By Jim Bradford, Ph.D.
The Bradford Report

From time to time when I use a new application, I seem to develop a kind of Tourette’s Syndrome characterized by teeth grinding, fist clenching, and dark mutterings. As I struggle through yet another badly designed, user-unfriendly system, I find myself wishing fervently that Bill Gates had finished college.

Technically, the user friendliness of a system is known as “usability.” There is an entire academic discipline (variously called “Human Factors” or “Ergonomics”) that is devoted to the study of usability. But if you don’t happen to have a Ph.D. in Ergonomics, how do you recognize a well designed, highly usable system?

Mental Models and the Psychology of Geeks

The human brain constantly monitors the environment and creates models about it. This allows us to think about our environment and make predictions about what will happen next. We carry over this natural tendency to model things into our interaction with computers.

Not all models are created equal, however. I have a friend who believes that if you set a thermostat as high as it will go, it will warm up the house faster. It is not an unreasonable model — it just doesn’t happen to be right.

The best system designers work hard to give you many clues about how a system works. This allows your brain to make a good model that produces accurate predictions about system behavior. When you encounter such a system, you begin to feel that the system is natural, intuitive, and easy to use.

Unfortunately, geek psychology doesn’t often lead to this kind of design process. In 1971, Gerald Weinberg published his (now classic) book, The Psychology of Computer Programming. To boil a long tome down to its essence, the kind of person attracted to computer programming is frequently the type of person the media would characterize as a “troubled loner.” Unfortunately, the design of usable systems requires a well-developed ability to understand how people think, feel, and react when confronted with a complex system. As a rule, troubled loners are not good at this.

As a consequence, human factors experts are often drawn from the “touchy feely” disciplines (i.e., anything other than engineering or computer science). They are often brought in to fix computer systems that are so horribly hard to use that almost no one can make them work. This strategy is akin to bringing in a doctor only after the patient has died. The usability specialist does what he or she can, but the result is usually a system that has evolved from being impossible to use to the point where it is merely frustrating to use.

The traditional approach to developing computer software (design-code-fix) is pretty well entrenched. Thirty years of preaching from academia has not noticeably improved the usability of computer systems. The key to usability, I believe, is an informed and demanding consumer. This is rooted in a fundamental property of a free market economy — if people stop buying poorly designed products, companies will eventually stop making them.

The Informed Consumer—How to Recognize Usability

Affordance

This design principle dictates that the appearance of things should provide a strong hint about how they are used. A hammer looks like it would be good for driving nails. A screwdriver suggests how screws should be managed. An espresso machine … well, not so much. Hammers and screwdrivers have good affordance and espresso machines have poor affordance. When you look at the user interface of a new piece of software, do the commands, buttons, menus, and other gizmos give you a good idea of how to use the system? If they don’t, it’s Strike One against the designer.

Prescriptive Feedback

When using complex systems, people will make mistakes. This provides the acid test for usability. Have you ever encountered an error message that says something like, “Illegal command or filename”? Good grief! Which is it, the command I just used or the file I just named? What law did I break? What makes a command illegal? Why can’t I call a file anything I want?

Can you imagine if other products were designed like software? Can you imagine a dashboard trouble indicator saying, “Illegal battery voltage or engine temperature”? If software doesn’t help you fix mistakes, then it is Strike Two against the designer.

Task Fit

Software is a tool. Some software is a tool for creating documents, other software helps manage your finances and still other software exists purely to entertain you. Well designed software should focus on doing a small number of distinct tasks (a half dozen at most) and it should be obvious how the controls of the user interface help you do each task.

Unfortunately many software companies prefer a “one size fits all” approach to development and end up creating a “one size fits nobody” product. If it’s not obvious how a software application’s capabilities relate to the task you have in mind, then it is Strike Three against the designer.

The Bottom Line

In recent years, the nature of our daily lives has changed to such an extent that many of us spend the majority of our working and private lives sitting at a keyboard. Usability has become an important determiner of the quality of life for citizens of the twenty-first century. If the software you use is not intuitive, if it is not helpful, and if it doesn’t fit the tasks you want to do, then walk away … just walk away.

Jim Bradford is a scientist, professor, and consultant dedicated to the art of making technology easier to use. He wrote this article specifically for the readers of HIStalk after we exchanged e-mails about the problem of usability in healthcare applications.

