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August 21, 2008 News 9 Comments

From Lloyd Bridges: "Re: ADT + EMR go-live. This is becoming far more standard as sites being converted are increasingly complex. OHSU replaced A2K and LCR big bang (all rev apps and majority of clinicals) with Epic. CPOE 6 weeks later. Slower implementations tend to get pushed by ever increasing  optimization cycles."

From Caroline Mulford: "Re: Dairyland. Rumor has it Dairyland is or has purchased APS out of Waco, TX?" I saw no announcements and nothing on Dairyland’s site, but APS’s is down.

From Otis Day: "Re: Siemens layoffs. I was speaking to Soarian Clinicals. However, I am hands-on familiar with both Financials and Clinicals. I happen to be quite close to someone who works in a multi-hospital site and they have had successful implementations (not to be confused with installation). This site also delayed implementation of some software deliveries, but not due to software availability. Mr. Judd doesn’t mention why Medicorp delayed their go-live. I do agree that Siemens is looking to improve short-term and milk INVISION. And why should Siemens care, or the customer, for that matter? If the customer is happy (and paying their invoices), where’s the problem? Does Mr. Judd suggest this is a negative situation?"

Listening: new Alice Cooper, still doing the mascara-and-codpiece shtick at 60. If you liked it then, you’ll like it now.

Microsoft pays Jerry Seinfeld $10 million to try to stop the bleeding, with Chris Rock and Will Farrell being considered to help him out. What a joke (and I’m not talking about Jerry’s material). Vista’s not selling, you can get most of Office 2007 for $99 with a "wink wink, I’m a student" discount, and the hottest Microsoft offering is an XP downgrade from Vista. Maybe Jerry will have some boffo lines about Amalga.

National Review, which I read on occasion, is sticking to the "healthcare can be saved with competition" mantra. "According to HHS Secretary Michael Leavitt, Medicare rents an oxygen concentrator at the price quoted above [$7,000 over three years] — with Medicare patients shelling out a 20-percent co-payment for the rental ($1,418) — that it could buy outright for only $600. When Medicare was set to implement a competitive bidding program for DME last month, Congress killed it."

CoxHealth (MO) mentions its homegrown bed board system as part of its Innovator Award. Looks pretty cool. Bruce Robison is the CIO there.

bedboard 

At least one doc is unhappy that Nuance has blocked the use of Dragon Naturally Speaking with EMRs in Version 10. "We found that some large hospitals were using the consumer editions of Dragon and not getting the accuracy, quality and manageability that would be achieved when using Dragon Medical." In other words, you have to buy the much more expensive Medical version for reasons that are financial rather than technical. 

Open source vendors Pentaho (business intelligence) and Open Medical Record System (EMR) will work together and integrate their products.

Xoova, a physician research site for consumers and poster child for those convinced that all it takes to change healthcare is a web site and a Foosball table, is apparently defunct. All that’s left is a blog whose last entry was in February, full of braggadocio and hipness right as the slow augering in was underway despite rosy press releases that mostly bragged on site hits. The company sniffed that it was "much more of a Health 2.0 site" than its competitors (which are still around, 1.0 apparently being more profitable). I can’t decide which is lamer, their name or the story behind it: "XO = hugs and kisses. OO = ‘you,’ as in, ‘this site is for you, you people out there seeking medical care and you doctors out there who wish to share your philosophy of care.’ Ova is both a Latin word for egg and a medical term for what happens to be the largest cell in the human body. And Va? Va means ‘go.’" If all that isn’t dot-bomb enough for you, they were even bragging on their Herman Miller chairs, the shark tank, and their proximity (in no way except physical) to Google. Most of these hip new companies are looking for buyers, not paying customers. In this economy, they’re likely to be riding those Herman Millers right into the toilet.

USA Today publishes hospital death rates online for MI, CHF, and pneumonia.

Your federal tax dollars at work: $300,000 for a Wisconsin pre-RHIO of some kind.

A reader pointed me to the court filing in which Epic apparently prevailed over patent leeches Acacia Research. My take: vendors, get yourselves a good lawyer and they will turn tail and run since there are plenty of other marks to shake down (like Siemens and GE) who will just pay up and write it off as a cost of doing business. The last thing Acacia wants to do is either have their patent (and gravy train) threatened. I hope Epic tore them a new one.

Intel is offering $100,000 for the best technology solution in global healthcare. Craig Barrett’s example: a PhD who created a cheap digital whiteboard from a Nintendo Wiimote (free download). You have until September 30 to register and January 31 to get your submission in. Pretty darned cool. "Barrett compared the world’ healthcare system to an ancient mainframe. ‘The hospital is the mainframe,’ he said. ‘If you get sick, you go to the hospital. What we need to do is bring the PC to the healthcare system.’"

whiteboard

Speaking of Craig Barrett, he rips the government on failing to encourage innovation and quality education (roger that) and also demos an unnamed PHR at the Intel Developers’ Forum.

