Thanks, appreciate these insights. I've been contemplating VA's Oracle / Cerner implementation and wondered if implementing the same systems across…
News 8/29/08
From Violet Baudelaire: "Re: RHIOs/PHRs. Are the goals so different between the RHIOs and PHR vendors that they will stay separate, or do you envision a time that they will merge? From a data collection perspective, are they not collecting mostly the same information from/to providers and payers, but only organizing and distributing it for different audiences and users?" The biggest differentiator of PHRs is that they give patients a place to record their own information, but certainly that function could be rolled up into RHIOs (and nobody in their right mind really expects patients to do that anyway). The biggest value of PHRs is potential direct-to-consumer advertising, so PHRs will desperately try to stay separate, hoping that RHIOs and system vendors don’t build the equivalent capabilities into their systems and squeeze them out of the revenue picture. That’s my guess, anyway.
From Tad Paoli: "Re: Howard Industries. Point-of-care cart manufacturer. 600 illegal aliens were arrested and the plant shut down." The newspaper stories rattled of a bunch of odd stuff made there, but I didn’t realize they did carts. The Mississippi plant is where fellow workers applauded as the illegals were hauled off by immigration, Legal workers claimed the illegal workers were getting preferential treatment and even the union was recruiting them. The company’s site indicates that the Howard Medical division sells computing and charting stations, COWs, scanners, and mobile devices.
From Blond Adonis: "Re: Epic. You buy the idea that Judy does not own a controlling interest in the company? And you are smoking what?" Pork shoulder, preferably over hickory, while watching college football (it’s back!) and drinking a Yuengling.
From Paranoid Googler: "Re: HIStalk search. Did you change the search engine on the back end from Google? And on a different note – regarding the guy who is so busy he wants you to write less, I bet I am as busy as he is and I want you to write …more. Actually, the size of the blog as it is today is just perfect, and don’t let any annular muscle tell you otherwise." Ha … he said "annular muscle." Before today’s redesign, there was an old search box on the upper left (it had always been there) that didn’t do a Google search. The one in the right column was a Google site search. Now, the Google one is the only one left since I had the other one removed. Jeez, that was confusing.
From Lance Tenor: "Re: free cataract surgery in India. Even as 29 people were fighting to get back their vision at Joseph Eye Hospital in Tiruchirapalli after cataract surgery, 34 more people, who also underwent the operation at the same hospital, were admitted to Villupuram government hospital after they complained of blurred vision." Nine will lose their eyesight permanently, leading protestors to break into the hospital and trash it. The culprit is preliminarily identified as infected saline ophthalmic solution. It reminded me of an old story about traveling con men in India who would claim to cure cataracts. They would poke the eyes of patients with a briar or stick and drain out the fluid. Patients could miraculously see again, they paid the con men, the con men skipped town, and the patients went blind right after since draining the milky fluid is a temporary solution and the eye poking caused even worse damage.
Pardon our dust as the site changes, but hopefully you’re noticing some benefits even though we’re not quite finished. The smoking doc graphic is smaller, the top links are now horizontal to push articles further up on the page, the comments work better, and the page loads faster. Next step: resized ads.
The potential class action lawsuit against McKesson that alleged drug price-fixing (along with First DataBank) has been dismissed by a federal judge. That was a huge exposure that could have been disastrous.
I saw no announcement, but I noticed that LingoLogix, the natural language processing company we profiled in April, has been acquired by Cerner. Or at least I think it was: the August 1 announcement was on their site this morning, but is gone now (but the commented out HTML below from their main page proves it). The contact page also says Cerner. Hey, I’d be proud of it. Maybe Cerner found them through HIStalk.
I don’t get the ‘tude: the local paper in SD headlines the locals who were "stung" because Medicare accidentally overpaid them and now wants the money back. "Somebody who did this (made the error) should pay it back," said one recipient who already spent the money.
Jobs: Director, Clinical System Architecture (WA), EMR Implementation Associate (MA), Cerner CPOE Consultant (any location), SeeBeyond/Sun Health Systems Integration (any location). Sign up for weekly job blasts.
Cisco buys Linux-based Microsoft Exchange alternative PostPath for $215 million, saying it will add e-mail and calendaring services to WebEx, another Cisco acquisition from last year. PostPath was pretty aggressive about claiming its 100% compatibility with Exchange and was getting traction there, so surely Cisco will spank Microsoft a little by continuing to sell it for that purpose. I know several hospitals that are running it, finding it exactly the same as Exchange except for the price.