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From Sam Axe: "Re: Scott & White. I am reasonably certain that GE/IDX is supporting the physician revenue cycle – not the hospital, which remains Siemens Invision. The GE article referenced in the response agrees with that and I believe they are probably accurate in their claims around the physician revenue cycle in academic medical centers." Thanks. I wish the press release had been more clear since both the customer and vendor in this case have separate offerings for inpatients and outpatients.

From Blago: "Re: Big shake-up at GE HCIT. Vishal Wanchoo out as CEO." Not according to Jennifer, a GE spokesperson and Inga’s new BFF, who said, "absolutely not." Inga was tickled, though, that Jennifer knew who she was when she called, even though she had thought Inga was someone I just made up. Now I’m inspired to invent up a huge staff of imaginary people, a seeming force to be reckoned with instead of some guy hunched over a PC for immoderate hours each day. Jade and Mariposa, massage my shoulders as I type, yes?

From Spanky: "Re: stimulus. How are pediatric providers going to get reimbursed for EHR use when they don’t bill Medicare?"

 

January’s HIStalk traffic set a new record, up about 40% from a year ago. Thanks for reading.

Listening: The Connells, jangle pop from Raleigh, NC since 1984.

Two Utah hospitals buck the trend and open up new expansions.

I heard from a CIO reader whose hospital, a big place, is 100% CPOE. I said I’d never heard of one doing all oncology and neonatal orders on a general CPOE system, but there’s at least that one. I agreed not to provide specifics, but I’ve asked for more information since I know many of us would like to know how they did it.

Who knew? The owner of ambulatory EMR vendor Purkinje, according to their site, is the famous VC billionaire John Doerr, backer of Compaq, Netscape, Sun, Amazon, Google, and others. His brother is the CMO and chairman of the executive board. John Doerr put $10 million into the company in 2007. The logo on the site now says GenesysMD even though the Purkinje name is used otherwise, so the company name appears to be changing (just confirmed with Margalit, the company’s product management director, who’s like me and working on the computer at 11:30 at night). Their deal: $399 per provider per month for software, unlimited support, hosting, interfaces, all clinical content (CPT, ICD9, First DataBank, etc.) and free training and implementation for users who sign up in February.

Over on HIStech Report, Inga interviewed John Shagoury of Nuance Communications.

DrM made a year-by-year table of payments and penalties for the House’s stimulus bill that just passed. I inserted it as a graphic above, so click to enlarge.

Hospital and employee information in Japan is exposed on the Internet when an employee copies data from a damaged flash drive to his PC, forgets the file is still there, then fires up his file sharing software at home. That’s happened before in Japan, I seem to vaguely remember. They love that Winny P2P client over there.

Speaking of which, a Computerworld article mentions on the danger of data exposure from peer-to-peer file sharing, citing a study in which a researcher found a document with full data on 9,000 lab patients, 350 mb of data from an anesthesia group, and an 82-field worksheet on 20,000 hospital patients. The last sentence is a little shot: "The range of health care information floating on P2P networks and the variety of sources from which it is being leaked highlight the disorganized and decentralized manner in which health care data is being collected, stored, used and shared, he said."

Here I go and run an interview with Peter Waegemann and he fails to tell me that they’re renaming TEPR to M-Health Conference. HITgeek has an idea: "If TEPR is changing its name, perhaps you could hold a contest or survey for what it should be."

A University of Chicago study finds that 90% of hospitalized patients couldn’t correctly name even one of the doctors taking care of them. Three quarters had no idea and 60% of the rest were wrong. Academic medical centers have a gaggle of people rounding in teams, of course, popping in for a few minutes once or twice a day, so maybe that’s not surprising.

Here’s an example of how insurance has corrupted the whole idea of patient responsibility: an LA Times article marvels that practices using real-time adjudication "can, and sometimes do, ask patients to pay those costs at the time of service." Shocking! Why can’t medical practices be like restaurants, gas stations, and mall stores in just letting people take what they want, walk out, and be billed sometime later to pay whatever amount is convenient? That should be the #1 step in healthcare reform — get patients to understand that healthcare isn’t free just because you have (or once had) an insurance card. The insurance companies escape consumer wrath because it’s the doctor’s office who has to come collecting what they didn’t pay.

