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July 10, 2008 News 14 Comments

From Pills: "Re: Doug Krebs. Tell ‘just asking’ that Doug Krebs left Cerner at the end of May. It was an amicable parting." I hadn’t heard that. His name is gone from the executive list, but his bio page is still up and I saw no announcement. Where did he go?

From Former Sage Employee: "Re: layoffs. My sympathies to the 235 Sage Healthcare employees who’ve lost their jobs this week. If the quote is any indication for how the reduction in force was executed, then it couldn’t have been with much compassion: ”They are all gone now,’ said Sharon Howard, senior vice president of sales and marketing with Sage Software Healthcare. ‘They are on severance. You give them two weeks’ notice, so they’re getting paid.’ As if ‘two weeks notice’ is a suitable exchange for the years of service that these people have given while this company continues to try to find itself through rebrand after rebrand. It’s true that, in this economic downturn, many companies are cutting back. It’s just too bad that these talented individuals weren’t worthy of a better farewell quote from the spokesperson member of the new management team. Best wishes to the 235 in finding a place to contribute elsewhere in our HIT market." Link. I have to admit that my reaction was exactly the same. I’d like to think it was a misquote, but Joe Conn wrote the piece, so I doubt that. I can only hope that something was missing without the context since it did indeed sound rather callous and I wasn’t picking that up from the company until that quote.

From Bill A. Bong: "Re: job change. Subodh Sheth, formerly sales VP of CareCentric, was named VP of Sales with AtStaff, Inc. a provider of patient demand and acuity-based staffing solutions. Not bad for him considering that staffing legislation is moving towards acuity-based staffing and away from ratio-based staffing (re: Illinois, Washington, and Ohio)."

From Buzz Lightyear: "Re: JJWild. As one of the affected JJWild/Perot consultants, I can confirm the layoffs last week. Cut employees got a phone call Monday morning with the bad news; in the afternoon an all-hands call was conducted in which the news was passed on to the remaining employees. Falling profits were blamed for the action. Severance packages were offered. It was specifically mentioned that there would be no press release regarding the layoffs." I can’t confirm, but not for lack of effort: Inga keeps trying, but they haven’t returned her calls. Unverified pending the company’s response, let’s call it.

From Interested HIT Investor: "Re: athenahealth. Interesting analyst report this morning on athena and their retail strategy. Do you know if WM/Target or their retail operators have since selected athena over eClinicalWorks? Figure you are the guy to ask." I haven’t heard, but I have readers who would know. Updates welcome.

From Mary Shelley: "Re: Epic. I heard that someone is using some kind of peer-to-peer alternative to RHIOs that Epic created. Any details?" I know they had developed some kind of information exchange add-on that a couple of hospitals were trying (it only works between Epic sites, I think), but I haven’t heard anything lately. It’s kind of interesting, but only in a town where big Epic customers dominate the market.

Jobs: Implementation Project Manager, Sales Executive – Wireless IT Solutions, Eclipsys Clinical Consultants, Consultant – Meditech Anatomic Pathology. Sign up for weekly job blasts.

Vermont Information Technology Leaders picks its EHR pilot systems: Allscripts HealthMatics, Allscripts TouchWorks, and GE Healthcare Centricity.

Nebraska Health Information Exchange will use Axolotl Elysium for its HIE.

NPfIT is losing its grip on impatient trusts wanting to move ahead with the way-behind project, to the point that trusts are given the green light (and possibly the greenbacks) to buy their own interim systems.

Health Partners (PA) will roll out a provider-health plan portal called AboveHealth. Healthation will do the heavy technology lifting.

Former Meriter Hospital CIO Peter Strombom editorializes about a proposed Wisconsin government interoperability project that just went to RFP for an architecture consultant. His gripe: the cost is estimated at $1.2 billion, it assumes that all hospitals will have EMRs to feed the 3-5 RHIOs it will spawn, and it’s planned as a centralized model with reposed data. He’s advocating a peer-to-peer model running on CCHIT standards, similar to a banking network with the Internet as the dial tone. $1.2 billion with no real funding model other than charging hospitals for access and hoping they’ll pay? I’m with him. My thoughts: the federated model may make more sense technically; a RHIO is a tough-to-run business, not a public good; everybody wants data, but nobody wants to provide theirs; and the high failure rate means proposed ones better do some serious and self-critical homework about financing, governance, and sustainability before spraying grant money over a roomful of panting consultants. And, it’s not likely that top-down mandates will get the job done better than the bubbling-up and eventual interconnectivity of local data exchanges.

So here’s a RHIO question for HIStalk’s readers: now that we’re in generation 2.x of RHIOs, what are the current best practices from a technology and sustainability standpoint? I like the work Medicity has done, I’ve heard good things about CareEntrust and the Indiana group, and I know the Bostoners were leading the charge with some interesting approaches. If you like the banking model, what would it look like in healthcare? Your thoughts are welcome.

