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 February 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Every HIMSS Annual Conference is the “Year of the Something.” CPOE, PDAs, networks, wireless, or CHINs. Newly minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.
Sometimes the Something booms, although often only after several years. Sometimes it disappears without a whimper. Neither outcome dampens the enthusiasm of HIMSS, consultants, and vendors to push a new, carefully orchestrated Something each year, likely because fewer people would attend conferences, hire consultants, and buy new products otherwise. Maybe they learned that from the car makers.
This is the Year of the RHIO. I’m not against that, but it would be nice if organizations finished implementing yesterday’s fads first, like CPOE and electronic medical records. Those are still a hopeful dream for the vast majority of hospitals. And, we know they can deliver value today.
At least some of the RHIO hype appears to be genuine (unlike the Year of the PDA, which everyone knew was a joke.) It seems that technologies developed by Connecting for Health and IHE will allow RHIOs to interconnect, at least according to groups chewing through government grant money. The enthusiasm is palpable, although those with functional memories will recall that technology problems weren’t what ended the Year of the CHIN in the first place.
Eventually, RHIOs will provide patient benefit (at least 3-5 years from now, I expect.) In the meantime, they could become CPOE redux: encouraging premature interest in immature products by unprepared organizations, consuming resources and organizational energies that could have been spent on more worthwhile projects.
Most hospitals still haven’t implemented bedside barcoding, smart IV pumps, electronic MARs, and clinical decision support, all comparatively inexpensive slam dunks compared to CPOE. But, we convinced ourselves to lead with CPOE through some bizarre logic and we’re still trying to get physicians to use it years later, passing up some great patient safety opportunities along the way.
In any case, RHIOs are about to morph from a science fair project run by grant-fueled big contractors to the mainstream. Uncle Sam is sending just one receiver downfield and it’s RHIOs. Whether you’re ready doesn’t matter. That virtually no doctors have EMRs that can contribute or use clinical data doesn’t matter. That hospital clinical systems still capture only a small percentage of electronic data doesn’t matter. What does matter is that RHIOs are hot and hospital executives will be encouraged to hop on the bandwagon.
I think many RHIOs will go right down the toilet through lack of a sustainable financing model, poor governance, or a general lack of interest in cooperating with barely tolerated competitors. Those that are successful will at least spur demand for better clinical systems in all settings. That’s good: according to several HIMSS speakers this week, we’re turning our backs on those systems just as they are becoming good enough to use.
Let’s celebrate the shockingly fast progress that’s been made on RHIOs. Clearly lots of good work has been done. But, remember that your first obligation is to ensure good outcomes for patients under your facility’s care right now. We need to finish implementing all those now-gauche technologies that didn’t make the HIMSS hot list this year.
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 Kinky Friedman: “Re: Misys. Misys announced this weekend that Vern is staying on board after the merger in a yet-undefined role. Mike Etue and Glen are thrilled.”
From CaryObserver: “Re: Allscripts. It will be interesting to see Allscripts Q1 results and the market reaction. My guess is deals stalled due to the announcement and things will get blamed on timing issues rather than execution issues. How many quarters will they miss before management is held accountable?” Well, a bad quarter now could jeopardize the deal, anyway. The Brits were already whining that MDRX was being overvalued, so that would be ammo.
From Delores del Rio: “Re: RHIOs. Not that another RHIO going under is news, but it’s (just) slightly more interesting when it’s out of Silicon Valley. I don’t feel the need to comment much myself since it’ll be easy for others to do so.” Link. California’s Smart Health is worm food after two uninspiring years. Board member Richard Levy (also chairman of the board of Varian Medical Systems) is quoted as saying that breathy estimates of RHIO cost savings will never happen, especially with the big California acute care players like Sutter and Kaiser building their own interconnected systems. Even Daughters of Charity CIO Richard Hutsell took a kick at the still-warm corpse: “There was no economic model that said this makes sense. Who is going to be the one in charge, to manage it and iron out all those millions of details?” CalRHIO’s got a much better chance because it reaches beyond areas of local competition and may have learned from the funding mistakes of its predecessors.