The IT department was at fault in the recent PC virus infection in England, incorrectly configuring antivirus software on some PCs and failing to get AV updates to some of them, an outside IT auditor finds.

If you want to know how the HIT industry is doing, forget all those publicly traded companies with a mishmash of products and businesses and look at the software-only company that has the most hospital customers: MEDITECH, which 2,200 hospitals are running today. For FY08: revenue was up just under 6%, but net income dropped 60%, mostly on investments (I hear that). Interesting: CEO Neil Pappalardo and CFO Barbara Manzolillo asked that the Board give them only the same bonuses other employees get and not the special Director bonuses since the company didn’t do very well, reducing their paychecks by 64% and 52%, respectively, over their 2007 comp. Neil’s shares are worth over $500 million even at the internally set share price that the militant shareholders always complain is artificially low.

A WV doctor and former town mayor is ordered to repay an insurance company $180,000 for blood tests and injections that patients never received. The doctor blames his billing staff and software, says he has nothing to do with billing, and that judges discriminated against him. He was nailed in 2007 for underreporting income from 2000-2002, when he also worked as a day trader.

GE Healthcare is following its Burlington layoffs with mandatory unpaid employee furloughs.

Hospital layoffs: Clearfield Hospital (PA), 33; Saint Joseph Medical Center (PA), 40.

Sure to fuel the healthcare debate: is it a good use of healthcare resources to provide expensive fertility treatments and preemie care to an unmarried, apparently unemployed, and bankrupt woman in her 30s and her new octuplets that bring her up to 14 children, all of them conceived through in vitro fertilization? She’s trying to be self-sufficient, though: she wants $2 million and a career as a TV child expert from either Oprah or Good Morning America in return for her story.

I don’t get how magazines think. An article mentions that Philips sold CPACS to a hospital in Saudi Arabia, but the headline in SmartBrief says "Philips strikes a partnership with Saudi Arabian hospital." If that’s the case, I struck a partnership with the local sports bar at lunch today when I bought a very good burger there. Just because salespeople murmur the P word to make prospects comfortable doesn’t mean there’s a legal agreement to share expenses and profits. Anything else is called "a sale." Funny thing is, the article it referenced called it that — SmartBrief added the "partnership" line.

CPSI announces Q4 numbers: revenue up 14%, EPS $0.45 vs. $0.36, falling short of earnings expectations but raising guidance and declaring a dividend.

MEDSEEK announces a 47% increase in contracts and a 33% increase in licenses for 2008, referencing its KLAS 2008 Category Leader status in clinical portals.

California is out of money, so it plans to stop paying bills Sunday. The controller whines that withholding money from Californians will delay economic recovery, blaming everybody except the state itself. CA is $25 billion short for 2009, unemployment is 9.3%, and median home prices are down 50% in less than two years. Like Florida, they weren’t complaining during the boom that benefited them, but can’t accept the idea that the good times have already rolled.

Amanda Adkins, a 34-year-old Cerner executive, is named chairwoman of the Kansas Republican Party. It probably wasn’t a total shock since she was the only candidate.

E-mail me.

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From Dr. Strangelove: "Re: medical education. Medical care & physicians take a lickin’ on this study of revamping their education. The issue was never getting enough physicians trained – it was getting them to work anywhere except the big cities where they could make enough money to stay entrenched in the social class created for them in the last half of the 20th century (and pay off medical school). Their attitude… well… that’s another thing entirely. It has to do with ‘the chief god in charge’ formula taught to them in medical school and in part to the kind of personality profiles it takes to survive medical school, an internship, and residency." A sentence from the report (warning: PDF) that advocates the reform of medical education: "The overarching theme that coursed through the discussions was the urgent desire to bring medical education into better alignment with societal needs and expectations."

From MM: "Re: vendor calls. The vendor calls and e-mails have gotten completely out of hand. A confluence of a new year and a very slow economy has everyone with anything to sell trying to make contact. My assistant, who is good at spotting the legitimate calls from random sales calls, has been tricked a few times this month. I can’t take it any more! Anyone else feeling a high level of sales activity?"

From Chef Tony: "Re: sponsor ads. We’re a sponsor and I’m a reader. I really dislike the animated ads, too. Nobody is hanging around to read each screens change. I deal with huge NYC agencies whose designer kids are often clueless about what gets information out to the target market. Unless it’s Super Bowl Sunday, educate or inform with ads, not entertain."