Nortel announces its "office on a stick" product (Nortel Secure Portable Office) that puts authentication, a VPN, and a virtual desktop on a USB key. When the key is removed, data and applications are removed with it.
I haven’t research it thoroughly, but this desktop remote control software can be downloaded free for personal use. A lifetime business license is $699. Pretty cool, maybe, for remote support or team projects.
A New Zealand health network bans iPhones, citing security risks and admitting that doctors aren’t happy about it.
Heartland Health, trying to clamp down on identify theft and insurance fraud, requires patients to show photo ID each time they appear for treatment. I think they’re in Missouri, but the goobers at the local paper are apparently so agog at the concept that someone from more than five miles away might be reading their site that they don’t put their location on it anywhere.
HERtalk by Inga
From Former Road Warrior: “Re: Misys/Allscripts. I have friends working at both of these companies. Each camp seems to believe their products will survive the merger and the sunset products will come from the other company. Meanwhile, salespeople are being told to expect some territory changes as the two sales teams are merged. Glad I don’t work at either company right now.” I am with you there. I read the following comment in the Raleigh area business journal: “The company also has strongly hinted that local layoffs should be expected, with Misys CEO Mike Lawrie telling analysts the day the deal was announced that they could ‘let your imagination run wild’ about potential synergies in the Triangle.” I’d be running wild all the way to Kinko’s to clean up my resume.
From Scott Shreve: “Re: Perot and Medsphere. HIStalk just recorded its 1.5 millionth hit. Besides the snarky commentary, HISTalk (and the lovely new addition of HERTalk) has continued to gain readership with its deadpan commentary that is always dead-on. As the readership has grown, the quality of the tips and the accuracy of the insight has also increased. I believe nearly everyone with a need to know turns to HIStalk when they need to know.” We thank Scott for the shout-out, which he made recently on his Crossover Health blog. Scott also makes an interesting prediction that Perot will buy Medsphere.
From Vendor Exec: “Re: ICD10 effect. I think ICD10 will be very hard on the older vendors. I would hope that most of the newer vendors planned for it (we did, as we knew it would come eventually). I think it will cause a squeeze on vendors more than anything, as it will have a significant cost associated with it. I do not think it will really hurt EMR sales, though, as I think the vendors will just have to suck it up and do it. I do think that it might push some clients into asking their hospital to help via Stark. In that way, I think it might help drive EMR sales.” While I’m sure most vendors have been planning for this change, I stand by my original assertion that we’ll see a number of product sunsets by companies supporting multiple similar solutions. Say goodbye to some of those oldies but arguably goodies (at least in the day) such as vintage Medical Manager and Misys PM.
From Wompa1: "Re: Duffy and Inga. She has a real retro sound to her music. I haven’t heard anything (recent) that comes close to her style. I might have to start listening to more Inga Radio.” Wompa1 is such the Renaissance man. On top of his regular thoughtful HIT commentary, he appreciates great music and has whipped out a follow-up Inga love sonnet (ok, maybe it’s not a love sonnet, but it made me feel loved nonetheless): “Inga the incognito, illuminating, intrepid investigator of industry intelligence. Tirelessly trudging through online tomes…”
There have been a few posts of late regarding standards (CCHIT and others.) It reminded me of a recent conversation with a friend who is in the EMR implementation trenches. As a vendor, the complexities of lab connectivity are giving him fits. The way he explains it, all parties agree that sharing lab data creates a more complete patient record (and presumably leads to better care.) However, each lab has its own set of standards, meaning each lab requires a unique interface. And because of mergers and acquisitions over times, the national labs typically have multiple products and a variety of “standards” (in other words, just because you have a Lab ABC interface functioning in Dallas does not mean it will work in Seattle because Lab ABC products may differ). The underlying issue is who pays for whatever changes are necessary to develop a standard and the required interfaces. Currently, he claims, there are no mandated standards, thus no pretty fix. So, I am left wondering if anyone can shed some light on this. Are lab standards an issue one of the various work groups is addressing? Are the labs on board?
And speaking of standards, the SEC is considering requiring all publicly listed American companies to move from US accounting standards to international model instead. That GAAP stuff always gave me fits when I was in college, so I say good riddance.
Carilion Health System (VA) makes the front page of the Wall Street Journal. Critics claim Carilion’s monopoly in Roanoke has led to care that costs as much as four times more than other regional providers. And if they turn to the local paper for solace, the big story there is that Carilion’s CEO was paid $2.27 million last year.