Another heparin IV vs. flush error, this time at Christus Spohn Health System (TX), where 17 babies got the frighteningly common 1000x overdose. At least two of them have died, although of uncertain causes. Barcoding is an obvious answer that unfortunately isn’t nearly as effective as you’d think (you can still mix the IV wrong), but I’m beginning to wonder if maybe general care hospitals should dedicate a separate area, staff, and pharmacy for kids. It’s just too easy to miss errors when general staff (especially in pharmacy) are used to handling adult doses, meaning peds overdoses just don’t jump out like they would in a peds hospital. I might be wrong, but I don’t recall that any of these cases occurred in a children’s hospital.

Speaking of the Texas overdoses, here’s a really dumb comment that tries desperately to ride on the PR wave. Leapfrog Group rushes out a statement that quotes CEO Leah Binder as saying, "Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take … If this isn’t a wake up call, I don’t want to know what one really looks like." I’m guessing she doesn’t know what one looks like – according to reports, the heparin was mixed wrong in the pharmacy. None of the recent high-profile incidents had anything to do with physicians or ordering – it was all product delivery, preparation, or administration where what was ordered wasn’t what was administered. Trying to shoehorn in the tired old Leapfrog CPOE mantra is just absurd. And even if it wasn’t so wildly irrelevant, that’s a pretty obnoxious "we told you so" to blast out while the families and hospital employees are hurting. I’m not much of a Leapfrog fan, but this makes me even less so.

Here’s an odd thought I just had. The people at work have no idea that I’m Mr. HIStalk, so I always fight the urge to pipe up and say I know (electronically, anyway) the execs at some of our current or prospective vendors. What if I came out of the closet? Would vendor bigwigs come around to buy me lunch, thereby baffling my co-workers with my newfound popularity? I don’t think any of them read HIStalk, so they’d be like "what’s with him?"

Nancy McDonnell is named IT director at Illinois Valley Community Hospital (IL).

Cardinal Health completes its restructuring into two divisions and may sell its pharmacy management services.

I feel much better about paying big federal taxes knowing I’m helping buy a hot site for a New Hampshire hospital. No problem, it’s not like the country is in the financial toilet or anything.

Lourdes Hospital (KY) will deploy a portal/clinical system from Informatics Corporation of America.

Intel gets FDA approval for its Health Guide in-home chronic condition monitoring system that includes device connectivity, reminders, education content, and communication capabilities.

The European Commission announces interoperability plans that would cover the entire continent. I think they’re the folks behind the Euro.

E-mail me.

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Currently there are "14 comments" on this Article:

  1. Bless you for this, Tim. (quote below). Did you see the comment that the Inst. for Safe Medication Practices said? ” If they only used barcodes.” Here the ABCNews link to the quote (last parag).

    http://abcnews.go.com/GMA/Parenting/Story?id=5346509&page=2

    Ross Koppel, Ph.D.
    Sch of Med, Univ of Penn

    Speaking of the Texas overdoses, here’s a really dumb comment that tries desperately to ride on the PR wave. Leapfrog Group rushes out a statement that quotes CEO Leah Binder as saying, “Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take … If this isn’t a wake up call, I don’t want to know what one really looks like.” I’m guessing she doesn’t know what one looks like – according to reports, the heparin was mixed wrong in the pharmacy. None of the recent high-profile incidents had anything to do with physicians or ordering – it was all product delivery, preparation, or administration where what was ordered wasn’t what was administered. Trying to shoehorn in the tired old Leapfrog CPOE mantra is just absurd. And even if it wasn’t so wildly irrelevant, that’s a pretty obnoxious “we told you so” to blast out while the families and hospital employees are hurting. I’m not much of a Leapfrog fan, but this makes me even less so.

  2. I loved your odd thought about people at work. It really made me chuckle out loud thinking about some of your co-workers’ dumbfounded faces if you were to open the closet door. Please stay in and keep Peter Parker masked.

  3. Epic Interoperability – They call it Care Everywhere and divide it into Care Epic and Care Elsewhere. Care Epic is Epic to Epic and is prebuilt (on industry standards) in to the product and is now live in its first sites. It is intended to work out of the box. Care Elsewhere is built on the same industry standards but for interoperability to non Epic sites where they expect it still to be more of a project than out of the box. Someday maybe it will be out of the box too.

    Both are basically Peer to Peer (and yes, Pete Strombaum is part timing it with Epic – no secret there). Epic think s RHIOs are dead ends and peer to peer, and likely patient controlled is the best bet to actually accomplish something.

  4. “Vermont Information Technology Leaders picks its EHR pilot systems: Allscripts HealthMatics, Allscripts TouchWorks, and GE Healthcare Centricity. ”

    No surprise here with GE and Allscripts office in South Burlington, ,VT

  5. RE: Pharmacy for Kids. Here is what our gasoline prices are doing in the Middle East where money appears to be no object in new hospital construction. A new Childrens / Adult acute care hospital under construction in the Persian Gulf is dedicating two separate Pharmacy initiatives for Adult populations and Pediatric populations.

