of clinical applications? Does a .NET smart client really solve deployment issues as neatly as a web application?”
Recommended: if you’re a Firefox user like me, upgrade now to the Beta 4 version. I don’t generally use beta releases, but this one’s a screamer (many times faster in Google Docs and other AJAX-type apps). Most plug-ins aren’t available yet for the Beta version, but all I really use is the Google toolbar and it already has a Google search box. Zero problems here.
Girish Kumar of eClinicalWorks passed along a short comment on the Mass BCBS conclusion that EMRs aren’t worth their cost to doctors. He says that eCW has a 95% adoption rate and that most of the physicians using their system would say they’re better off with it than before.
Reminder: if you’re not getting e-mail updates, put your e-mail address in the “Subscribe to Updates” box to your right, even if you’ve already subscribed from the old site (which is no longer being updated, thus not sending out e-mails). If you’re not sure, sign up anyway - it will tell you if your address is already on the list and you won’t get double e-mails.
Intercepted e-mail: Kaiser’s medical group will start a pilot this summer of a thumb drive-based Personal Electronic Medical Record for emergency use. Files are encrypted and read-only, printable to PDF. Contains a concise record of hospitalizations, allergies, doctors, visits, labs, problems, and demographics. Sounds pretty cool.
Tennessee Medicaid will pilot e-prescribing using Cerner software.
Donna Krause is named CIO at Truman Memorial Veterans’ Hospital, having worked her way up from pharmacy aide over a 25-year career there. Congratulations - darned impressive.
Financial Times says investors are skeptical of the proposed Allscripts-Misys merger, with investors passing on the new shares issued to fund it, leaving ValuAct Capital to eat them themselves. From the piece: “… suggesting US shareholders either don’t believe Misys Healthcare is worth this much, don’t believe the deal will go through, don’t understand it, or don’t trust a management that has presided over 64 per cent share price decline over the course of the year.” They missed one: that continued Misys involvement might actually be negative to the business Allscripts was already doing.
The CEO of MedAssets is team director of the US Olympic wrestling squad. Something else to wrestle with: its Q4 numbers, Revenue up 45.7%, EPS -$0.20 vs. -$0.16. Shares are down a third since the December IPO, with a market cap of $706 million.
Stolen, unencrypted, PHI-containing laptop #650 or so: NIH.
An Australian hospital is accused of hiring a nurse to manipulate the “time seen” ED triage data to make the hospital look better.
Robert Wiebe, formerly of the VA, is named SVP/CMO of Catholic Healthcare West.
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Inga’s Update
Lynn County Hospital District (TX) selects Opus Healthcare Solution’s OpusClinicalSuite for its patient information system. The three rural hospitals within the district will use OpusClinicalSuite ASP.
Design Clinicals adds a new client in Iowa. Myrtue Medical Center (IA) is implementing its MedsTracker medication management program.
Medinotes partners with Hawaii’s Akamai Practice Management to provide EMR to small, independent practices. Akamai is a practice management and reimbursement service provider.
digiChart’s OB-GYN Version 7.0 is the latest EMR ambulatory package to receive CCHIT certification.
I suppose because it is such an important use of our tax dollars, HHS just opened a second public comment period to define the following terms: EMR, EHR, PRH, HIE, and RHIO. Actually HIE has already been defined as “the process of electronic health information exchange, not a governing function or entity” so HHS now needs names for a sixth term that will describe “the function or entity that governs health information exchange beyond the confines of a specific regionally based community.” Personally I think Mr. H and I should have opened the blog up and gotten readers to define the terms and then pocketed the millions HHS is spending on this project.
Transcription system provider Healthcare Technologies is partnering with GSA vendor Network Federal. The agreement will facilitate the delivery of HTI’s medical transcription programs to federal, state and local government healthcare customers.
EMR Dude sent me a link to his blog “The Crabby Daddy,” where he provides some commentary on the Allscripts-Misys deal, noting his ties to both companies (he worked at Medic and A4 and now Allscripts.) His take is that the market was in need of consolidation and sends a reminder to the new management that “people enjoy working for a company where quality of life and a fun factor are present.” Probably a good reminder if Misys is involved. Remember this post from a few months back? “From Dan Panama: Re: Misys. Vern said at the business update yesterday that an overwhelming number employees in the employee survey said they are not having fun anymore. Vern’s response: ‘You have to earn the right to have fun.’”
