The convergence of the Information Technology and Clinical Engineering functions is likely to accelerate in the years ahead. This convergence centers on six shared areas:

• Goals. Both functions have goals of improving the safety of care, enhancing clinician decision making, and improving clinical operation efficiency.
• Infrastructure. Both functions need to leverage the enterprise wired and wireless networks, workstations, and server farms.
• Knowledge management. Clinical information systems and medical devices increasingly have computer-based decision support logic; logic that must be kept current, checked for inconsistencies, and assessed for impact.
• Applications. Applications such as acute care documentation and cardiology systems are integrations of applications and devices.
• Regulations. For example, the FDA is examining IEC 80001, which would place enterprise IT networks, which are linked to biomedical devices, under FDA oversight.
• Support. Both functions may need to work together when devices and/or applications and/or infrastructure encounter problems.

Despite the acceleration of convergence, crafting effective working relationships between the functions remains a significant problem.

Most Clinical Engineering departments do not have formal reporting relationships to the Information Technology department. The two groups have differences in culture, vendors, support requirements, regulation, and domain knowledge that often cripple working relationships. The vendors that serve the respective departments don’t often understand the needs of the other departments, e.g., the need to co-exist with other vendors on a wireless infrastructure.

While convergence is challenging, it is essential that it happen — technically, managerially, and strategically. This convergence will require efforts on the part of provider organizations, vendors, regulators, and professional societies. The convergence starts with the two groups sitting down and talking to each other.

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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From Squirmy: "Re: Compuware. Compuware’s Covisint subsidiary hires convicted former Detroit Mayor Kwame Kilpatrick for their Dallas office." Kilpatrick, on five years’ of probation and disbarred after serving 99 days in jail for obstruction of justice and assault following his sex-and-text trysts (and his administration is still under a federal corruption investigation), bags a job as a Detroit-based Compuware account executive. Hopefully he’ll be well paid since he owes $1 million in restitution.

From Mark: "Re: stimulus. I was looking for comment or perspective on a disturbing article published in the WSJ. As a healthcare IT professional who works with EMRs, this scares me." The article, A Health-Tech Monopoly, is actually an editorial that claims the bill will make ONCHIT all-powerful, concluding it will "be deciding which platforms are up to code and shutting down competitors" and will hamstring IT users with "faux privacy provisions," leading to government healthcare price controls and micromanaging providers. The author isn’t named, but if it’s not Betsy McCaughey, it’s someone who thinks like her. ONCHIT is not new and has been entirely benign, although I’d double check once their bank account gets all those extra zeroes. They won’t (can’t) shut down software vendors, at least those able to pay a not-huge sum to earn CCHIT certification (maybe that would have been a nice use of the stimulus money – fund CCHIT and make its EMR certification free). Also, the stimulus bill isn’t a never-ending blank check for imposing socialism or running roughshod over privacy — voters will still have some say. Right-wingers like me hate the bill because it’s probably going to be one giant wasteful failure that will eventually leave the country worse off once the big spending party is over and they bring the bill to our children. Democrats love it because it tries to do something, at least, and might help average people now that the fat cats have gotten their handouts. Like always, zealots on both sides preach loudly to the choir and breathe each other’s air, convincing nobody who wasn’t already in their camp (here’s a liberal counterpoint, for example). Right or wrong, the stimulus bill is pretty much a done deal at this point, so editorializing is pointless. You saw the effect of grassroots opposition to the bank bailout – zip (about the same as its results).

From HawkI: "Re: University of Iowa Hospitals and Clinics. They had a successful go-live of Epic’s Inpatient Pharmacy, Critical Care, and eMAR products this week. May 2, they go live house-wide with documentation and CPOE." Nice. Congratulations to them. How’s Epic Pharmacy and the connection to CPOE? I haven’t heard anyone say.

From Inside Outsider: "Re: Sunquest. More layoffs yesterday, including the remainder of the Service Exec team, which coordinated support for clients."

From Art Vandelay: "Re: HIMSS conference. Never thought of it before, but another alternative could be some podcasts, video podcasts, and use of SlideShare for an ‘open source’ conference. Mr. HIStalk, you could take the next step with this one. Allowing attendees to make requests would be pretty cool and then use the normal discussion board to have a time-bound Q&A. The authors could distribute free with HIStalk as the coordination point pointing to their URLS." A brilliant idea. An HIStalk education center, which could also screen presentations imposing publication-like standards (disclosure of interests, author affiliations, etc.) and no commercial pitches (or at least clearly labeling them since those can be educational, too). And, letting readers vote on each using a star system (like Amazon’s) and with a mini-discussion board for each presentation like Art said. All free, of course. Art and I just ran the idea up the flagpole — are you saluting or not? Let me know.