    The design includes separate and exclusive physical facilities for all adult patient medication processes and pediatric patient medication processes under one acute care enterprise. Duplication of services? I think unequivocally – NO! See how you can solve at problem when you throw enough money at a problem with an American pharmacist at the helm.

  6. My most recent intelligence tells me that Wal-Mart is still working with eClinicalWorks. So no athenahealth there. Have no idea about Target though.

  7. I have been working with the standards and policies of the European Commission for eHealth Initiatives for the last two years. I find the United States consensus to be one big complex Board meeting circus.

  8. Thanks for the information on Doug Krebs. I worked for Doug back in the day when Cerner was a flat organization. As a professional Doug was always a class act, smart, savy, a real people person but at that same time focused and determined. If anyone knows where he went I would appreciate it. He is probably taking time off which he deserves and should do. Being overseas for as long as he was he needs to decompress and figure out what he wants to do when he grows up. He would make a great CEO or President of a company.

  9. RE: Epic and peer to peer.

    Epic has an application called “CareEverywhere” that was developed originally for Kaiser (because or their monstrously large implementation, all across the country) but is now being used by several other clients. (Parkland I think is one for example) The proccess involves having certain items that are “tracked” from an master enterprise server that locks records in “baby” servers. This allows you to set conrol for, example, provider records and dept records so that the addresses are fed in from a legacy system into a master server and then spit out into the instances. This will allow you to keep a record of every provider in every server, but assign admitting and RX and order signing priveledges by service area instead of enterprise wide.

    Another cool thing it does is the chart sync functionality. If the patient in the share MPI has an appointment a nightly proccess will shuttle the patint records from the patients “home” server to the server where the appointment is, so that inthe morning when the PT shows up the records are already pesent. Also, if the patient just shows up in the ER out of the blue the system will initiate a chart sync immediately which takes up to 30 seconds. (sometimes longerif the network is under heavy load, but is is surprisingly fast in my experience) Also this creates a “subscription” from one server to another so that any updates taking place on either server will update the other one for a specified amount of time, allowing the PCP and the encounter MD in the remote location to followup with the patient as neccesary.

    These are just some of the features of CareEverywhere. It is a great system which I can envision someday being able to integrate all the Epic clients assuming HIPPA and all the legal ramifications can be worked out. As far as going outside of Epic, who knows how that would work. I heard that Kaiser is implementing a “PEMR” (Personal EMR) program that will allow a special visit report to be spat out into a PDF and kept on an encrypted USB keychain that the user can take with them to another doctors office. Sounds like a neat idea.

  10. PS About knowing who you are…. if you listen to that eclectic music while you are in the office it seems like it would be easy for any of your employees to guess you are Mr. H if they read the blog…. I have never heard of much of the music you listen to and that seems like a good way to tie you to who you really are 🙂

  11. As a former Sage (WebMD ) employee this is no surprise.

    “Today’s realignment continues the focus on addressing client priorities and service. As part of the restructuring, many cross-functional, internal electronic data interchange (EDI) positions – including support and clearinghouse development – will consolidate under a single business leader to spur innovation, increase speed to market and coordinate faster response in support.

    Wow all it takes to improve customer service is reducing staff. Maybe Sage should reduce headcount further to improve customer service.

    I thought Sage’s sales had done a dead cat bounce and were headed up!

  12. Timmy D is describing what Care Everywhere was. This product was renamed to Care Everywhere Enterprise and eventually to Intraconnect. This is essentially a way for a single (large) organization to link multiple Epic database servers together to act as a cohesive whole.

    EpicWatch is describing what Care Everywhere is today. This is meant to link servers owned by different organizations to share patient data between them. Sounds similar, but the restrictions on the usage are completely different.

    Hope this clears things up a bit. Care Everywhere has to be the most confusing brand Epic has ever come up with…

  13. Thanks for the update on CareEverywhere. You are right that my information is very outdated – I was only on the peripherary of any careeverywhere installation although I was very impressed that Epic was able to put it together. It is indeed very confusing as I recently was talking to a couple of Epic TS people and they had a really hard time explaining it as well. Also EpicWeb…. which I guess is a Web Based interface for the Epic frontend? They had no idea what that was either 🙂 I dont blame them there are so many products its probably hard to know your own that you are responsible for without understanding all the others.

  14. In response to a 7/1/2008 comment:

    From Mary Shelley: “Re: Epic. I heard that someone is using some kind of peer-to-peer alternative to RHIOs that Epic created. Any details?” I know they had developed some kind of information exchange add-on that a couple of hospitals were trying (it only works between Epic sites, I think), but I haven’t heard anything lately. It’s kind of interesting, but only in a town where big Epic customers dominate the market.

    This will be used at CHOP and I believe it is Data Courier – will allow date replication between build environments and possibly outside. Could be potentially used for THIO’s that are all Epic Compliant







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