From Doug Dinsdale: "Re: Allscripts. A stock board posting claims that Allscripts Healthmatics and Allscripts Professional were scheduled to lose CCHIT certification last week. Is that true?" I don’t think so, but I’m sure Allscripts will clarify. According to the CCHIT Certified Ambulatory EHR 2007 list, both products were certified a year ago. I’m working from memory here, but I think certification is good for two years, i.e. even though CCHIT issues new criteria every year, vendors don’t have to recertify (with one exception: Stark and anti-kickback donations require products to have been certified within the past 12 months, but not necessarily on the current criteria, and extensions are available). You just have to pay CCHIT’s annual maintenance fee (huh? CCHIT requires payment of a maintenance fee even when a vendor doesn’t use any certification services, which was the justification for the fee in the first place?) For stimulus purposes, I think both products are good for another year in any case. I’m sure someone with a more expert opinion than mine can help.

From Friend of Tim: "Re: it’s a good thing you’re a nice guy." Link. Michael Arrington, the "surly and macho" founder of the Silicon Valley blog TechCrunch that carries quite a bit of investor influence, takes a leave of absence after receiving death threats and having someone walk up to him at a conference and spit in his face. I am a nice guy – thanks for noticing (cynical and juvenile, sure, but we all have our crosses to bear).

From Dinger: "Re: Baylor/Perot. Any word on how it’s going? I’m hearing rumblings."

From Paul Molitor: "Re: HITECH. I have to respectfully disagree with John Glaser’s interpretation of HITECH. You get the same compensation per clinician regardless of when that clinician starts to use an EHR. The declining payment schedule per ‘eligible professional’ begins with the ‘payment year’ in which that professional becomes a ‘meaningful EHR user’. The start of the declining schedule is not anchored in a specific calendar year and the schedule applies to each individual. A relevant excerpt from Sec. 4311: ‘(ii) AMOUNT- Subject to clause (iii), the applicable amount specified in this subparagraph for an eligible professional is as follows: (I) For the first payment year for such professional, $15,000. (II) For the second payment year for such professional, $12,000.’ See here for the full text."

From Moose Haas: "Re: MRI/TEPR. Completely washed up. Went to their event last year. It had to be one of the worst events I’ve ever attended. Rumor is MRI is being shopped, but no takers." I appreciate Peter Waegemann’s taking the time to share some thoughts (several  of which I agree with). 

From Sam Butcher: "Re: physician practices delaying EMR purchases. Many groups will delay. Those interested in EMRs for business or clinical reasons have already bought. The remaining ones are resisting change claiming EMRs cost too much or aren’t better than paper. These are the same groups that resisted electronic claims years ago. It’s no surprise that many of these practices are poorly managed. The same paralysis happened with practice management stimulus during the debate over Hillarycare." That’s an interesting observation. As much as I don’t believe the Most Wired hype, it would be interesting to compare the quality and profitability of non-technology using practices to the others. There are certainly plenty of badly managed practices out there (one way to identify them is to check the name tag of the least competent person in the reception area: if that person’s last name is the same as the doctor’s, expect the worst).

From Carpluv: "Re: physician practices delaying EMR purchases. Obamanations, grand idea for financial help for EHRs, has stopped the buyers in their tracks. They’re all waiting for the handout. Great momentum change!"

From Elsie EHR: "Re: physician practices delaying EMR purchases. Same song, different year. On July 21, 2005, the NY Times ran an article about the VA’s VistA system titled ‘U.S. Will Offer Doctors Free Electronic Records System.’ The article, which was widely quoted and reprinted, painted a rosy picture of the ‘free’ system. It was eagerly read by practitioners who were actively looking for an EHR as well as those who were on the fence. All that press prompted thousands of physicians to put their EHR plans on hold so that they could ‘wait and see’ what free goodies the government would provide. Some are still waiting." Link. That’s the most over-hyped and under-delivered part of Brailer’s original plan — giving away VistA (hospital and office) to legions of clamoring providers. Flop (see: Free Kittens).