Listening: Sunny Day Real Estate, defunct emo since 2001 for obvious reasons: they declined publicity, refused to play in California, lost their lead singer when he converted to Christianity, used gibberish for lyrics to get the songs out faster, and released an all-pink album with no writing. I admire that, although I’m not sure why.

Harris Corp. gets a 10-year outsourcing contract from nearby Health First (FL) to provide support, training, and network security.

Cerner gets a two-year extension of its UK contract with Atos for Choose and Book. And, BT will resume its Millennium rollouts in London after fixing earlier problems.

Students in Rwanda can take an 11-month software development program that encourages them to further develop the OpenMRS system, a project led by Regenstrief Institute and Partners in Health. Students are trained in Java programming, web development, and informatics.

The Army buys 10,000 more Dragon Medical licenses for its physicians as part of a provider satisfaction project with the AHLTA EMR. "Being able to speak notes into an e-health record at the patient’s beside — rather than staring at a computer screen typing — also helps improve doctors’ bedside manner and allows them to narrate more comprehensive notes while the patients are there, or right after a visit. That cuts down on mistakes caused by memory lapses and boosts the level of details that are included in a patient record.”

Former Summit Healthcare CTO Charles Williams starts his own company, Infinity Healthcare, which I ran across in this news item.

Odd: a visitor reaching into his pocket to pay for lunch in a Colorado hospital’s cafeteria hits the trigger of the gun in his pocket, shooting himself in the leg (he’s been Burressed!)

I swear those Hollywood types need to start writing spec scripts about the Emageon saga. It’s off-again for the umpteenth time, as HSS’s parent company, Antigua-based Stanford International Bank, won’t provide the money for it to acquire Emageon. Meanwhile, these blogs (Link 1, Link 2, Link 3 – thanks to the reader who sent them) paint an interesting picture of the bank, which the first one claims has one shareholder, a single board member who is an 85-year-old used car dealership owner, is audited by a tiny Antigua company run by a 72-year-old local, and somehow manages to pay abnormally high interest rates on CDs despite big losses. That last linked article makes some rather strong statements, claiming the bank is a scam and "going down very soon." All unverified by me, of course.

Strange lawsuit: A Florida woman is arrested and charged with practicing medicine without a license after two women suffered injuries from the "buttocks enhancement" injections she administered.

Canada is running its own EMR stimulus: $500 million more to Canada Health Infoway, bringing the total to $2.1 billion ($1.7 billion US).

Want to see the real-time ED load of several Western Australia hospitals? Sure you do.

Open source software companies (seems like an oxymoron, doesn’t it?) urge President Obama to consider open source EMR applications. "Open-source software brings transparency to software development. There are no ‘black boxes’ in open-source software and therefore no need to guess what is going on ‘behind the scenes.’ Ultimately, this means a better product for everyone, because there is visibility at every level of the application, from the user interface to the data implementation. Furthermore, open-source software provides for platform independence, which makes quick deployments that benefit our citizens much easier and realistic."

Another Vendor You Won’t See at the HIMSS Conference

A reader had asked us to confirm that Picis will not attend the HIMSS conference (along with several other companies that we already told you about). Inga jumped to action and e-mailed some questions to CEO Todd Cozzens. Since I’m a neurotic rule-follower, I’ll run his answers here instead of as a "Moment With" since she asked only three questions, not my standard five.

How’s business?

We’re holding up pretty well. We just finished a very strong year in 2008, with new bookings up well over 40% over 2007 and solid improvements across all business lines in a quarterly customer satisfaction survey. Our SaaS business is driving a lot of that, but we were pleasantly surprised to contract with many net new ED and OR customers in the back half of the year. In all we picked up over 20 new hospital systems – not many companies doing that these days. And of course these contracts also help drive better margins and cash flow. 

We also released a slew of new products in 2008 – most notably our integrated EDIS and facility coding system and some very well received BI tools and decision support capability in our OR product line. Our focus in recent years of integrating point of care revenue management seamlessly into our high acuity clinical automation products is helping us maintain good traction throughout the slowdown in hospital capex spending.

Has Picis pulled out of HIMSS?