From The PACS Designer: “Re: Web 2.0 magazine. TPD thought HIStalk readers might want to brag to their peers about seeing one of the first of a string of new ways to read magazines and books online. Cardiovascular Business Magazine is one of the first to employ reading their magazine as it would look in your hands. To go to a featured article on the front page, click on it and you’ll be brought to the article’s first page. To proceed to the next page, move your cursor to the lower right hand corner and drag the page to your left. Have some fun exploring and reading online!” Link. There’s probably a medical records analogy in there — the paper metaphor was so strong that somebody took the latest, sexiest technologies just to emulate it on-screen. Can I get a chisel and stone tablet plug-in for Word?
Listening: The Czars. Big, haunting vocals over lush melodies. If a guy could sing Paint the Moon like John Grant, he’d need one of those deli ticket dispensers to make the smitten ladies wait their turn to idolize him.
Epic launches its next big construction project in Verona, getting Campus 2 underway. The local paper says the company is up to 3,000 employees (tripled in five years) and over $500 million in annual revenue. The article took some nice shots at Epic’s competitors, noting Epic’s KLAS ratings, its disdain for publicly traded companies, its six sales reps, its unwillingness to negotiate prices, and its resistance to selling out or going public. The new digs will add 1,700 offices to the 1,500 built in Campus 1 in 2006. Here’s a story about the Epic treehouse (the picture below is from the Wisconsin State Journal). Thanks to the reader who sent the links over – cool stuff.
Daughters of Charity chooses SIS’s perioperative solution.
Vendors and consultants, meet your newest competitor: University of Pittsburgh Medical Center. UPMC will install five clinical applications in 14 months in three UK hospitals under the banner of a for-profit company it formed last year. UPMC and the hospitals have also formed a joint venture to sell IT services to other UK hospitals. Per CIO Dan Drawbaugh: “The Newcastle contract is the first of what we hope will be many international agreements for our information technology services.” They have an unfair advantage in that they run every information system known to mankind, so they’re certainly living the vendor-agnostic creed.
Presidential candidate (and my choice, not that it matters) Ron Paul endorses B.J. Lawson for a North Carolina House seat. Both men are physicians and graduates of Duke University School of Medicine. Lawson was a founder of mobile computing vendor MercuryMD, sold to Thomson in June 2006.
Industry long-timer Dale Chernich is named CIO of WestCare Health System in Sylva, NC. I know he used to be with Dynamic Control and I think he was somewhere in PA for awhile (Hershey, maybe?) and most recently at Medical College of Georgia.
Picis will have a May 14 webinar on its Perioperative Dashboard. A customer will be presenting. Since they e-mailed me a press release, I felt empowered to conveniently ignored the copyright warnings at the beginning of their online demo and take a screen shot because I though it looked cool. You can click to enlarge, at least until they tell me to yank it down.
May is “Legacy Free” Day, according to a New York medical society. CMS and HIMSS want clearinghouses to send NPI in the provider identifier field of claims. CMS information is here. NPI is required starting May 23.
Penn White is named medical director of WiFiMed Holdings.
My editorial this week at the newsletter: “The First Lesson I Learned Working for a Vendor: Products Don’t Need to Be Great, Just Good Enough.” I’m obviously still holding some grudges toward the crappy vendor I worked for years ago.
BidShift apparently felt its conjoined name was too descriptive of what it offers, so, like every other company before it, it dug out a Latin dictionary and came up with Concerro. That will no doubt strengthen its brand recognition among people who have been dead for centuries.
Community Hospital of Bremen (IN) gets $500K of someone else’s money (yours, specifically, if you pay federal taxes) to buy more Meditech stuff.
Wall Street Journal has an article on healthcare security lapses. Not much new, but it does mention that HHS has yet to levy even one HIPAA fine, although some incidents have resulted in criminal prosecution.
A survey of second-year medical residents in Canada says that 75% of them want to use EMRs.
Here’s a fun piece about medical tourism from the perspective of several patients who not only used it, but enjoyed it. Mentioned: grocery chain Hannaford Bros.. which offers overseas procedures for which it pays the employee’s share of the bill, flies the employee and a companion to Singapore, and pays for two weeks in a hotel for recovery. “He was blown away by how patients were treated – each are picked up at the airport by limousine and get to stay in hospital suites complete with mini-fridges. Physicians are always prompt; their bonuses are tied to how long they keep patients waiting.”
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Inga’s Update
Quest Communications CEO Edward A. Mueller is named to McKesson’s board of directors. He was formerly CEO of Williams-Sonoma, which sounds like a much more fun gig. McKesson also announces that more than 10 community hospitals have signed on for its Paragon HIS solution and Practice Partner EMR/PM during the past year.