Great news: 86% of people remember ads stuck on hospital walls or on wall-mounted monitors. That’s probably at least double the percentage that remember what doctors tell them.

GE Healthcare gets another FDA warning letter.

Remember this as you’re paying Oracle maintenance: Crazy Larry exercises a few options, netting him $544 million. Not to worry: at current prices, he’s still got $26 billion worth of shares.

E-mail me.


HERtalk by Inga

From dogofwar: “Re: Picis Survey. The announcement says that 87% believe a government-run EHR is the answer, but the slide shows the opposite.” Good observation. That 87% pro-government EHR number was buried in the press release and I thought it was surprising. I checked with the Picis folks and they confirmed that the write-up had an error. The text should say, “Close to 90 percent said government-run EHRs are NOT the answer, when questioned, but many expressed interest in joint funding from the private and public sectors.”

Sonitor is awarded a 2008 North American Frost & Sullivan award for Emerging Company of the Year based on its contributions to the RTLS industry and improved US market presence.

I had asked readers to comment on the impact of the ICD-10 transition and MGMA provided a response (OK, perhaps they weren’t responded to me, but the timing seems coincidental.) MGMA issues a statement that while they support the move, the proposed timeline is “not workable” due to the extensive changes required of health care facilities and insurance carriers. MGMA estimates that 95% of medical practices will have to purchase software upgrades or new software to accommodate the changes. Stay tuned.

HealthSouth is nw offering free wireless Internet access, courtesy of a new agreement with Wayport.

Good Samaritan Hospital is live on MEDSEEK’s eConnect clinical portal, enabling its 600 physicians anytime/anywhere access to disparate IS systems through one gateway.

Waukesha Memorial Hospital is installing RF monitoring systems in its pediatric and maternity wards to product infants and children from abduction (what a sad world we live in). RF Technologies is the vendor providing transmitters for patients’ wrists or ankles. The setup also includes receivers that track when a patient moves too close to a doorway, setting off an alarm and locking doors immediately.

Halifax Regional Medical Center (NC) integrates IntelliDOT BMA with their Meditech HIS. Caregivers will utilize a wireless handheld barcode point of care device.

MemorialCare Medical Centers (CA) contracts with Accenx to provide an interoperability platform for its physician outreach program.

Kryptiq (healthcare connectivity provider) acquires Secure Network Solutions (administrative workflows such as appointment reminders, waitlist management, and electronic billing statements.)

GE Healthcare recognizes six healthcare organizations for their innovative use of Centricity products.

Eclipsys announces Ali Zarzour as VP and GM of Middle East operations. He comes from Microsoft, where he served as a healthcare industry manager in the Middle East and Africa.

Five Sharp HealthCare hospitals are deploying Premier healthcare alliance’s SafetySurveillor infection control and pharmacy modules to track and prevent healthcare-associated infections and optimize antibiotic use. It sounds like cool technology that apparently 200 hospitals are using nationwide. Anyone have any comments on whether it works as advertised?

E-mail Inga.

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Currently there are "9 comments" on this Article:

  1. How funny to hear about Dragon. We were just going to implement it somewhere even though it is a hassle. With the extra cost maybe we will forgo that entirely, which means less revenue for them. Way to go Dragon!

  2. Re: Impact of ICD-10-CM transition. One impact will be a screeching halt to EMR adoption by small to mid size practices. Getting paid takes precedence for limited resources over joining 4% of your colleagues in spending a lot of money to adopt an EMR and not getting much benefit from it.

  3. ICD9 to ICD-10; that’ll be a real monster. CMS has talked about it for years, now their getting serious.

    Per a recent Nolan study:
    “Either way, the initial costs to vendors alone was estimated at $55 million to $137 million. According to the HHS proposed rule, two major vendors told HHS they would devote 10% of their workforces to the ICD-10 conversion. Another vendor estimated it would take between 50 and 100 man years of work to ready their systems while yet another said only a few development years would be needed.” – Modern Health Care 8/22/08

    Watch for vendors to lay this one off on clients, if you’re negotiating a contract now or in future, better get a ICD-10 upgrade clause put in (just like Y2K), or the upgrade bill could really hurt. You’ll quickly see why ICD -10 stands for (I Can’t Deal with it, need $10 mill more!)