From E. Buzz Miller: "Re: event. Will there be an HIStalk reception at HIMSS this year?" Wow, lots of people have been e-mailing that question, so thanks for the anticipation! I believe that’s affirmative, so keep Monday evening free. I’m hoping to line up a couple of notable speakers, maybe (and/or holding a spot for a HISsies winner or two if they’re game). For those who went last year, I’m open to suggestions on how to maximize the networking opportunities or anything else that would make it more meaningful and memorable. I never really asked attendees what they liked best or how to make it better, so now I am. Some people would just put out food and drinks, but I’m too neurotic to just let it unfold.

From Trimaxion: "Re: Stanford. Stanford Hospital has again delayed its Epic CPOE Oncology (Beacon) go-live of their Comprehensive Cancer Center. They have serious patient safety concerns, need new development, and can’t scale the complexity of the site." Unverified, but I know some Stanford folks read and may reply. I can’t say I know of any oncology app that isn’t a work in progress, though. The protocols and pre-dose monitoring and calculations are a bear. Even the so-called "100% CPOE" hospitals usually punt on oncology (and some or all of peds, like NICU).

From Bobby Peru: "Re: layoffs. Keep up reporting them." An interesting counterpoint from Think Positive: "I would propose to you that it is no longer news worthy or interesting news if another company has a layoff. I agree in better economic times this type of insight into a company’s fortunes or failures is helpful guidance to your readers." Think Positive is right, I believe, because it is indeed neither newsworthy or all that insightful that a vendor lays off staff these days, unlike the pre-recession when such activity might foretell future problems or shifts in strategy. Maybe this is a happy medium: I’ll keep reporting layoffs (provider and vendor) only if they have been reported elsewhere. Is that good, or should I follow Bobby’s suggestion and keep running whatever I hear? Let me know.

In the meantime, in the absence of a ruling, Omnicell supposedly dismissed somewhere between several dozen and a hundred field support employees on Wednesday, but an official number of 101 was given with its Q4 report: revenue up 7.1%, EPS $0.10 vs $0.09. Those are darned good numbers if you ask me, but cutting payroll is the most common hunkering down for weathering the economic storm overhead. Cold, but smart.

It’s your last chance to cast your HISsies ballot.

Listening: brand new alternative hard rock from Hoobastank, who kind of disappeared after one hit several years ago. I like it a lot – it’s harder than their older stuff. I still hate the name, though.

Intellect Resources has a new newsletter, which I always enjoy. The "traveling Flat Healthcare IT Man" piece is fun – wish I’d thought of it for HIStalk (it’s from a children’s book called Flat Stanley). They also have a new website with both HIT positions and candidates.

A huge win for GE: Scott & White chooses Centricity Business (the old IDX billing system, I assume) for patient access, revenue cycle management, and BI.

Jobs: Cerner Clinical Systems Analyst, Pre-Sales Engineer, EHR Clinical Trainer and Implementations, IT Director. There are some nice positions and employers posted.

Here’s an interesting example of commitment to healthcare: El Camino Hospital is purchasing the physical plant of Community Hospital of Los Gatos, putting current ECH CMIO Eric Pifer in charge there. ECH is taking over June 1 when Tenet’s lease runs out, but Tenet said, screw it, we’re closing the hospital on April 10 because it’s losing money anyway and we’d rather just cut and run. Employees thought they were finally going to be safe under ECH, but now they’re all getting the axe. ECH says they can’t get it ready to re-open until the fall. As a for-profit company, it’s the right business decision for Tenet, I suppose.

Humana will contribute provider incentives to encourage participation in the Wisconsin HIE (would one sound that out as WHEE or WHY?)

While I’m thinking about it, I’d like to thank the companies that sponsor HIStalk and HIStalk Practice. It takes guts to put your ad (flashy or not) beside some of the stuff I write. For most of them, it’s not a sterile transaction handled by detached PR people — it’s company executives who want to support what we do and who pull the strings to get the bean counters to write a check to a vaguely untrustworthy-looking enterprise working out of a PO box. Make your own decision on what to buy or from whom, but if you get the chance, thank them for their support.

Investor’s Business Daily covers athenahealth in an article purportedly about subscription EMRs, but mostly about ATHN stock.

If you’ve e-mailed me lately, hang in there and I’ll get back to you. It’s nearly impossible for me to do much more than skim the inbox until the weekends since HIStalk, HIStalk Practice, and HIStech Report are kind of in full swing at the moment (there will be record readership in HIStalk this month, which is surprising since the first several days were a long holiday weekend for most folks).