Qatar University pharmacy students will use Cerner’s Academic Education Solutions for EMR practice.
A survey of European general practitioners finds that 87% use a computer, 70% the Internet, and 66% for consultations.
David Brailer and his Health Evolution Partners firm announce their first investment. Evolution is providing an eight-figure financing commitment to e-Rx company Prematics. Brailer will join the company’s board.
Misys partners with Wolters Kluwer Health to enhance the clinical content of MyWay.
Sunquest opens a new London office as its international headquarters. The company has 17 UK hospitals using its systems.
The Indiana HIE is considering taking its expertise outside of the state to share with other markets. Leaders would like to see its model become the national norm. It may not be a bad idea given its success financially (self-sustaining without grants and donations; the 39 participating hospitals pay service fees, but not the 8,500 physicians).
Premier will promote Eclipsys solutions to its 1700 hospital members.
The 18-doctor Florida Cardiology group is implementing Sage’s Intergy EHR and PM. The software will be web-based and available across the group’s eight locations.
E-mail Inga.
From Hates to Lose Things: "Re: stolen medical records. Sounds like the records that were stolen were encrypted. At least they are using their EMR if they already have 2 M records backed up!" Link. Thieves break into an archive company’s truck and steal backup tapes containing two million medical records from the University of Miami. It took the company two days to tell the university and another month for UM’s School of Medicine to post a public alert. At least backups are hard to do anything with. UM has stopped transporting tapes offsite, great unless they get nailed with a hurricane again or have some other local catastrophe.
From Orlando Portale: "Re: Second Life. Important to remember that Second Life (SL) is a rich 3D development platform, some what analgous to Java or C++. So, one’s impression of Second Life really comes down to the quality of the design and user experience of the particular property you are experiencing. Currently there are a limited number of Second Life healthcare examples — check out the UK. NHS Poly Clinic or Virtual Palomar West (disclaimer: that’s ours)." The problem is that you (apparently) have to register first, choose a name and avatar, and do all that geeky stuff before you can ever get to somebody’s site. Nobody’s going to do that. It needs to be as simple and fast as getting on a webinar to attract that same executive level user. I’m sure it’s fine once you get there.
From MilitaryMD: "Re: CliniComp. FACT: Haudenschild is definitely back as CEO, having gone through four management teams in four years. He has reconstituted the same team that delivered buggy code and poor customer service in the 2001 era. Severe morale problems among the staff, expect those with alternatives to bail. OPINION: Most likely, he just gave up on selling the company and will try to squeeze whatever profit he can out of the existing and contractually committed customer base by trimming staff and under-delivering on service and new releases." Inga spoke to a colleague who officially confirmed through the company that he’s CEO again.
From Pippi Longstocking: "Re: Cerner. I hear that Cerner has been sniffing around HIMSS trying to re-engage with sponsorships, ads, off-site events, etc., but that HIMSS has rebuffed them, saying no exhibit, no opportunities."
Listening: Ours. Depending on the tune, sounds like U2, The Doors, or Radiohead. Impress your friends with music they’ll like by someone they’ve never heard of.
McKesson will lay off 114 employees on July 11 at its Gilbert, AZ office. I think that’s where some of the former Per-Se transaction processing people work.
Sharon Pfaff is named CIO of Cancer Care Ontario (Canada).
The Leapfrog Group (remember them?) announces its CPOE Evaluation Tool.
Steve Lieber of HIMSS says doctors won’t trust PHRs. I’ve been saying that all along, but he’s got more vested interest since EMR vendors pay HIMSS while PHR vendors probably won’t. He’s right, though: duplicated tests don’t cost a doctor or patient anything, so why should the doc put themselves at risk by trusting someone else’s information, no matter what the source? I bet they redo a lot of tests even when the paper records are right there in front of them. That’s how defensive medicine works.
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Art Vandelay on Yet Another Reason to Use What We Have
Not to be doom and gloom, but there is a major storm on the horizon. A number of organizations have gone on a capital spending binge. Interest rates are adjusting up. This is just like over-buying a house with an adjustable rate mortgage. For health care organizations, the binge usually involves major new facilities and major information systems. Large depreciation expenses are (or will be) coming our way. This will impact the bottom-line financials that lenders review.