And while I was on Crabby Daddy’s site, I noticed a post about the Common Ground Clinic going live on EMR. This is one of the New Orleans clinics that received funding from HIMSS (and Allscripts in this case) to fund EMRs in the Katrina aftermath. It’s led me to wonder how many other clinics have successfully gone live as part of the HIMSS Katrina Phoenix project and what applications they are using.
I sat in during part of HIMSS’s first virtual conference last year and found it interesting enough, especially for a person who lacks the discipline to listen to a webcast without checking e-mail and taking the occasional phone call in between things. I am almost positive that the first time around that you had to pay a fee if you wanted to participate in the education sessions for CME credits. However, for this third one coming up April 23-24, I notice the whole event is free. Plus there seems to be a strong list of speakers, including Jonathan Bush, Matthew Holt, and John Halamka. I have to assume the exhibitor packages (which start at $5,000) are selling like hotcakes or else HIMSS wouldn’t be offering the conference at no charge.
I am sad to report that I a clear loser in the basketball pool. I knew my selection of Duke was risky, but who would have guessed they wouldn’t make it past the second round. My sole consolation at this point is that I am ahead of Mr. H, but given North Carolina is his top choice he still has a good chance for a strong finish. I’m cheering for Davidson here on out.
E-mail Inga.
A reader heard that MUSC was implementing the Oacis clinical data repository/EMR along with McKesson’s Horizon clinical systems and asked me to find out more. CIO Frank Clark was quick to offer to let HIStalk’s readers know what’s going on in his organization. Some interesting projects, as it turns out, of which the Oacis implementation is certainly one. Thanks to Frank for letting me call him at home to chat.
Tell me a little bit about your organization and what kind of projects are happening at MUSC.
We are a freestanding academic medical center. Our mission is education, research, and patient care. We have about 800 physicians and another 300 residents and fellows. We operate three hospitals - two adult facilities, a children’s hospital, and a psychiatric hospital, for a total of about 850 beds.
Of course, we have the big outpatient clinics where the College of Medicine faculty hone their clinical skills and stay current. It’s probably a $1.6 billion operation enterprise-wide.
Tell me about your IT department.
IT has 250 FTEs. Most of those are centralized within the Office of the CIO. The combined clinical and academic operating budget is probably $35 million. The capital budget ebbs and flows, depending on the projects. We’re in the throes of a big clinical implementation of advanced point-of-care clinical systems within the hospitals, about two years into that and another year to go.
That’s all McKesson, right?
Pretty much. We’ve been a best-of-breed organization. When I came in about five years ago, we had a lot of stuff in place. We couldn’t rip it out and start things over from ground zero. We’ve got systems like Cerner lab, IDX radiology, and Agfa PACS.
We made a decision for McKesson as a preferred vendor. In fact, on Wednesday, we signed a large revenue cycle contract with McKesson . They have a new product, a new ADT, registration, and patient accounting product. We’re implementing their document imaging technology in the business office and also in medical records.
You have a PhD in mathematics. That’s got to be a difficult academic accomplishment. Do you find that’s a good fit for what you’re doing today?
I think I do. I’ve always been involved in computing, very early on as a user and more recently as a provider of services. I’ve always used computing in my academic career and in teaching. My PhD was in applied mathematics, so it had a nice fit for computational analysis.
I started out in an academic career and sort of drifted over into providing IT services. Then the CIO role become an established C-level position, so I moved into that.
How do you run things with regard to IT governance?
Governance is essential to good IT service and a good IT environment. It was one of the first things I set about to establish when I came in here. With any organization, the first thing I’d put in place is a well-defined IT governance structure.
We have various committees that represent different factions of the organization — the clinical, the education, the research, the infrastructure — and we structure that and have it well-documented and then get buy-in from the leadership. I think the key to that is constituting those committees and councils with the right people, people who have an interest and a passion and have the time and who are going to participate in the settings. That really forces stakeholders to take ownership and responsibility. It doesn’t put all the responsibility on IT.
Often issues will come up and people will automatically say, “That’s an IT issue”. Because it has some computing faction to it, people just want to default to IT. The governance really forces users to look at workflow and process and management issues. More often than not, it’s not a technology issue. It comes down to poor workflow, poor process, poor management. So it really pushes back. It doesn’t let people dump on IT. It really forces people to take ownership. It brings people’s common interest and needs together, and looks at technologies.