I went with some girlfriends this week to see the movie Mama Mia. It’s a total chick flick that left my pals and me dancing and singing on the way home. If you are guy wanting to understand the stuff of female fantasies (e.g. rekindled lost love, hunky men on remote Greek islands, looking glamorous while singing at the top of your lungs), then buy a movie ticket, sit in the back, and observe middle aged women letting loose.
Sage Software Healthcare names former Cerner VP Lindy Benton as COO.
It appears as if Google Earth has more uses than simply checking out your home on the Web (or your boss’s home). Olympic cyclist Kristin Armstrong details how she used the application to help with a gold medal (I included a photo of Kristin because I bet Mr. H overlooked this one on TV. If you missed his Inside Healthcare Computing editorial yesterday, he only noticed the beach volleyball babes).
The CHIME folks tell me that CIO registration is up for their 2008 Fall CIO Forum in Henderson, NV in October, despite concerns over rising travel costs. And for budget conscious vendors, CHIME has a new entry level Foundation membership option. The Associate level member is $20,000 a year, far less than the $75K Premier level. I suppose you can’t knock an organization for having high fees that prevent vendor membership from outnumbering the CIOs (like at HIMSS, for example). I have actually been to a CHIME meeting in the past and am sorry my own rising travel cost concerns will keep me home this year. They are a fun, smart bunch.
Perot will buy Medsphere? Oh dear… poor Perot (are they French?) I guess they have never tried to install Vista and do anything in Mumps, it is almost as complex as Cerner.
Perhaps they should set their sites on one of the real open source solutions – didn’t Clear-health just replace the Vista user interface (which Medsphere worked on for years) in about 90 days 🙂
RE: Blond Adonis’ comment that “you think Judy doesn’t own a controlling interest”.
She doesn’t own one – but she retains majority voting rights (by a small margin). Owns less than 50%, but can still choose the course. That said, she will listen to and consider ideas from everyone from a first day new hire to a 20 year veteran.
Regarding your take on PHRs, “The biggest value of PHRs is potential direct-to-consumer advertising”:
The problem is, what’s an ordinary multi-diagnosis person to do while waiting for the RHIOs to go live? Someone I know is diabetic, hypertensive, and allergic to IV dyes, sees multiple physicians (primary, endocrine, cardiology, derm, podiatry, dentist, GI) and nobody shares records. Given that he is essentially health-illiterate and takes a lot of meds, he needs something that will coordinate his care and give him print-outs to help keep track of meds, tests, and appointments. The slowness of PHR acceptance hurts people like this. Even if he had one, most of his docs wouldn’t be ready to take advantage of the technology. One doc uses Medem which is nice, but the rest of them probably wouldn’t log on. If not PHR, what’s the solution?
PHRs and RHIOs: An important distinction that was missed is that PHRs are moving to a model where they will be consumer controlled. The consumer will define what goes into them as well as what will be shared. The same can not be said for RHIOs, who’s governance practices of consumer health data is all over the map.
RHIOs also have the very real problem of defining a sustainable business model as virtually all of them today live hand to mouth on various grants.
As for PHRs, the premise that they will be ad supported is not borne out in what is actually happening in the industry. One can certainly argue that this is the case with WebMD, which is aggressively going after the ad spend, but if you look at Revolution Health, which was pursuing a similar strategy, they fell flat on their face. No, the future of PHRs and their business models, which do show signs of sustainability will be more complex than a simple ad model relying on subscriptions and sponsors (providers, payers, employers and others). For example, I know of one PHR vendor that recently won a large contract with a massive state University who will offer the PHR free to incoming students.
Future as I see it will be an amalgamation of PHRs, PHSs (the platform plays of Dossia, Google and Microsoft) and HIEs that will define the NHIN. RHIOs will languish and end up in the dust bin.
And to BigNurse, I know of a couple of people in similar circumstances. It is unfortunate that many doctors still do not see the value in PHRs or are reluctant to allow the ready release of a consumer’s record into such. This will change in time, but it is going to take a lot of education and I’m not seeing enough of that to date among caregivers.
And yes Inga, Mr. HIStalk missed out when he didn’t see Kristin take the Gold. She’s one hot cyclist!
Final note, thanks Mr. HIStalk for improving th comment write-in box. I can now actually see what I am writing and hopefully my spelling will improve.
Sage doesn’t get it, again. Physician offices are not hospitals. To bring in a COO with Cerner and DEC experience to address a client base of 14,000 clients of which 7,000+ are 3 provider or less practices, creates a long ramp up time until the issues are understood and fixes are created. Their competitors have to be laughing their heads off…again.