Interest rates will adjust in a troubling way if the binge did not result in a return on investment that matches the depreciation and overhead of the investment. Consider that Park Nicollette is paying an extra $5-6M on its debt a year due to a recent rate adjustment. I believe we will see some de-installs of EMRs given the lack of tangible returns to offset the ongoing costs.
If the scenario above sounds like your organization, it is a good time to develop your budget contingency plans beyond the typical 1-3% cut. The finance department will be knocking on your door soon. When I develop my lists, I categorize the opportunities into cuts, consolidations, efficiencies, and growth opportunities. The last three areas usually take money to make or save money. Remember, "No company ever shrank to greatness".
The PACS Designer on Open Source Software
OpenEMR is a software platform in the SourceForge.net community. Contributors give their time to enhancing software solutions by continually updating performance issues, which is good in one sense, but may be less good for the end user. If your office has an experienced geek who is willing to submit change proposals regularly to the OpenEMR community, then it may be a solution to consider for your staff.
As with anything that is free, there are some negatives, so tread gingerly when considering OpenEMR. Also, OpenEMR shouldn’t be confused with OpenEHR which is from "The openEHR Foundation", a not-for-profit company, with its founding shareholders being the University College London, UK and Ocean Informatics pty, Australia.
The OpenEMR consists of appointment scheduling; patient registration; payment and insurance tracking, processing, and collecting; charting and record keeping; prescription writing; laboratory tracking; patient check-in/check-out, tracking and handling.
Installing OpenEMR on a Windows 2003 server can be challenging for the less experienced installer. Hiring the services of a professional in this area of software development is highly recommended.
In conclusion, you have to be extremely cautious when a free solution has had only had minimal usage in the last few years. Also, bugs found several years ago still have no responses with fixes, so you would be wise not to extend an effort to use OpenEMR without help from outside service providers.
TPD Usefulness Rating: 3.
openEMR site.
Inga’s Update
The 265 bed Washington Hospital (PA) implements MobileMD’s HIE and EA solutions to connect to its physician community. The 33 participating practices can receive a variety of reports real time even if they don’t have an EMR.
A couple of weeks ago I mentioned the closure of an Ohio mental health facility because they owed McKesson $13,500 for some medication. Fortunately the police took off the padlocks at least temporarily while they negotiate with McKesson. While I am all for everyone paying their bills, why is McKesson going to such extremes to collect an amount equal to two days of John Hammergren’s compensation?
VC firm Psilos Group commits a $13 million investment in HealthEdge.
I am on a little weekend vacation and my Internet connection is weak, so I’ve told Mr. H I have to cut my post short. I also happen to be at one of those spots that requires you to start happy hour early , so there is that issue, too.
E-mail Inga.
From Sharp-End: "Re: bedside barcoding. I’m interested in talking to people from hospitals who have purchased BPOC systems or are looking. Questions: how important is system price vs. total cost? Is your implementation queued behind that of other clinical applications from the same vendor? Have you assessed total costs?" If you’re willing to swap e-mails or chat with Sharp-End (who’s an independent consultant), e-mail me and I’ll connect you.
From Little Enos: "Re: CliniComp. Rumor has it that owner Chris Haudenschild is back on top as CEO. They have acquired some great deals without him running the mother ship. Can you confirm? Why now? They’ve turned over several CEOs." We’ll try to confirm. I used to mention it when they changed CEOs, but it got old.
From The PACS Designer: "Re: Web 2.0. The mainstream media are starting to pickup on the Web 2.0 theme due to the Web 2.0 Conference being held in San Francisco. The BBC reports that ‘Web 2.0 is set to be embraced by Enterprise 2.0 as businesses prepare to spend nearly $5 billion by 2013 on social networking tools and over half of the companies in North America and Europe see Web 2.0 as a priority for next year’. TPD has posted numerous comments about Web 2.0 in the past and is happy to see the concept gaining some traction with financial backing from the C-level types." Link.
From Bird Fidrych: "Re: Cerner. I was telling a friend what a great read HIStalk is and how much I enjoy it. She sniffed that you’re a paid shill of Cerner’s and have no credibility. Say it ain’t so, Joe!" It ain’t. The only vendor money I get comes from those companies whose ads are staring at you on the left. I’m surprised someone would even make that claim given the ripping Cerner often takes here (not to mention the pretty good record of accuracy I have, which would seem to squash the "no credibility" theory). She’s sniffing, all right.