I think it avoids duplication and re-duplication of functionality because it forces people to look at the inventory of stuff that you already have. Often, people just automatically say, “We need to go out and get a system for this.” More often than not, that functionality exists, so if it meets 85 or 90% of our needs, then we’re not going to go out and buy another system.
What would you say your most important or most pressing projects are right now?
These clinicals that I mentioned, which are nursing documentation, barcode administration, meds administration, and CPOE. We have a lot of research systems that are going on. We’re trying to really streamline and organize the research process. We do about $200 million in funded research and we want to try to scale that to $300 million over the next four or five years. So we’re working with those provosts of research, reorganizing that whole research support sector. Once they’ve identified their strategic imperatives, goals, and objectives, we will look at how we can use technology to assist them.
Going back to the governance issue, it forces people to not just look for technology solutions, but to identify what their strategic imperatives are and their goals and objectives. Then, from an IT perspective, we try to align our initiatives in support of those goals and objectives so we don’t get the cart before the horse. Often this happens — people tend to throw technology at it. It’s been my experience that if you’ve got a bad process and you automate it, you just it do it bad faster. I think that governance helps people to realize that technology is not the panacea or the magic elixir.
So if you’re with McKesson that means you’ve got Meds Manager, HEO, AdminRX, and HED, probably. Tell me where you are with those and what you’ve learned along the way.
Meds Manager is fully deployed. Expert Documentation, we’ve got half of those beds that I mentioned a moment ago. CPOE, we started the initial roll-out in April. AdminRX is probably, like Expert Documentation, about half rolled out.
I guess the vendor is not always right. They still have problems. You would think that as many implementations that they’ve had with these products that most of the issues have been worked out, but I guess that’s not always the case. The people on the ground, the McKesson people who are here on site, are often not the most knowledgeable or the most skilled.
What I’ve learned is that you try to identify within the organization, say McKesson — and it’s huge — it’s a difficult challenge to find the right person to get the right answer, rather than trying to work through the people who are here. I know McKesson doesn’t like that. They like for you to work through the team and the protocol, but we don’t do that.
We just had a team go to McKesson’s clinical brain trust outside Boulder. We send a team out there twice a year. They talk with the right people. So you establish names and contacts. These are the people that we go to when we have issues. That’s been my experience and it’s proven to be successful. That’s just the way I work. McKesson can like it or lump it.
If they’re not performing, we just don’t pay them. Of course, we’re a big McKesson client, so it doesn’t take long for the AR to build up. When it gets to be a million or two million dollars, they pick up the telephone and they call you. I say, “Well, look, when you start performing, I’ll start paying.” I think that’s one of the advantages of the single vendor. You’re doing so much business with them that you really show up on their radar screen. If you stop that revenue stream, it doesn’t take long to get their attention.
You’re hitting some big change management projects that involve a lot of clinical users. What kind of structure are you putting in place, on the informatics side, to get this done?
Going back to the governance model, big projects like this call for an overall steering committee. They’re at a high level, the 50,000 foot steering committee that makes the very big, broad decisions. For each of those products that you mentioned, there’s an implementation oversight committee or council that has people at the operational level. They look at workflow and change management. How is Expert Documentation going to change the way nurses deliver care?
We spent a lot of time before the implementation in thinking through that and talking with other organizations like Vanderbilt and Duke, organizations in our state — Spartanburg Regional and Anderson. These are community-based McKesson clients. Talking with counterparts — “How has that changed the way you deliver care and the workflow?” We’ve really paid a lot of attention on the front end to those kinds of issues.
What are you looking at in terms of success metrics?
Being an academic medical center, we have access to people who are very helpful, skillful, knowledgeable, and experienced in this area. A lady who is in the College of Health Professionals — we bought part of her time. She has worked with the nurses to identify metrics. She did a baseline on these metrics. Like how long does it take to do assessments and how long does it take to get vital signs into the chart?’ Now she’s gone back, once we got a sample size large enough, and done the post-measures.
We’ll do the same thing on trying to measure the reduction of adverse drug incidents. On CPOE, we’ll look at the reduction in lab orders like Chem7’s and portable x-rays. So, we have some well-established metrics that we are measuring. We will report those out. The same thing is true in the perioperatives, OR and anesthesiology. Measuring throughput. We’ve been able to move more people through the OR. Also, the anesthesia coding and charting. We’ve got a project to measure that as well.