Speaking of CHLG, I heard this from Vendor Val: "El Camino Hospital plans to bring CHLG up on their Eclipsys Sunrise computer system and introduce physician order entry. Great news – for their competitors. CPOE had some success at El Camino because the city subsidizes the hospital and the hospital subsidizes the close-knit Independent Physicians of El Camino with free eClinicalWorks. Of course these MDs are very tech-savvy and have link-ups with the hospital’s Eclipsys Sunrise systems and can view lab data, medical histories, and procedures from the comfort of their own offices (they attract a lot of Stanford Hospital doctors who cut their teeth on computer glitches, spotty interfaces, and lots of downtime). But Los Gatos is a diverse collection of paper-happy independent physician practices who have no incentive to invest in technology and many are aging retirees with no interest in learning new programs."

Nextgov reports that Rob Kolodner will be staying on as ONCHIT.

California’s ED doctors sue the state, claiming that the ED system will collapse without additional funding. The state is ranked last in ED access and 43rd in ED payment. The docs claim EDs are getting the state’s burden of caring for the poor and elderly dumped on them. The state’s Department of Health Care Services had a cheery response: more budget cuts are likely, with proposals on the table to cut Medi-Cal’s budget by $1.1 billion and cutting physician reimbursement on March 1. I’m no expert, but this sounds like a seriously explosive situation there since I remember how ugly the King-Drew situation got.

Rich Elmore reminds me that his blog post mentioned the possibility of delayed provider EMR decisions because of Uncle Sam’s potential golden handshake.

St. Luke’s Regional Medical Center (ID) restructures its 28 IT positions into 18, forcing incumbents to play musical chairs to decide which 10 get the boot. It seems that hospitals are falling into one of two camps: (a) those who have big-ticket IT projects underway and aren’t about to jeopardize them to save a few IT salaries, and (b) those who never really believed that technology was all that valuable and are robbing the IT operational and capital budgets for more critical needs.

A UK survey calculates that dry cleaners there found an estimated 9,000 USB sticks, some no doubt full of sensitive information, that were left in the pockets of clothing dropped off.

E-mail me.

HERtalk by Inga

From Comforter: “Re: layoffs. Cabell Huntington laid off between 30 and 40 middle managers a couple of weeks ago, saving between $3 and $4 million per year. Many were-long time employees, with more than 20 years of service. One questioned how the hospital could have committed $40 million to Cerner a couple of years ago, but now finds itself in dire straits. Security escorted the employees out of the building immediately, standard policy for sure, but compounding the duress of getting fired.” The local paper reports that 40 jobs were eliminated earlier this month.

From Jason: “Re: Faxton-St. Luke’s Healthcare. You may have already heard, but Faxton St. Luke’s is an Eclipsys client.” Thanks for the correction. I erroneously said they had Cerner.

From Inside Outsider: “Re: Rob Kill. Is the new CEO of Virtual Radiologic Corporation really named Rob Kill? First time I’ve ever heard of a person named for breaking two commandments." Funny, although I bet Rob’s heard it too many times to do anything except grimace and give a polite, dry two-beat chuckle (HAH ha).

From Ziggy: "Re: Hospital marketing. With all the troubling economic news, budget cuts, and all, I am wondering the effect on hospital marketing? What are other hospitals finding to be most effective for the money?” Medicare fraud?

Sometimes it’s the little things about a company that can turn you off. Last September, I semi-seriously made fun of this Med Com USA press release because the first sentence went on forever. Lo and behold, here’s a new one just about like it: “MedCom USA, Inc. (OTCBulletinBoard: EMED) a leading provider of HIPAA compliant healthcare and financial transaction solutions for the healthcare industry, which recently signed letters of intent to acquire PayMed USA, LLC and Absolute Medical Software Systems, a leading provider of HIPAA compliant medical, dental, healthcare and financial transaction solutions for the healthcare and dental industry is pleased to announce that it has appointed an additional board member resulting in three independent board members and one inside member.” But what annoyed me the most was that in order to open their Web site with my Chrome browser, I was required to upgrade to a newer version of Flash (which I blew off, because I decided I didn’t need to see their site that badly.) If you read the press release, you’ll notice they had some high-level turnover, so I’ll give them the benefit of the doubt and assume they haven’t had a chance to focus much on marketing.

