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‘home grown’ is used as a derogatory statement that refers to software that was developed by a single person using outdated technology with limited testing and no documentation.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.

Two 19-year-old students develop Refill300, a free e-prescribing and refill site.

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.

E-mail me.

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:

Case study from Microsoft (Word document)
Case study from Avanade, our strategic partner in software architecture and development

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.

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The discussion draft (warning: PDF) of The American Recovery and Investment Act of 2009 in the House of Representatives contains only $2 billion in new funds specific earmarked for healthcare IT, with that entire amount to be managed by the Office of the National Coordinator. The remainder of the $20 billion figure that was quoted for healthcare IT would  be distributed by CMS as pay-for-performance incentives that have not yet been defined.

ONCHIT’s short-term $2 billion spending would be targeted for nationwide information exchange, healthcare professional training (possibly in informatics, not specifically stated), and grants for hospitals and doctors to acquire CCHIT-certified products.

A report from Piper Jaffray analyst Sean Wieland says that most of the CMS incentive funds will go to hospitals, with the intention of covering 1/3 of the cost of electronic medical records systems, but not prior to purchase.

Meanwhile on the other side of Congress, testimony from yesterday morning’s Senate hearing on Investing in Health IT: A Stimulus for a Healthier America is available online in video and PDF formats. Witness testimony is included from Jack Conchran of The Permanente Foundation, Janet Corrigan of the National Quality Forum, Valerie Melvin of the GAO, Peter Neupert of Microsoft, and Mary Grealy of Health Leadership Council.

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From Seattle: "Re: HIMSS. At the HIMSS Washington dinner last night, Dave Garets of HIMSS Analytics disclosed that he and others from HIMSS had been working with the Congressional Budget Office on the HIT proposal.They were asked what would it take to get all hospitals to Stage 4. Apparently the proposal includes both inpatient and ambulatory and will be a combination of grants, loans, and Medicare rewards, including up to $1 million in ‘reimbursements’ for systems already implemented. When the speakers panel discussed this, two of the four suggested that this was a lousy idea and seriously questioned why we should be reimbursing anyone. They suggested instead delaying ICD-10 or using the simpler Canadian version or simplifying claims and payments, also focusing on reducing provider time by eight hours a schedule using technology instead of just buying more technology." HIMSS Analytics shows that 95.7% of hospitals haven’t yet made it to Stage 4, which requires all ancillaries to be installed, CDR, controlled medical vocabulary, CDSS for both error checking and clinical protocols, clinical documentation, PACS in all areas, and CPOE (even though you only need one live floor to claim victory). Maybe someone should get the cost and outcomes stats from those who have since I doubt there’s a corresponding improvement. Using that logic, Detroit should be rewarded for buying new robotic welders as a way to create safer and better cars. Why not just pay them for making safer and better cars? Makes sense unless you sell robotic welders.

From Terry Jacks: "Re: Ministry. Is anyone going to point out that this Cattails system that has been recognized recently in the press is not a vendor, has no clients, no implementation staff, no service staff, and no customers other than their own docs? I thought we went away from home grown systems in the 1980s?" I think you may have given Pete inspiration for a future posting. From its data warehouse design above, it’s not exactly a stripped down, spur-of-the-moment system and it’s also CCHIT certified, so I’ll be interested to hear more about what they’ve built.

From Snake Pliskin: "Re: Sutter. The period of time that it has taken Sutter to implement Epic is NOT a reflection of Epic. Sutter is pushing the envelope. When you look at Epic, it’s pretty amazing to realize just what they have accomplished over the course of the past eight or nine years since they entered the inpatient arena. Sutter is a confederation that covers a huge geographical expanse. It’s been about establishing common governance, common processes, achieving consensus, responding to changes in technologies and patient care needs, the desire to improve work flows. I’m going to give Epic and Sutter kudos. Really. It’s a monumental task."

From Seattle: "Re: ICD-10. Compliance deadline extended to October 1, 2013." Link. AHIMA is "applauding" with its imaginary hands, but only for HHS’s approval of ICD-10. It’s not happy about the deadline extension. On the other hand, AHIMA doesn’t sell or use information systems, so that’s easy for them to say (good for coders, too, probably).