How are you going to implement the Oacis repository?
Oacis has been in here since 1994 or 95 and its predecessor before that. Don Simborg started that company many, many years ago. So they’d been in here a very long time. We have a number of very knowledgeable Oacis users as well as IT people. We know Oacis probably as well as anybody, collecting data and the ODR, the clinical data repository, since ’95. That’s thirteen years of clinical data.
It’s rather elegant. The commitment I made when we signed the McKesson contract was that if the McKesson Physician Portal, which is their physician viewer, was not superior to the existing product, we wouldn’t change it out. So about a year ago, we began to look at installing the portal and we got our physicians to look at it. They said, “No, this won’t work.” It won’t work in an academic setting because most of the work is done by the house staff. A resident might have to cover 80 patients, so its not like a community-based physician who comes into the hospital and has one or two patients. The portal is great for them. I had installed the portal in a community-based setting and it worked well.
I thought it had matured and evolved over time, but when we looked at it a year ago, in my judgment, it hadn’t evolved much. So we came to the conclusion that it would not work. It just so happened that Emergis Oacis had a new release, a Java-based release of the viewer and the repository, so we stuck with it. We’ve rolled it out and it will be our enterprise-wide clinical viewer. We import Expert Documentation information into it. Physicians can launch CPOE out of it. So, it’s kind of a single sign-on type environment.
So you are responsible for doing the back-end integration with the Horizon database back into Oacis?
Yes. We’ve worked with Vanderbilt. Vanderbilt did it. It’s not a strategy that’s strikingly different from what is being done at Vanderbilt and Duke, which are both McKesson clients. In fact, Vanderbilt developed the McKesson CPOE. It was called WizOrders and McKesson licensed it. Vanderbilt has installed most of these products that you alluded to a moment ago — Meds Manager, Expert Documentation, barcode administration. They have a homegrown product that’s similar to Oacis called StarCharts/Star Panel. It’s something they developed there. It’s very similar. So they had cracked that nut as far as importing Horizon stuff into it, so we worked closely with them and emulated what they’ve done.
Do you think this will get people’s attention to look at Oacis as an alternative?
Yes, I think it will. In fact, my counterpart in Greenville, Doran Dunaway of Greenville Hospital System, which is one of the largest hospital systems in the upper state — he’s very keen on it. I don’t know whether he’s signed the contract. He looked at the Vanderbilt StarChart/StarPanel, which is being marketed. He looked at a number of different products. He came to the conclusion that it was as good as anything around.
Who’s commercializing the Vanderbilt product?
It’s called ICA, Informatics Corporation of America.
That’s right, I know those fellows.
They’ve got an install in Bassett Health in Cooperstown and it’s being used over in Memphis and it’s a nice product. We looked at it long and hard, but when our caregivers looked at it they said, “This is good, but what we have is equally good, so why would we change it out? If it was vastly superior then we could do it, but what we have is good.”
You’re right, I think the Oacis product is one of those jewels in the rough. It’s widely used in Canada and Australia. Texas Southwestern Medical Center uses it. A lot of people jettisoned it in the nineties –- Atlantic Health, University of Chicago pushed it out. I guess we were on the threshold of doing it until we looked at the McKesson portal and it wasn’t a good fit for academic medicine in our judgment.
As a matter of fact, we signed the contact with Emergis to put in their data warehouse. That’s a Sybase product. We’re in the process of bringing it up. It will be a true research warehouse. In the past, we’d gone against our transaction systems to extract data, but we’ll pull stuff out of our production systems and put it into this warehouse. The schema is optimized for research.
You’ll be able to take your data that’s historic, since you’ve got all that longitudinal data, and move that over to the warehouse?
Absolutely. We’ll pull out all thirteen years, extract it out, put it into Star schema, and optimize it for research.
That’s interesting. What kind of projects do you think will come out of that?
Any of the principal investigators of clinical trials, research … as I said, we do about $200 million now and we hope that the warehouse is going enable us to grow that in scale. Most of it is NIH-funded research, but we do a lot of clinical trials. I think it will make it easier for the researchers to get access to patient data and financial data. We’ll use it for outcomes, accreditation reporting, and CMS.