Listening: Sinch, thinking man’s metal/prog/alt from Philly.
CalPERS, the retiree system for 1.2 million retired California public employees, announces that it will support CalRHIO’s statewide RHIO. Medicity is involved, I assume, since CalRHIO uses its technology.
AHA’s for-profit subsidiary endorses Vocera badge communicators (in return for? …) That got me interested in digging: the "non-profit" parent AHA took in $102 million in one year, according to its most recent federal records, enjoyed an $18 million annual profit, has $126 million in assets, and paid its CEO $1.9 million. That CEO was previously a member of Healthcare Research Development Institute, an "exclusive club" that got the attention of state attorneys general (here’s the story from The New York Times and here’s the list of the pocket-liners who couldn’t eke out a living on their massive non-profit hospital salaries alone). Gary Mecklenburg was its CEO; he was also the CEO of Northwestern Memorial who earned $16.4 million as a parting gift (the hospital’s CIO got $665K in comp that same year, close to a record). We’re not exactly talking vows-of-poverty nuns selflessly taking care of the sick, are we?
Speaking of salaries, NHS’s Richard Granger was so good that it will take two civil servants to replace him (his was the highest-paying job in British government). They’re adding a CIO position in addition to the Director slot, each advertised at an annual salary of $400,000 (at current exchange rates, which values US dollars at slightly less than Confederate ones).
Cerner’s shares get a nice pop after the earnings announcement, going from the high 30s to today’s close at $46.49. Now if Neal will just send over my check for shilling, we’ll be all set.
Medsphere announces an OpenVista go-live at Lakin Hospital (WV).
CPSI’s just-announced Q1 numbers: revenue up 13.8%, EPS $0.33 vs. $0.24. Sweet.
Jerome Grossman, whose long list of civic and educational accomplishments includes co-founding Meditech, has died of cancer at 68. I wrote about his lawsuit against the company in 2004.
Transaction processor MedAvant (aka ProxyMed) gets a nastygram from its auditors: they think the company’s about to go belly-up. Market cap is below $14 million. The CFO just quit, revenue is down, losses are up. Other than that, it’s going great.
GE’s Jeff Immelt makes excuses about the company’s performance, ending with a tag line of "building the best products." Ironic in healthcare IT, of course, since its products are at or near the bottom in most of the important KLAS categories (well, technically speaking, it bought them instead of built them, so maybe that’s his out).
Microsoft’s Q3 numbers: revenue flat, EPS $0.47 vs. $0.50.
The CEO of the healthcare business of Siemens quits after an investigation finds new evidence of corruption in the former Siemens Medical Solutions Group. At least 10 countries are investigating the company for bribery.
Varian Medical Systems’ Q2 numbers: revenue up 19%, EPS $0.56 vs. $0.46.
FDA problems didn’t help GE’s financial performance. Now, the agency has warned Philips Medical Systems about manufacturing practices in an Ohio plant.
Shares of WebMD Health tank after the company warns of weak advertising demand. The stock was down 12.2% Wednesday. Earnings will be announced on May 6.
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Art Vandelay on VistA Outages
The VA’s recent experiences with server consolidation are not surprising. The root cause for one of the incidents is no different than the Parkland experience with their Epic outage (operator error). The VA’s other major incident was caused by a hardware failure.
In my experience, the two other common causes of outages are human failure to execute some manual task during an upgrade or poorly written software (ex: memory leak, runaway process). When consolidating servers, testing is a must. Back-up/restores, fail-over, and monitoring must all be tested in the backroom. User downtime processes and the communication plan should also be tested.
With M platforms, the monitoring and automation tools are rarely present. Epic has actually put a significant amount of effort into building the "RedAlert" Toolkit to assist its users. I am not sure if the VA has done the same development. I have also found the attention and rigor behind smaller and distributed environments is usually lacking.
In the non-M world, the architectures are usually already integrated with monitoring tools at various layers. This includes the OS, app. server and database layers. These vendors have also matured enough to provide the basic SNMP traps. Those of us from the early mainframe era were in a similar position and "rolled our own" utilities. Now these utilities can be purchased at exorbitant prices from IBM and CA.
To compound the problem of a lack of tools for M platforms, I rarely see the mainframe rigor in the client-server and web environments. The rigor comes with documentation, change control procedures, well-understood dependencies, defined testing plans and separate environments. It is a must to test these plans in the real world.