With the meltdown of Satyam Computer Services, other outsources like EDS, Perot, and ACS hope to pick up a few new clients. One consultant estimates Satyam will lose $2 billion worth of business to competitors over the next two to four months.

Tennessee expands its medical video network to allow physicians to treat pregnant women in rural counties. BCBS of Tennessee Health Foundation has provided $1.8 million in funding to allow perinatologists to view live ultrasounds remotely.

HIMSS announces its support for HIT provisions under consideration by Congress, citing three reaons: 1) the economy will benefit as jobs are created; 2) patients will benefit because of increased safety, and, 3) doctors will benefit because it reduces the current cost barriers. They don’t mention this, but of course it would be helpful to their 350 corporate members (and thus they themselves) as well.

A survey finds that hospitals and health systems are cutting back on both capital spending and unprofitable healthcare services. Hospitals are worried about declining investment values, shrinking margins, and stagnant philanthropy. This report reminds me of our own little survey to your right. If you are a vendor or a hospital, let us know what effect the economy is having on your world.

I wonder if this is just a co-incidence? Mr. H and I start using Twitter to keep abreast with all things HIT. Three weeks later Twitter seeks to raise at least $20 million in Series D funding. That’s a bunch of tweets.

The U.S. Bureau of Labor Statistics reports that retail prices for hospitals increased 5.9% in 2008, compared to 8.3% the year before. Wholesale prices for hospital services increased 1.5%, compared to 3.9% in 2007.

A CDC report finds that the total number of outpatient surgeries increased from 1996 to 2006, from 20.8 million to 34.7 million visits. Outpatient surgery visits accounted for about one half of all surgery visits in 1996, but nearly two thirds of all surgery visits in 2006.

Eastern Maine Medical Center announces 76 job cuts, reductions in overtime, and holds on several projects. The hospital was a 2008 Davies Award winner. The local paper also noted that the hospital’s CEO received almost $700K in compensation and benefits last year.

Wetzel County Hospital (WV) receives government approval to seek up to $6 million in bonds, which includes $175,000 to upgrade its CPSI EMR and Payroll applications.

Trustees with Regional Medical Center (SC) approve a $78,000 contract with HIMformatics to oversee its Cerner IT project.

Tenet Healthcare says it expects a Q4 net income of $5 million and $63 million in earnings for 2008.

Would the average person pay $20 to e-mail a medical specialist for advice?  A physician group is betting on it, having launched a Web site designed to give anyone with a medical question the chance to receive medical advice, medical recommendations, and medical information from specialized medical doctors. 

Revenue cycle management company MTBC outfits its own airplane to be a flying promotional platform. Well, why not? Guess it beats the yellow pages, especially if you’re marketing to pilots.

Norton Healthcare (KY) selects Unibased Systems Architecture to provide resource management software and services.

ICA announces the deployment of its data and technology aggregation solution at Lourdes Hospital (KY).

E-mail Inga.

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An HIT Moment with ... is a quick interview with someone we find interesting. C. Peter Waegemann is CEO of the Medical Records Institute.

People often compare HIMSS and the Medical Records Institute, often on the basis of their respective conference (the HIMSS annual conference and TEPR). How would you characterize the difference and do you see HIMSS as a competitor?

HIMSS and Medical Records Institute (MRI) have very different goals and points of view. Both started about 25 years ago. HIMSS developed into a very successful “mainstream” trade show with an attached membership organization. MRI’s conferences have emphasized the education component and helping providers to understand the consequences of EMRs and HIT.

For MRI, the main goal was to promote EMRs and to stimulate and provide leadership in standards development. I was instrumental in the initiation of standards organizations such as ISO TC 215, but when MRI felt that there was a lack of meaningful results, it supported ASTM International’s, relinquishing its leadership to HIMSS, which took over technically. While HIMSS has been a strong supporter of ONC, HITSP, and CCHIT, MRI has pointed out the negative influence these efforts have had on HIT developments. 

In summary, MRI has been the counterpoint to HIMSS in terms of strategy.

Why is Medical Records Institute set up as a for-profit organization rather than a non-profit like HIMSS? Is there much of a difference and are other healthcare membership or conference organizations set up similarly?