  4. Regarding the above mention of Nuance’s Dragon NaturallySpeaking version 10. The fact is that previous versions of Dragon NaturallySpeaking did work with various EMR programs (allowing physicians to dictate directly into the system). The decision to make EMR capabilities available in Dragon Medical only is threefold:

    1). Our customers: While 70,000 caregivers use Dragon Medical speech recognition software to drive clinical documentation, there is a substantial clinical user population who use consumer versions of Dragon NaturallySpeaking in medical settings and simply do not achieve the accuracy, quality, profitably or usability that would be achieved with Dragon Medical. We have received negative feedback from clinicians about the performance of the consumer versions of Dragon in medical settings via KLAS (a research firm specializing in monitoring and reporting the performance of healthcare vendors) and from customers themselves.

    2). What goes into Dragon Medical: Nuance has made a significant investment in building, tuning and distributing Dragon Medical for exclusive use by the health care industry. The integration and engineering required to deliver the ease-of-use of Dragon Medical with all major EMR vendors, including Allscripts™, Epic, Misys®, GE® Healthcare, NextGen®, Siemens, eClinicalWorks, Meditech, McKesson®, Cerner and Eclipsys®, requires a Herculean effort, comprising thousands of man hours in developing and testing. As one would expect, there is a premium associated with the delivery of this capability and the resources devoted to further hone and evolve the product to meet the specific needs of the medical end user.

    3). The difference in solutions and cost: It is common practice in the software industry to set a price structure equal to the value of functionality that a solution offers and is consistent with other enterprise/professional vs. consumer software offerings (Microsoft’s Office Home = $100 vs. Microsoft Office Professional = $500). Dragon Medical 10 is the only Dragon solution that offers medical specific vocabularies and language models, optimizes accuracy for medical dictation and provides integrated EMR voice activated commands and documentation. The decision has been made to associate these specific medical features, along with other new version 10 functionality in Dragon Medical only.

    We believe there is a sound and equitable business judgment underlying our decisions, yet we understand the frustration from some customers who have been using non-medial Dragon versions in medical settings. Please note, along with the launch of Dragon Medical 10 in September 2008, Nuance will announce attractive upgrade offers for all customers. We are committed to extending the value and user base of all Dragon versions and will work with our customers to do so.

  5. Counterpoint to Winston – this will bring the independent doctors out to ask the hospitals for the combined EHR-Practice Management donations under the Stark and Anti-kickback changes.

    Re: Frank Poggio’s comments – right-on. You would be wise to your contracts. If you are having to approach your vendors for some budget relief, we are trying to wrap it in with this asks to the vendors. This was before a real target date was set so we unfortunately received a puzzled response from 75% of the vendors.

  6. Counterpoint to Art: how much extra $$$ will hospitals have, when they too, are focused like a laser beam on continuing to get paid?

    The ICD-10-CM upgrade is going to suck lots and lots of cash out of the health care system that otherwise could go to EMR adoption.

  7. The hospitals will have more money for a select few physicians than the independent physicians will “choose” to have

  8. Dragon version 10 thoughts…
    #1 Users of pre- v10 can go right on using Dragon in their EMR’s.
    #2 The ROI using Dragon is high; the difference in price between the premium Medical program and lesser v10’s is made up within a month.
    #3 EMR’s are so aggravating to manipulate and document in that any help we can get is appreciated and I appreciate GREATLY the work Nuance has done to improve this product! I have never seen a product undergo such superb improvement over time and I have been a Dragon user since v6.

  9. I’ve been training Dragon users for over 10 years and here are a few more thoughts:
    1. The price difference between Dragon Professional and Dragon Medical is about $500 – a small price to pay when seeing the difference in performance between the two products
    2. If someone is using a version less than Professional in an active practice they haven’t got a good grasp on what they’re really missing anyway; it’s like loading a shotgun with rock salt to kill a grizzly, or buying steak knives to use in surgery.
    3.Time is money-The time spent trying to use a non-medical version of Dragon to create a medical dictation is NOT cost effective for any physician.







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Reader Comments

  • Allscripts watcher: I agree with Goose Island. I have no dog in the hunt (and am uncomfortable with the Epic/Cerner duopoly - we need as mu...
  • Boy Wonder: More CareOtter (Allscripts side EHR) observations...CareOtter's webpage is suddenly down and the YouTube video reference...
  • Peg Leg Pete: The Allscripts Sunrise implementation at Baptist Pensacola is officially off the rails. The project is now two years out...
  • Redwood: Sounds like Care Otter’s secret sauce is running on top of Microsoft Azure. Not sure that warrants a special project t...
  • Andrew (Hedgeye): Hi Goose Island - Thank you for the comment. You are right about Jefferson Health and Epic. We believe Allscripts is a...

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