From MM: "Re: home grown systems. Foul! When I read people call software built by healthcare providers as ‘home grown,’ I can feel the hair on the back of my neck rise and my blood pressure go up. In the 1980s, that may have been an accurate statement, i.e. that providers built ‘home grown’ systems, where ‘home grown’ is used as a derogatory statement that refers to software that was developed by a single person using outdated technology with limited testing and no documentation. Today, there are some leading healthcare organizations designing, building, and deploying commercial grade software. With the move towards ‘Agile’ development, one can no longer equate the number of developers with the quality of software. Another point is that the software developed by a healthcare organization is ‘lighter’ and simpler than vendor software because the requirements are lighter." See below for an example of this from MD Anderson, which hardly fits the ‘home grown’ label.
From Salesgal: "Re: EEOC. [EMR vendor] is under investigation by the EEOC for unfair layoff procedures during the June 2008 layoff. All of the complaints are lodged in [sales manager’s] district. Seems he let go pregnant, ill, and staff who were not his groupies and kept his favorites who were not selling. He was ultimately let go, but several reps with solid experience and sales numbers were lost." I’ve omitted the names since I have no official documents to back up the statement. Sounds juicy, though.
From Rowdy Piper: "Re: layoffs. Orlando Health (formerly Orlando Regional Healthcare System) has ‘reorganized’ positions across the institution by eliminating positions and placing many of those affected employees into other (many times lower paying) jobs. Additionally, they have instituted a system-wide hiring freeze and have started to cut hours for many and even forced time off over the holidays."
From Corndog: "Re: UHIN. Very impressive that Axolotl beat out Medicity right in its own backyard. Intermountain Healthcare has been shrewd in using technology to advance the quality agenda and must have liked what it saw." Maybe, although its big GE partnership doesn’t seem to show infallibility. Still, Axolotl has strung together some pretty good wins recently.
The President-elect is still talking up healthcare IT, this time in a TV interview: ".. in the economic recovery package that we put together, we have a lot of investment in making the health care system more efficient. Those are things that had to be paid for anyway. Just a simple thing like converting from a paper system to electronic medical records for every single person can drastically reduce costs, drastically reduce medical error, make not only health care more affordable, but also improve its quality."
HIMSS Analytics brags (confusingly) that "85 percent of hospitals in the contracting phase of an IT acquisition have signed with a CCHIT Certified vendor since November 2007." There’s no such thing as a certified vendor, only certified products, and even that certification only covers EMRs, not most of the software applications a hospital uses. Does that mean that 85% of hospitals that have bought any IT system in the past year also bought a certified product, or that those who bought a product covered by CCHIT (inpatient or ambulatory EMRs) certification chose the certified one? If they only bought a server (which is an IT acquisition) and no software, how were they counted? Mumbo jumbo aside, it doesn’t really matter — everybody shamed the vendors to lay out the cash to get certified, so it’s not like hospitals have much of a choice other than in office-based EMRs, where they might pick a lesser-known vendor despite dozens of certified ones. It’s not like having certified products available opened the floodgates – they’re buying the same old products that just happen to be certified now. Results, not surprisingly, haven’t changed – just the cost. Products are interoperable, but users aren’t.
And speaking of CCHIT certification, Allscripts Professional earns Ambulatory 08.
UC Irvine Medical Center is proud that its anesthesiologists have stopped falsifying surgical records by filling out forms before the surgery starts as CMS found earlier, now thwarted by its new SIS software the prevents them from doing so.
Former Healthlink VP Ed Kopetsky is named CIO of Lucile Packard Children’s Hospital.
Jonathan Bush and David Brailer were on CNBC. There’s not much new since the TV guys require everything to be simplified so they can understand it, but I bet JB can’t wait until Tuesday when the talking heads will have to drop their "president’s cousin" knee-slappers unless he’s also related to Obama.
Conditions are so bad that Columbia St. Mary’s (WI) intentionally slows down its $417 million new hospital project that’s already almost four years old.
Big layoffs for Wellpoint: the struggling insurer will drop 600 employees and another 900 unfilled positions.
GE Healthcare will lay off in "the low to mid-single digits" as a percentage worldwide.
Hospital layoffs: Tulare District Hospital (CA), no number given; Excela Health (PA), 70; Wellmont Health System and Mountain States Health Alliance, 195; Fox Chase Cancer Center (PA), 80; Montgomery Hospital Medical Center (PA), 17. Brazosport Regional Health System cuts the hours of hourly employees and issues a mandatory 10% pay cut for salaried ones. There are more, too many in fact for me to keep writing about, so suffice it to say that nearly every hospital is freezing discretionary spending, cutting capital budgets, and laying off staff.