From Rommon: "Re: Palmetto Health Baptist Easley. The 50-year-old upstate SC hospital to be spun-off from the largest healthcare system in the state, Palmetto Health, and co-owned by PH and GHS. ‘Not related to the economy.’" Link. 

From RIS Guy: "Re: Agfa. Agfa is, for the second time in four weeks, today going through a US reduction in force of about 60 people. This time, it’s front line sales and service."

From Billy Lyall: "Re: site visits. I have worked for vendors for much of my life and I’m always sensitive to site visits. They’re no easy thing to manage from the vendor perspective. They can be risky — even the best site visit could go downhill quickly. They consume a lot of time for the host. Of course the host is going to get something, maybe some discount on support hours or licensing of new products, but maybe even just special attention from the vendor. But, my impression of the people from the hosting site has always been that they are candid about support issues, implementation hurdles, staffing, and ability to meet end user needs. There’s always the opportunity for sidebar conversations." I enjoyed Ricky Roma’s piece and have asked for more if he’s willing. Inga and I found him by accident and were enthralled by his writing.

From Webbed_Feet: "Re: OHSU. Reorg and layoff alert; Oregon Health & Science University (OHSU) completely re-orgs IT. The final numbers are not published yet, but dozens have been told they will be laid off and will get formal notice on Wednesday. As part of the re-org, the CIO and CHIO formally announce the Clinical Informatics department that encompasses workflow analysis, clinical reporting, HIM nad RN and MD champions for the Epic project." OHSU has been struggling, so it’s probably not too surprising that something had to give.

From Medarling: "Re: Ivo Nelson. I heard interesting comments that Ivo Nelson, former CEO of Healthlink before selling to IBM, may be doing a comeback? Anyone else hearing this?" His LinkedIn profile indicates that he has started a new consulting business in Houston called Ivo Inc., which may or may not be just him puttering around a little. I finally found a personal e-mail address for him and sent an inquiry, but I haven’t heard back.

The House Appropriations Committee released a summary of its stimulus plan Thursday, which includes $20 billion for HIT. It will be interesting to see where the money would go once the details come out. Since Obama wants a quick jolt, the only reasonable way to disburse it would be through organizations that have been efficient and trustworthy in the past. How else, other than parachuting in pallets of cash a la Iraq, could that much money get into play quickly? Who would you trust to dispense it thoughtfully?

David Brailer writes his thoughts on the national health IT agenda, which unfortunately came out about six hours after I sent him a list of interview question and hoped for a response. He says he hoped to let the market drive EMR adoption when he was running ONCHIT, but it didn’t happen, so government incentives are needed. However, he nearly echoes my previous writings, I’m proud to say: "We should not incent physicians and hospitals simply to purchase electronic records. We get no benefit when a physician or hospital buys an electronic record. What we should do is reward the use of these tools as part of a patient’s care." He advocates pay for use. He also points out the obvious need for bunch of clinical informatics people to get all this stuff up and running, which of course is a hundred times harder because every vendor’s system is different and it takes years to really learn each one. He also suggest updating HIPAA and privacy rules, arguing that trusted providers are constrained while companies like Microsoft aren’t because they aren’t providers. Here’s his big pitch: "President-elect Obama should consider one single change that would do more to reshape medicine into an information industry than anything else: have Medicare treat electronic visits as equivalent to in-person visits." Brother Dave, this choirboy hears you loud and clear and says amen, although I might change that last big pitch to: "President-elect Obama should consider one single change that would do more to reshape medicine into an information industry than anything else: put a stop to all the ridiculous documentation requirements for getting providers paid, many of them imposed by Uncle Sam himself through his big payors like Medicare." Imagine how good EMRs would be if all the crap involving billing and malpractice defense could be eliminated and systems redesigned from scratch for the patient’s benefit, not that of the government and the insurance companies. It’s no surprise that the best clinical improvement came from the VA’s VistA – the hardhats didn’t have to program in that 80% of the average hospital system that has nothing to do with patients. Hospitals bought their first computers because of Medicare complexity and that hasn’t changed.

The chair of the House VA committee says he will investigate reported software problems that caused patients to get wrong drug doses and miss treatments. The problems: IVs ran longer than intended and information showed up on the wrong patient. If he finds the perfect information system anywhere in the world in all that investigating, I’d like to hear about it.