Thanks to Inga for your favorable mention of CHIME. Not one of Mr. H’s favorites.
“I haven’t research it thoroughly, but this desktop remote control software can be downloaded free for personal use. A lifetime business license is $699. Pretty cool, maybe, for remote support or team projects.”
My IT consultant uses it for support. I use it personally as well. Works great, have not found any issues. Look forward to your review.
John@ChilmarkResearch said “Future as I see it will be an amalgamation of PHRs, PHSs (the platform plays of Dossia, Google and Microsoft) and HIEs that will define the NHIN. RHIOs will languish and end up in the dust bin.”
How soon do you think states/regions will abandon their RHIO projects and look to contract with the PHR vendors to provide the data exchange functions they are looking for?
Hello Earth to leyden Clearhealth has done nothing but shown pretty pictures. They took Medsphere’s CIS application and did no recoding….but rebranded…hey if I were in college that would be called playjorism.
ClearHealth added their own billing and scheduling functionality to Vista. I agree it is difficult to tell if it is really integrated with the Mumps backend. Not that I get the appeal to touch an ancient backside that only Epic seems to understand (certainly not Epic clients which turns out to be profitable for Epic but will spell their long term doom).
If I were in college I would have spelt it plagiarism 🙂
leyden said “Perhaps they should set their sites on one of the real open source solutions” (and linked to a wikipedia page)
What about Medsphere’s VistA isn’t open? ‘Cause it’s not listed on your link?
I absolutely agree with you that we don’t know what CH has done. They’ve got some screenshots that give the appearance they’ve copied one-for-one the CIS application look and feel, but they show none of the deep functionality required to call theirs a replacement. I call vaporware (until they show us more).
In case those pesky amyloid plaques are kicking in and you’re having problems remembering your 10-digit NPI, here is a helpful look up site for you: http://www.npinumberlookup.org.
And don’t worry just be happy getting ready for ICD-10 coding that increases our diagnostic pick list from a mere 13,500 diagnostic codes to a great selection of 120,000 diagnostic codes. How considerate under ICD-10 to upgrade our inpatient procedural codes from poultry 4,000 to 200,000 codes. Are you ready for the deployment of ICD-10? http://www.aapc.com/ICD-10/index.aspx.
Gee, remember the good old days when you only had to remember your user name + password and your mobile EMR was a hand-held paper towel?
Medsphere is as open as CH but its a mute point because the only people with the patience to figure out how to do anything with the system are soon going to be *not* developers OF the system but patients IN the system…
At least with CH it is written in a scripting language that the next generation can actually read. Trust me the only people working on Mumps are those suckered into Epic and forced by their elders to slave over a language that deserves to be relegated with Digital VMS.
Hmm, does Cerner still use ‘Open’ VMS ?
Sigh, if only Linus had taken an interest in Healthcare we might have something Open that hospitals could use that actually reduced costs, not kept the consulting firms afloat with unnatural fees for implementation.
Leyden – have you actually ever used or seen mumps? I guess those 26 commands and 26 functions are more than you can handle? I’m tired of all the bashing of the only technology that has really ever worked well in healthcare (IDX, Sunquest, Vista, Meditech, HBO Star Series, et al). Just because you haven’t bothered to learn it doesn’t make it bad. Uninformed people have maligned Mumps ever since it was named. It used to be ‘that slow language’ because it was interpreted. Never mind that it was faster than any of other implementations, due to the effecient, fast, reliable data store built into it. But wait, now all the ‘modern’ scripting languages are interpreted, so we can’t complain about that any more, so let’s call it ‘ugly’, or ‘clunky’, or ‘confusing’. I call baloney on the whole mess. The underlying data storage model is still better at modelling healthcare data than relational technology ever was, or ever will be. Now we have Google, Yahoo, and others trying to reproduce independently what Mumps has been for 30 years – hierarchical, schemaless data storage. Too bad they are trying to reproduce it instead of just using the technology that has had 30 years of development and bullet proofing.
PMD,
Long answer:
It will take awhile for states to move away from the RHIO model (BTW, not only states are funding these efforts, here in MA, it is BCBS funding the RHIO initiative).
We may already be seeing glimmers of this change as represented by the Governor of MN’s statement to first provide all state employees with a PHR then roll it out more broadly to all MN citizens.
A lot of change afoot in this market and we’ve yet to see the real impact of the platform plays – if they take off, it could all happen pretty quickly, otherwise, long road ahead. Do believe that these larger platforms will be what states look to for data aggregation/sharing and then contract with the smaller PHR providers to deliver specific functionality to their constiuents.