We’re being very conscious and prudent about controlling costs and hunkering down on our business. Don’t let anyone tell you there isn’t a completely different environment out there now — if they do, they’re either lying to you or have their head in the sand. For example, we’re balancing our portfolio with our marketing spend — we’ve increased our attendance at domain-focused trade shows (ACEP, ASA, ENA, HFMA, etc.) and decreased our presence at more general shows such as HIMSS. 

We surveyed our prospects and customer base and found that over half had imposed a travel ban or would not be attending. We figure that spend is about the equivalent of an investment in a small R&D team that could work on a new product. We want to maintain our focus on innovation and R&D in this downturn to come out even stronger on the other side. We still will do a lot of HIMSS-sponsored events, such as HIMSS virtual tradeshow presentation. Our Webinars on driving profitability through clinical business intelligence had record attendance for HIMSS last year.

What’s your take on the HITECH part of the economic stimulus package?

When I ask the same to CEOs and CFOs of providers, they say, "Make my hospital solvent and viable and I’ll have the right capital to invest in IT." So, the $80 billion to prop up Medicare for the states will surely help there.

Another little-known provision is expanded tax credits for municipal bonds. That’s a major source of hospital financing that’s been completely shut down, and getting that market churning again will have a big affect. The average hospitals only has about 50-75 days of what they call uncommitted cash on hand to bridge the gaps between operating expense obligations and revenue from payors. It’s sad to see hospitals laying off people, not because their numbers are particularly bad, but because they need to bridge their working capital shortfalls

As to the grant money, we still haven’t seen wording in the final bill that obligates hospitals to spend the grant money on healthcare IT. I’m also curious to see how the incentive money is applied and what the criteria are — that still has not been worked out, to my knowledge. The increased funding for the national HIT office and interoperability could be very useful if spent wisely. Re-inventing the wheel is not the answer — there are already many interoperability standards available. 

The key is obligating the vendors to be interoperable. Don’t let them talk out of both sides of their mouth by saying they’ll comply with all standards, then propose proprietary data lockout products to health systems. I like Peter Neupert of Microsoft’s term of "data liquidity." We need to increase data liquidity in healthcare as much as we need to increase monetary liquidity!

E-mail me.

HERtalk by Inga

From Gary: “Re: NCR brings Patient Self-service Downunder. Love your work. Mr. H is lucky to have someone as dedicated and talented (and beautiful) as you on his team. Now that the obligatory ‘sucking up’ is done, we are doing a rather ‘soft launch’ of our entrance into the South Pacific region.” Since Gary appears to know how to work the system at HIStalk, I agreed to give him a plug. Plus I was excited to know we have readers in Australia, especially since he has agreed to take me shoe shopping in Melbourne any time. Gary is heading up sales in the South Pacific for NCR’s healthcare self-service group.

Marisco Capital Management acquires a 5.7% stake in athenahealth. The 1.88 million shares of stock are estimated to be valued at $630 million.

athenahealth also names David E. Robinson as executive VP and COO. His most recent role was executive VP at SunGard Data Systems.

Cancer Treatment Centers of America opens the nation’s first all-digital cancer hospital at Western Regional Medical Center in Goodyear, AZ, which would make it the first Stage 7 hospital in the HIMSS Analytics EMR Adoption Model. It’s using Eclipsys Sunrise.

Speaking of Eclipsys, it picks up an endorsement from Genesis Physicians Group, a 1,450-member IPA in Dallas. IPA members purchasing the PeakPractice product will be eligible for discounted pricing.

USC agrees to pay Tenet Healthcare $275 million to acquire USC University Hospital and USC Kenneth Norris Jr. Cancer Hospital. The deal ends a three-year fight over the control of the facilities. Employees will stay on.

A 57 year-old woman who questions a $143 pregnancy test charge on her detailed hospital surgery bill is told it’s standard procedure even at her age. She’s pushing for a policy change. I am still hung up on the fact that the test is $143 when the at-home version is about ten bucks.

Emory University Orthopaedics & Spine Hospital (GA) opens this week and will feature a Cerner CareAware my Station system in each of the 45 patient rooms. I also noticed the hospital offers four private luxury suites with two separate living quarters. Amenities include fine linens, plush towels, two fax machines, a conference/dining table, in-room newspaper delivery, and gourmet room service.

HCA seeks to raise $300 million in a bond offering to repay bank debt and to amend terms of some of its loans. Earlier this month, HCA announced its 2008 net income was $673 million, down 23% from 2007.