West Virginia University Hospitals and its physician group were to have gone live with Wave 2 of their $90 million Epic implementation over the weekend. That’s $18,000 per user or $180K per doctor, just in case you were wondering.
Sen. Chuck Grassley’s investigation turns over another hidden fact: the orthopedics chair at University of Wisconsin-Madison pocketed over $19 million in five years from device maker Medtronic. He claims the money was royalties for patents he holds. So how the heck was he able to keep all that money without the university knowing (that is, unless he was intentionally cutting them out of the deal even though he’s a full-time employee)? He claims he fully disclosed his relationships and never implanted any of the devices in his own patients (so does that mean their care was better or worse?) In fairness to him, the university’s disclosure forms have a top category of "over $20,000," so that’s their fault for not being more specific.
I’m puzzled: why did the National Research Council and then the Senate ask Microsoft (and Intel, for that matter, in NRC’s case) for its opinions on healthcare and technology? Peter Neupert gave the company’s view (warning: PDF) of what the future of healthcare should look like, but everywhere I’ve worked, they just sold expensive, trouble-prone IT plumbing and gave CIOs free trips to Redmond. Of course Microsoft envisions a radically different and technologically future – that’s their only hope for elbowing aside companies like Meditech that have been automating healthcare while Bill Gates and Jerry Seinfeld were still in high school. I’m not saying they shouldn’t have an opinion, only that I don’t get why anyone would give it much value when they’re dabblers at best. At least its rumored layoffs apparently didn’t happen.
AT&T is developing software that will use both WiFi and a low-power technology called Zigbee to send home monitoring information to providers.
Amazon Web Services makes some of its huge public data sets, including genomic and census data, available at no charge for developing cloud applications.
Three UK hospitals are rolling out e-prescribing in what’s called the UK’s biggest eRX project. JAC Computer Services, a subsidiary of Mediware, is providing the application.
M.D. Anderson’s EMR Project
By Lynn H. Vogel, Ph.D., FHIMSS, FCHIME
Vice President and Chief Information Officer
Associate Professor, Bioinformatics and Computational Biology
The University of Texas M. D. Anderson Cancer Center
I asked Lynn Vogel about the project they’ve been working on at M.D. Anderson. Here is his response.
The January issue of Advance will have some comments on what we are doing with regard to ClinicStation and its SOA architecture, with some observations regarding comparisons with commercial products.
The fundamental problem is that every commercial clinical systems product on the market today relies on a single, physical data repository, generally with HL7 interfaces, and is based on relational data base architectural models that are now close to 20 years old. Outside of healthcare, the IT world has embraced Services Architectural models and is now moving into semantic data models as well. But the cost of a major architecture change is simply prohibitive for commercial healthcare IT vendors. For all the talk about interoperability challenges, not being able to incorporate new data models into our clinical systems environments down the road may be a much larger constraint on improving our nation’s health.
The advent of genomic (or personalized) medicine presents very different types of data from what we have been accustomed to historically. For the most part, clinical data has been viewed as a series of discrete data models — you have a particular laboratory value, or a radiology report, or a graphic from an echocardiogram that you send to a repository via an HL7 message — so incorporating new data of this type into the repository via HL7 has not been a problem. But genomic data models tend to be based more on pattern-matching than discrete data, and products that rely on a single physical data model have real problems integrating these new data types. In addition, the vast volume of genomic data that is now being collected and increasingly available for matching can become unmanageable within a single data model and repository structure.
M. D. Anderson is now working on a parallel product, ResearchStation, also built on the SOA framework, that for the first time promises true integration of research data (e.g., biomarker data) with data from clinical practice. We hope to exploit UDDI capabilities as the actual linkage process between data and services from ClinicStation and ResearchStation. All of this, of course, says nothing about the vocabulary and terminology challenges we face in healthcare, for which is there is simply no comparison in any other industry. This is where semantic models promise to make a significant impact — and major technology vendors such as Oracle are already incorporating such capabilities into their product suites — but these are not even on the radar of the major healthcare IT vendors.
A couple of references with more specifics on what we are doing:
Wes Rishel from Gartner included our work as a case study in his presentation a couple of weeks ago at the Gartner Healthcare IT Symposium, so I think the word is getting out about the usefulness of SOA and how it can help us to deal with a number of the data challenges in healthcare.