Short answer:
Platforms take off: 2-4 yrs
Platforms stall: 6-8+ yrs
Platforms fail: Your guess is as good as mine.
Mumpsguy – of course I have
You can program in A, B, C or D for all I care – but please don’t tell me that you need a specialized language or data model for health care when the rest of the world is using relational databases for a reason. The only reason Mumps is around is because people dislike to move from something they know to something more efficient.
I compare to sticking with a VAX and using a CISC processor instead of moving to UNIX and RISC. It makes no sense to stick with the old just because it does a few operations better – you need to look at overall performance.
Same with MUMPS. Using a database that excels at hierarchical storage just because you can find lots of hierarchies in health care is hardly a reason to give up on a relational database and object orientated programming. Just doesn’t make sense, unless you are only a MUMPS programmer and looking for job security (kidding).
The next generation that will end up calling the shots will never roll back the language and design improvements that have advanced software development over the last decade. And CIO’s will want easy access to their database sans any viruses 🙂
MumpsGuy, it’s widely-regarded outside of healthcare IT that MUMPS is relatively unmaintainable compared to modern languages/platforms, for various reasons (most of which do not have to do with data access, as you seem to think). I’ve hashed out some of the specifics previously here at HISTalk, in an attempt to at least go past the superficial arguments–so that even if you disagree with me in the end, you know specifically why I believe what I do.
The #1 reason I think MUMPS is not a viable platform today is because of the weak MUMPS ecosystem (or the smaller ecosystems within everything we call “MUMPS”). When compared to something like, say, Java, MUMPS has almost no tooling, enterprise vendor support, commercial or open source libraries upon which to lean. I believe that if we had a vibrant ecosystem, any deficiencies we have would be quickly patched up or worked around.
Witness Ruby on Rails. Sorry to bring in the “hype” or “fad” of the day, but it is an excellent example. Rails originated in Ruby. It was not the first MVC web framework of the day, but it was the first framework to popularize this concept (among other innovations). Today, just a few years later we have Rails-like frameworks for Java (Groovy on Grails), .NET (Monorail), Perl (Catalyst), PHP (Cake), Python (Django), Smalltalk (Seaside), and so on. A few years ago you could claim “but PHP doesn’t have an MVC framework!” Now you have CakePHP.
PHP had enough community support that, when they collectively realized what a great thing Ruby on Rails was, they went ahead, adapted the concepts and built their own framework in PHP. Thus, they improved their own ecosystem, borrowing from outside.
This is just one example of what a vibrant ecosystem brings you. Don’t forget tools like code coverage, automated testing, source control systems or adapters to existing source control systems, compilers that compile your code into another language or platform, third-party backup vendors, multiple IDEs, debuggers…
So I ask you: do you think MUMPS (or your specific variant) is a vibrant ecosystem? If not, what do you think you’re missing? I’ve explained a bit of what you’re missing, but do you agree with my list? Don’t you think this kind of stuff matters?
Do you think that you, the MUMPS community, is more vibrant and more innovative than the rest of the world, combined? Don’t you think you could adapt concepts originating from the outside the community?
—
And I’m not saying we need a MUMPS on Rails framework, please don’t 🙂
My first attempt to add a lengthy comment doesn’t seem to have worked, so I’ve now put my thoughts on the Mumps debate into my own blog at:
http://www.outoftheslipstream.com/node/125
I’m hoping that this will go some way to providing a rational and sensible analysis of the situation.
Re: the complexity of lab connectivity.
I work with hospitals sending data to physicians’ ambulatory EMRs, and I had to say “thank goodness I’m not alone” when reading your comments. I’ve been to many conferences (TEPR, HIMSS, World Health Congress, etc.), and nobody seems to be able to tackle the thorny problem of “semantic interoperability.” Everyone can speak HL7, but that’s only half the problem. There are so many different entities that need to agree on what each of those data elements MUST ACTUALLY MEAN that I’m not sure we’ll ever see a solution. I heard one speaker say something like “we can send a man to the moon, but we can’t exchange healthcare data.” His point was that it might take that type of governmental effort (and mandate) to make this happen. I cringe thinking about it based on what’s happened so far on the governmental front with the NHIN, CCHIT, etc., but he may be right…
Something hilarious…checking the Wikipedia definition of “semantic interoperabilty”–there’s a box at the top that warns “All or part of this article may be CONFUSING or UNCLEAR.” Well–that’s it in a nutshell, isn’t it!!!
Re: Mumps
I LOVE this blog!