The son of an 89-year old woman who died at a UPMC hospital charges that the facility’s new and untested Cerner EMR system was a major factor in her death. The woman, who was undergoing treatment for strokes and dementia, left her unit and ended up freezing to death on the hospital’s roof. The suit claims that the staff caring for the woman was struggling with a system that “they were not properly trained on,” placing patients “at a severely increased risk of harm and death.” The family’s attorney charges that UPMC ignored warnings that the records system could put patients at risk because UPMC had an ownership interest in Cerner Corporation.

In an attempt to expose medical students and doctors to its new surgical procedures, surgeons at Henry Ford Hospital (MI) use Twitter to provide real-time time surgery updates. During a surgery on a kidney cancer patient, doctors used a laptop in the operating room to give a play-by-play of the action, plus answer online questions. Is it really 1.0 of me to hope my surgeon doesn’t Twitter during my next surgery?

A new KLAS research report claims that more hospitals are looking for aggregation solutions that provide a more complete view of medical records and documentation. Such solutions would help clinicians improve patient safety. The report names six vendors that account for 85% of contracted deployments, with MEDSEEK owning the largest installed base. KLAS concludes the solutions from Microsoft and dbMotion are the most functional. The other top vendors include Medicity, PatientKeeper and CareFx.

Greenway Medical Technologies and Navicure partner to offer more integrated solutions and services. Both are “Best of KLAS” winners in their respective areas.

Perot Systems announces its Q4 financial results, which included a profit of $29 million, compared to $44 million in the same period last year. Perot blames the bulk of the 34% drop in profit on a client termination.

iMedica names Mark L. Richards its new VP of Sales. Prior to iMedica, he was the divisional VP of group practice sales at McKesson’s Physician Practice Solutions business unit.

Data Dimensions, a provider of business process outsourcing services for healthcare, promotes Jon Boumstein to CEO.

SCI Solutions wins three eHealthcare Leadership Awards for its Consumer Portal self-scheduling application. The awards included Best Business Suite, Best Overall Internet Site, and eHealth Organizational Commitment.

Healthvision closes the fourth quarter with 22 new client engagements.

Infinity Healthcare Solutions partners with Stratus Technology to resell Stratus hardware, software, and service products.

NextGen announces that AltaMed Health Services (CA) and Valley-Wide Health Systems (CO) have selected its enterprise software solutions. Both are community healthcare facilities.

E-mail Inga.

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: the first two articles were added as comments to previous articles, but because of the large number of links they included, they were automatically discarded by the blog spam-catcher, so I never saw them. I do not censor comments except in extreme cases (ones I’ve gotten include claims of past criminal records by named individuals, obvious vendor pitches disguised as a reader comment, and personal attacks – those I will either delete or edit). So, if you left a comment and it hasn’t appeared within a day or two, e-mail it directly to me.

Comments on MD Leader 1/27/09, Ministry Health and CattailsMD
By Pragma

Thank you for including links to back up your statements with peer review evidence. A good effort. It’s something we don’t see here often.

“EHRs Do Not Improve Quality” Your link to a study conducted between 2002 in 2004 (released in 2007) about ambulatory-only EMR systems, peer-reviewed, but disputed by many (even at the time). It is worth noting this is not a study referenced by… well anybody, in two years! And in medicine that wouldn’t hold up very well. Is it really that cut and dry? That clear?

http://www.bmj.com/cgi/content/full/bmj%3b330/7491/581
http://www.itif.org/files/HealthIT.pdf
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2253693
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=685103
http://www.cchit.org/about/casestudies/index.asp
http://www.fhin.net/eprescribe/Benefits/AdvantagesToProviders.shtml
http://www.fiercehealthit.com/story/ehrs-boost-quality-raise-costs-at-community-clinics/2007-01-22
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1479999

There are other studies. Often peer reviewed and indexed. I could go on and on and on … and on. But wouldn’t it be worth people doing the research themselves? This is medicine, the last time I checked it was a science. Let’s do the clinicians the service we expect of them.

Your basic statement is a truism, but it’s an obvious truism (or it should be). It’s not the EMR, it’s how it is used. How it is customized, and how the data is normalized and utilized. We must be cognitive of EMRs allowing the customer flexibility. EHRs do enable this. Paper does not. Paper and EHRs are just tools. And humans are pretty good at using them, when they are not given reason to not use them.