HIMSS, having gotten the not-for-profit status early on, has been a huge, profitable organization that is well funded, with reserves in the millions. MRI is the small, independent organization that has always been more interested in making a difference than making money. MRI felt that it could be more effective in its mission unfettered by a Board and the complications of a not-for-profit organization.

What is MRI’s point of view on the state of EMRs and best use of any healthcare IT money that’s made part of an economic stimulus package, particularly in light of the National Research Council’s report about the unmet technology needs for improving patient care?

MRI has repeatedly stated that the progress in the field of EMRs is shameful and argued that this cannot be blamed on such myths as lack of physicians’ interest (see this article). 

Unlike other organizations, MRI is not driven by the prospect of big money for the industry. MRI welcomes the prospect of funds to improve the quality of care with technology solutions, but it is one of the rare voices that warns that the expected savings may not occur quickly, that the infrastructure is not ready, and that (as in the past) wrong avenues appear all too likely to be pursued. 

In its letter to President Obama, MRI  asked for orchestrated efforts to determine the necessary healthcare infrastructure changes in order to achieve electronically enabled healthcare. In other words,  rather than rushing into a big spending spree, a national effort needs to be funded that openly addresses all the hypes, explores various and perhaps unpopular strategies, and develops effective ways to spend this money safely and efficiently.

Why did MRI develop an interest in cell phones in healthcare?

MRI has a long history regarding cell phones and mobile technologies. Almost 10 years ago, MRI joined the Mobile Healthcare Alliance (MoHCA) to coordinate cell phone activities in healthcare and I served as chair of MoHCA. Several years ago, MoHCA’s Executive Director joined MRI as Vice President. It has been natural that we followed that industry and recognized its potential value to healthcare.  

There has been a re-emerging wave of mobile phone applications for healthcare. With over hundred companies, this is big and will be disruptive to providers and other stakeholders. MRI calls it the “mHealth revolution”. For this reason, the Center for Cell Phone Applications in Healthcare (C-PAHC) was formed in 2008. 

Mobile devices and applications will be instrumental in the success of many health IT goals, such as documentation at the point of care, success of personal health records, integration of personal health records into EMR systems, disease management, and many more. Most of all, mobile technologies represent the breakthrough opportunity for EMR interoperability and implementation among many other applications. MRI supports the formation of the new, independent, not-for-profit mHealth Initiative Inc. and will encourage its efforts toward accelerating mHealth and its benefits nationally and internationally.

What predictions do you have for the healthcare IT industry over the next 1-3 years?

MRI sees four major drivers for the next three years. The first is, of course, the new Administration and whatever comes out of its efforts.

The second is the “mHealth revolution”, addressed above. Expect, for example, that in 2012 more than 50 million people will have their PHR on a mobile phone and will send information in advance of any visit to a provider. 

The third driver will be the interoperability standards through ecosystems (Microsoft, Google, mobile phone, etc.) that will enable true continuity of care. Expect most of these developments to come from industry innovation, not from traditional standards bodies.  

The fourth driver will be the Internet/consumer movement.

Overall, there should be more progress than in the last 10 years toward a safer, more efficient and cost-controlled healthcare system. 

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The current version of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the larger economic stimulus legislation, will alter the HIT industry and the IT plans of our organizations.

For outpatient electronic health records, the Act puts some non-trivial money on the table. A provider who uses a certified EHR can get a maximum (through Medicare) of:

This totals $41,000. This will clearly increase interest in adoption and could represent a lot of revenue for a provider organization.

To get this money, a provider must demonstrate that they are meaningfully using health information technology. What does "meaningfully" mean?

• Using e-prescribing
• Connecting through HIEs to improve the quality and coordination of care
• Submitting information on clinical quality measures.

While we might be more or less clear about what e-prescribing means, clarification is clearly needed about what we mean by the second and third criteria.

It is anticipated that HHS will spend 2009 providing specifics and clarity about what providers have to do to demonstrate meaningful use. This means that most providers will have one year – 2010 – to finish EHR implementation and put in place the infrastructure, applications, training, etc. needed to get the as much of the incentive money as possible.

This is a tall order. And it means that providers should start moving now (if they aren’t already) even though the dust has yet to settle on the specifics.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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