Frustrating: I bought those squiggly, energy-efficient Sylvania bulbs from Sam’s that say on the box they’ll last seven years. So far in one bathroom, four of six have burned out in just a handful of months. Ripoff?

John at Chilmark Research weighs in on the Medicity-Novo Innovations merger.

Simon Samaha MD, who we old timers remember as CIO of Cooper University Hospital, is named president and CEO of Summit Medical Group, a 140-physician medical practice in New Jersey.

McKinsey Quarterly noodles on Why Americans Pay more for Health Care. The big reason: outpatient care, which is theoretically cheaper than inpatient care, but only if it replaces it. One culprit CT and MRI scans, which makes it very profitable. Also: "Well-insured patients who bear little, if any, of the cost of their treatment have no incentive to be value-conscious health care consumers. Moreover, even if they wanted to be value conscious, they don’t know enough." Let’s repeat: providers will do whatever they can get paid to do, just like every other profession. It’s not illegal, immoral, or even harmful – it’s just expensive for whomever is picking up the tab (not the patient, in most cases). If you want them to stop, then don’t pay them for doing it.

As Inga mentions below, LinkedIn yanked my photo, a shot of the Unknown Comic. How do they know it wasn’t me wearing a bag? Here’s my thought: I’ll chose an HIStalk reader’s picture and put it on my profile. Then, I’ll see who recognizes them at HIMSS and ask them to report back whether they received any accolades, assaults, or indecent proposals. In fact, I could swap reader pictures once a month so that I am, in fact, an HIT Everyman or Everywoman.

MedAvant, rescued from bankruptcy in September by selling out to Marlin Equity, acquires the Medicare Crossover business of HDM.

The Motion Picture & Television Fund will close its hospital and nursing home in Woodland Hills, CA due to $10 million a year in operating losses, laying off 290 employees.

GE Healthcare announces the merging of its two Milwaukee area divisions, diagnostic systems in Waukesha and clinical systems in Wauwatosa (did they intentionally choose towns with odd yet similar names?) The company boldly claimed it was about growth, no doubt the same reason they’ve been laying employees off and closing plants. It’s also shutting down the GE Healthcare Lunar office in Madison, moving manufacturing to Milwaukee. Despite the oddball name, it makes equipment to measure bone mineral density.

In that vein and locale, Wheaton Franciscan also announces its latest growth strategy: the forced evacuation of another 100 or so employees on top of the 250 positions already eliminated. If you live in Waukesha County, watch out for traffic near the unemployment office.

<shameless self-aggrandizement>A New Zealand integrator working on an RFI there asked me a few weeks back if I would mention their interest in hearing from US software vendors who might participate in a big patient records project. I did and the company says they got more than a dozen inquiries. Also, from a company who ran a text ad like those you see to your right, "We have seen more clicks from your site than any other of our ad locations (Google, Yahoo, etc.). You have a great site and I love reading it every day." </shameless self-aggrandizement>

That’s an HTML joke above, in case you didn’t get it.

Planned business closings and layoffs, courtesy of CoStar Group: Irvine Regional Hospital and Medical Center (CA) was to close Thursday, laying off 510 employees (above). Health Research Association (CA), the clinical trial support organization of USC, will lay off 79 employees on January 30.

Odd lawsuit: the family of a man who died after elective spinal fusion surgery at specialty hospital West Texas Hospital is suing the now-closed facility, claiming its medical staff didn’t recognize his blocked airway complications. His wife repeatedly asked staff for help, the hospital PA covering the ED (!) was paged, nobody thought about establishing an airway, and the wife gave him CPR. The hospital’s action: they called 911.

Jonathan Bush is on CNBC again. He quotes the IOM report and rails against the government gravy train. Worth watching, even if the gaggle of amped up hosts constantly interrupts him at a nearly intolerable volume. "Pay for data, pay for results, and you can’t believe how fast doctors will get out there and get online."

Hospital layoffs: Gaylord Hospital (CT), 11; Wyoming Valley Health Care System (PA), 20; Banner Health (AZ), 334; Mt. Carmel Health System (OH), 300; Rogue Valley Medical Center (OR), 20.

The CEO of Carolinas HealthCare System is doing OK, though, having been paid $3.5 million in 2008. They claim he earned it, which at least is slightly different than the standard excuse of having to pay competitively to attract such notable talent to a non-profit endeavor.