It will be the gold standard, the system of record. We hope that we can terminate the existence of a lot of these pop-up databases. We’ve got a myriad of them and hopefully we can consolidate it all into the warehouse so we’ll know that any information that leaves this organization came out of that repository, that warehouse, and hopefully it’s accurate and consistent.
Other than Oacis, are there any other applications or vendors that you’ve run across that you think, “Wow, the average hospital has probably never heard of this product or this company, but it’s really cool and it’s doing a lot of good for us.”
There’s a product called Novo out of Georgia.
Novo Innovations.
Yes, Robert Connely. I think Robert is a smart guy. He used to be with McKesson. I think that product seems to be on a very strong trajectory. They seem to be really winning business.
Any kind of tools or anything you’ve found made a big difference or fixed a major problem?
No. I think it’s difficult for these niche players to break in because of the really big players like McKesson, Cerner, Eclipsys, Epic, and GE-IDX. I think more and more organizations are going to move towards preferred vendors because most of these big players now have a fairly robust suite of products, both clinical and financial.
It’s going be difficult for these small players to continue to exist in the major product areas. In the small niche areas, they’ll continue, but for basic HIS kind of stuff, I think its going to be difficult and for standalone labs systems or standalone PACS. We see the integration of radiology and PACS. All these big players have that product now, so I think it’s going to be difficult for some of the small players to continue.
The HIMSS leadership survey seemed to indicate pessimism about funding, capital, and IT resources. Are you seeing any effects?
The housing market is in a rut, but people will continue to get sick and continue to need care. All the predictions show that by 2017 we’re going be spending $4.3 trillion. I don’t see that dissipating.
We seem to be doing OK. Our margins are very respectable. As I said, we just opened the new adult hospital. So I don’t see that healthcare sector being impacted by this so-called bad economy or recession. I think the demand for healthcare will continue to grow. People will continue to get sick and need the service. I don’t see the pessimism, unless it’s a spill-over from the general mood of the country.
Do any vendors stand out as either very well positioned or struggling?
I think Epic is in a good position because of their work with Kaiser. As you know, with the relaxation of Stark, hospital systems are going to do more with community-based physicians. Those organizations that have a suite of products which allow them to do that, I think, are going to be in an attractive position.
All the big players are scrambling to integrate the outpatient and the inpatient. I think that world is going to change. In the community-based setting, it’s always been bifurcated, but the model is going to be more like us. More like the academic medical centers, where you have a closed staff model; and more like what we’re trying to do with Oacis and the viewer is to have an enterprise-wide clinical environment, where a caregiver can access a patient’s information and it’s transparent to them as to where this information was gleaned, whether it was captured in the clinic or whether it was captured in an acute care facility.
With the relaxation of those laws, I think hospitals are going to be able to woo physicians and say, “OK, if you will bond with us, if you will only admit to us through this ASP model, we’ll provide an electronic medical record. We’ll house your data. It will be your data." I think that’s an issue that will have to be resolved — who owns this data. Hospitals will be able to say, “We’ll host this and you won’t have to outlay any cost”. So it think those vendors that are positioned to do that, and I think Epic is because if all that work with Kaiser, I think they’re going to be in an enviable position. I know McKesson is scrambling to try to close that gap. That’s true of Cerner, GE IDX, and others.
Anything else important going on in your world that we can talk about?
We are just trying to finish out this clinical implementation and start the revenue cycle because that’s where the money is. We’re trying to capture more of the money and collect more of the money. It all goes to the bottom line and provide the margins to fund other kinds of things.
One of the big buzzwords was PHR. A lot of the big players are moving into that, players like Microsoft and Google. McKesson has RelayHealth and, I’m sure Cerner and others. Medem, I don’t know if you’re familiar with them …
Yes. Ed Fotsch.
They look very attractive and I think they’re well positioned to do that. My understanding they have partnerships with Google and Microsoft. I think they are going to begin to gain a lot of this market share. That will be a big initiative to us — driven by marketing — trying to have more of what people want and that is online services: read the bill, pay the bill, do some pre-admission/pre-registration scheduling, online consultation with physicians.
We don’t have a lot of referring physicians, but we do have some physicians who have a special case, a transplant or whatever, and they need to move their patient into the center here. How do we push information or pull information back to those referring physicians? Also, as consumers take more control of their healthcare, they will want these health records stored somewhere. So I think that’s going to be a big push over the next few years.