E-mail me.

HERtalk by Inga

From LinkedIn Customer Service: “Re: your profile picture has been removed. The picture is in violation of the LinkedIn Photo Policy because it is not an accurate representation of you.” What? My avatar is absolutely an accurate representation of me (in an optimized, sexier, Barbie-ish sort of way.) Apparently only “photographs” are acceptable. Mr. H is also miffed because his profile picture (a photograph) was also removed. His was the one with the bag over his head, which apparently is one of Mrs. H’s favorites since he likes to wear the bag around the house all the time (I didn’t ask). I just posted a new photo of myself. We’ll see how long before that one is also removed.

I have to say the quality of the writing and commentary from our readers is amazing. In the last week we’ve had some excellent stuff out there, both on HIStalk and HIStalkPractice. Thanks to everyone taking the time to support our sites by providing thought-provoking, smart, and entertaining material. We are always looking for great content, so drop us a note if you have any HIT reflections to share.

Retired Gen. Eric Shinseki, Obama’s pick to head the VA, vows to develop an EHR for active duty personnel and veterans and make business practices as paper-less as possible. Shinseki tells senators during his confirmation hearing that the barriers have not been technical, but rooted in the VA and Defense department’s leadership.

Also on Capitol Hill, NQF CEO and President Janet Corrigan tells a Senate committee that effective use of HIT is essential to improve quality, safety, and affordability.

GE Healthcare confirms its former IDX Systems headquarters in Vermont is cutting staff and other costs. A GE spokesperson would not discuss the number of employees affected.

Hill-Rom Co. also confirms job cuts and operational consolidations. The company plans to cut about 450 positions in the US. Hill-Rom laid off 150 employees at the end of 2008.

If you’ve been affected by all the recent layoffs, perhaps it will make you feel mildly better to know that healthcare workers in other countries are also suffering. Swedish medical officials announces plans to cut 900 jobs (6% of the workforce) in order to reduce costs.

Toronto General Hospital pilots its first surgery checklist, aimed at reducing adverse events.

Here is a new must-have item for fashion-conscious, cold-fingered iPhone users. The thumb and index-fingers on these $40 gloves by North Face are covered with special fabric that includes silver.

Mr. H mentioned an odd lawsuit last week that involved a deaf patient who sued her doctor for failing to provide a sign language interpreter. She ended up winning $400,000. A company called LifeLinks saw the lawsuit as an opportunity to promote its remote translation services, which allow providers to connect with interpreters and sign language specialists via the Web. Providers only pay for the interpreters’ time, which undoubtedly costs far less than $400K.

Medicare beneficiaries in Arizona and Utah test new PHR software that includes two years worth of Medicare claims data. Patients can manually enter additional data. Some additional information can be uploaded electronically. Personally I think I would be more inclined to use an EHR that was pre-populated with at least some data, so this sounds like an interesting pilot.

University Hospitals (OH) launches a new physicians’ portal that combines electronic prescription writing with medication reconciliation.

Blue Shield of California Foundation announces its intent to stop issuing HIT grants, citing more pressing healthcare needs. Last year the foundation issued almost $11 million in HIT grants.

Two Illinois hospitals settle lawsuits alleging they overcharged uninsured patients tens of thousands of dollars. Resurrection Health Care and Advocate Health Care have agreed to recalculate bills and give refunds to needy patients eligible for free or discounted care. In addition, Resurrection will extend a 25% discount to all uninsured patients, regardless of income level.

Anne Arundel Medical Center (MD) implements VISion:Asset Management from Versus Technology to provide real-time tracking services for hospital assets.

Nuance Communications and IBM announce a licensing and technical services agreement to enhance and expand speech solutions, including incorporating IBM technology into Nuance’s speech products. Nuance will also purchase speech-related products from IBM. Nuance also reveals that Warburg Pincus has agreed to purchase $175 million of Nuance common stock. Nuance plans to spend some of the money on merger and acquisition activity. The purchase represents almost 17.4 million shares.

CSC wins a $265 million, 7.5-year contract to replace North Carolina’s Medicaid Management information system.

Polaris Venture Partners acquires a substantial interest in National Electronic Attachment, a provider of secure electronic data for claims attachments.

Telephone equipment maker Nortel Networks files for Chapter 11 bankruptcy protection

CareTech Solutions and EnovateIT team up to create a custom wall station for Crittenton Hospital Medical Center (MI). The e645 Computing Wall Station will be mounted into individual patient rooms for point of care documentation.

The University of Pennsylvania School of Nursing and Eclipsys form an academic partnership that will incorporate Eclipsys technology into the curriculum.

Tawam Hospital in Dubai goes live on Royal Philips’ iSite PACS, the first public hospital in the Middle East to do so. Tawam Hospital is affiliated with Johns Hopkins Medicine International.

E-mail Inga.

Pete Sanderson’s Responses to Comments from Yesterday’s Post

Comment #1
A partner and I are ramping up to start a consulting practice sharing best practices for HIT projects. We are consistently amazed at what a little project management rigor can do to keep the ship on course. Thanks, always interested to hear success stories and lessons learned on HIT projects.

Feel free to share a few of your success stories

Comment #2
I can understand that you don’t want people padding their budget estimates to ensure 100% success, but I also understand why someone might bristle at having their project labeled a failure for completing work too far ahead of schedule or producing something at a lower cost than expected. Much is learned during the course of a project, and it seems like you might inadvertently be disincentiving people from taking advantage of optimization opportunities.

Good point. Every project includes identifying named human resources to accomplish tasks and achieve deliverables. You identify named resources to make sure they are not over allocated.  You seek to avoid asking someone to do 100 hours worth of tasks during a 40-hour work week. As you learn during the course of the project, you produce change requests that either free up resources or seek additional resources for your project. The Project Management Office balances all the change requests from a portfolio of projects trying to balance organizational priorities and resource availability. It can be tricky, but allows the organization to track projects and provide adequate resources where and when needed. An added benefit is the ability to forecast needs and being proactive to meet needs months down the road.

Comment #4
‘Good process and leadership trumps bad software.’ There are some many things wrong with this statement I don’t know where to start. Suffice it to say I completely disagree. Nothing trumps bad software.

With truly bad software, you are correct. The statement should really read, "Good process and leadership trumps marginal software or software that is mislabeled as bad software." How many times have you replaced a product thought of as bad software only to find the problem has not been fixed? We often find our trouble with software is due more to how we have chosen to implement it rather than with the software itself. The point is, business leaders should optimize processes and use of the software before deciding the software is truly bad. Good process and leadership can often improve the use of software mislabeled as bad saving the time and cost of implementing a new product.

E-mail Pete.

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The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Employee Annual Reviews
By Ed Marx

I admit it. I don’t like doing annual reviews. Few people enjoy them. Even fewer are good at them. I wish I were the anomaly, the freak. Sure, I’ve read all the theories and attended requisite training classes on how to make a review a non-event and make it productive. But this is supposed to be CIO Unplugged, right? Not CIO Fantasyland.

Most believe they are a star and, whatever your rating scheme, they should qualify as the poster child for the “top box.” Many of us desire to be number one in all our endeavors. Though I do appreciate the self-esteem and confidence this attitude exhibits, can everyone be “top box”? Should they?

No.

It’s easy to cave into temptation and give overly optimistic reviews to avoid discomfort. I’ve done it; I’m tempted every year. Then I kick myself for giving in because ultimately I’ve benefited no one. In fact, I end up undermining my employee and my organization. Worse yet, if I’m not modeling appropriate and accountable reviews, my subordinates will follow my poor example. (Ouch, I feel the pain as I write.)

Therefore, this post is as much encouragement to me as it is to you. Since it’s that time of year again, we the leaders are going to invest the time and energy to make the review honest and meaningful. You with me?

Here are 3 tips:

1) Spandex—man’s brutally, honest friend. If you want to know where you stand with weight management, pull on a pair. I can try to fool others in terms of fitness, but the single best test I have is spandex. Someone can tell me I’m fit, but when I see the rolls of fat hanging over the spandex… This sort of accountability keeps me on the right path. We need spandex attitudes in our careers to ensure our performance is in check. Give honest feedback even when it’s uncomfortable. You’re employee deserves to know the truth no matter how brutal. Nobody likes flab.

2) Satiate the hunger. While I did say we tend to believe we are top dog, deep down most of us long to improve. If I can give my subordinates one tangible thing to improve, most will clutch it like a pit bull clenching a bone. Imagine if your boss gave you one strength to focus on every year to help you move to the next level, and you really did something with it. You might become CEO! That annual performance review might start to look pretty admirable.

3) Break it down. Two years ago, I switched to doing performance reviews quarterly. This helped make the annual review less dreadful. When you’re tracking progress, evaluating, and encouraging throughout the year, there are no surprises to contend with. In fact, I leverage this same format with my manager monthly! I desire constant feedback. My recent annual review ended up uneventful, and I got a nice big bone to chew on.

My final reminder to myself and a word of encouragement to you. Not only is it our responsibility to our organizations to give accurate and meaningful reviews, but aren’t our people worth the effort, despite potential discomfort?

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

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Successful Projects

With the use of project management methodology, Ministry Health Care has consistently improved the success rates of IT projects. Any effort installing new software or requiring more than 100 hours of IT time is considered a project. Even using project management, 25% of our closing reports reflect a failed project; one that was not managed to the agreed upon timeline, scope or budget.

Before you start thinking your projects have a better success rate than ours, here is what we define as failures:

• Actual expenses varied by more or less than 10% of budget
• Total project hours varied by more than 10% of planned hours
• Completion date varied by more than 15% of the original completion date
• Two or more material scope changes
• Less than 80% of project objectives attained
• The project’s impact on the organization was not anticipated or was not effectively communicated

Business leaders often bristle at being told their project was a failure because they brought a project in under budget or with fewer project hours than budgeted (the cause of the majority of failed projects). However, we are managing a portfolio of projects limited by resource constraints. If all our projects come in 20% under budget, that means the organization accomplished 20% less than it could have with the same resources.

We also do an additional evaluation at least six months after the closing report evaluating if the project achieved its long-term objectives. Many failed projects are subsequently vindicated. 

I recently completed a Physician Executive MBA ( PEMBA) at the University of Tennessee. My classmates were physician leaders from across the county and numerous foreign countries. Their experience with IT projects was uniformly negative. In general, they thought IT was done to them rather than with them. These leaders reaction to IT should give us all a pause to evaluate our implementation strategy.

Will Weider, our CIO, recently listed Ministry’s "lessons learned" based on 2008 projects:

• Test thoroughly
• Good process and leadership trumps bad software
• Roles should be clearly defined and consistent with our Lean and Six Sigma engagement and acceptance strategy
• Business leaders should fully understand current practice and issues before new software or process change is considered
• Hours are consistently under budget due mostly to the assignment of unnecessary contingency in the project plans.
• Formalize Lean and Six Sigma activities in EHR project plans

We did have one perfect project last year (on time, one budget, satisfying all objectives): a medication reconciliation project at one of our internal medicine offices. This project was not initially supported by our CIO because it was a duplication of effort. We are in the process of implementing CattailsMD electronic health record, but this site will not go live for some time. The CIO correctly pointed out the existing software that was utilized will be replaced by CattailsMD.

The Project Team, comprised of nursing and clinician staff, rightly argued the software was the easy part; the tough part was establishing a standardized process for medication reconciliation. A standard process can be adapted to the future software solution. The team was lead by a Black Belt utilizing lean methodology to map out a future process flow and then used standard change management tools to achieve stakeholder engagement and acceptance. IT and project management played a supportive role. The project was done with the clinicians rather than directed at them.

Our deployment of the EHR will be accomplished with the same techniques used in our medication reconciliation project. Ministry Medical Group will own the implementation assisted by IT and Project Management. While the organization will establish certain high level standards, each practice site will use lean methodology to define its own standardized work flow. A system-wide rollout the EHR software will be accomplished through multiple small work site-centered projects allowing clinicians and staff to improve and own their work flow.

With the new year starting, sit back and evaluate the success of your projects. Share with us your lessons learned, the common characteristics of your successes and how you were able to achieve the acceptance and engagement of your stakeholders. I look forward to hearing from you.

Peter Sanderson, MD, MBA is a family physician and Director of Medical Informatics and Operations and Executive Sponsor, EHR Program, at Ministry Health Care. He can be reached at pete.sanderson@ministryhealth.org. He also blogs at MD Leader.

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