I am sure in Egypt there were many who railed against the failures of papyrus. Who advocated for more use of stone. Well they lost, and we as humans adjust. Cows? Not so much. I happen to think clinicians are better than cows. I have seen this. I have actually seen Doctors say they have seen the benefits and enjoy using an EMR! Wow! Kinda goes against everything people are saying here, right? Sometimes reading this site I think clinicians are cows. Who simply must have workflows duplicate their paper world exactly. So isn’t the question what are these people doing wrong? Because it can be right.

Wouldn’t a more constructive argument from the detractors be, “Which is the best EMR for quality, and why?”, not, “They do not work”, “There is no evidence”, “it’s a waste of money”? You wouldn’t know this from reading HIStalk, but there really is far more, recent, peer-reviewed empirical data to show they do. The truth is…. ahem.. out there?

Anyway, it’s an old and fruitless argument. They will be implemented, it’s just a case of how well. The people who care, and do not have an agenda, will ask questions such as “how do we make them better”, “How do we increase quality with available data”, “Isn’t all this data GREAT! What are we going to do with it!”, “Ok we have an EMR, now let’s try doing something for the Doctors, give a little back for the extra time they spend documenting”, “How can we make a logical thing like a computer, mirror illogical real life workflows?”, “How do we stop decision support annoying clinicians, so the continue to use it and not just click OK?”, “How do we take hospitals from hugely political organizations to ones that’s make decision to a truly best practice?”. The others often show their clear lack of objectivity.

Comments on the Interview with Glen Tullman, CEO of Allscripts
By Al Borges, MD

Dear Mr. Tullman:

Thank you for coming on HIStalk for an interview. This site is read on a daily basis for those of us with an interest in HIT, and having you come to visit is wonderful.

Didn’t President Obama pledge not to surround himself with lobbyists? Aren’t you, your company, and your coworkers the ultimate lobbyist group, showering Obama with donations for the past two years alone? From what little I could find on the Google, you personally gave President Obama at least $144,300.00 in donations in the two years prior to his election (1). Your employees gave $20,662 during the same period (2). Your company, Allscripts/Misys, also gave the possible future HHS Secretary Daschle $12,000 speaking fees on 8/2008 for a lecture (3).

Now this activity seems to have put you into the unusual position where you are the personal advisor of the President of the United States of America on how to channel money to your company, ultimately enriching yourself while the American taxpayer, and especially doctors have to foot the bill. President Obama has put the wolf to guard the hen house!

You can’t believe how much I resent the fact that you, a vendor selling a product, is now in a position of power where you can determine how Medicare pays me, a physician. I’m sure that I’m not the only doctor out there that feels this way. Unlike you, I don’t have the lobbying power to get Obama’s ear. You’ll be able to sign up in the short-term those who already have EMRs, but once you get close to 20% uptake of these incentives, you’ll begin to bump up against the less CCHIT-certified-EHR-hard-core, more knowledgeable physicians like myself who don’t want to buy into a multi-thousand dollar EHR to please the likes of the Medicare pinheads in order to be able to get paid adequately for our work.

What this bill will eventually do is to damage Medicare as physicians refuse to see new Medicare patients or dis-enroll altogether. It also will begin the process of destroying the small solo to group office over the next 10 years, offices where 75% of doctors work in currently. These offices won’t be able to survive under the burden of these unfunded, onerous, unneeded mandates that you are trying to promote to satisfy your agenda. Students will think twice before going into medicine if not only do they now have to pay off their loans but also pay for a $30,000.00 CCHIT-certified EHR, and worse yet, use it.

Lastly, you mention that “[CCHIT-certified EHRs are] a benefit to all of us in terms of quality and also in terms of cost reduction” without there being any real data showing such. In fact, there is data showing the opposite(13). Recently we’ve had alerts about data input errors from both the JACHO and the US Pharmacopeia (4,7-12). You have the National Research Council finding that HIT systems used by several major health providers has fallen short of achieving healthcare delivery goals envisioned by the Institute of Medicine (5). Recently, two HIT experts have penned an open letter to President Obama, warning him against investing too many federal dollars in existing electronic health records systems(6). David Kibbe, MD, a technology adviser to the AAFP, and Brian Klepper, PhD, founder of consulting firm Health 2.0 Advisors, stated that existing EHR systems are:

• too expensive
• difficult to implement
• disruptive to practice workflows
• not proven to improve patient care, and
• don’t do a good job of sharing information with each other.

So Mr. Tullman, do the right thing and stop the insanity of using taxpayer money to bail out a portion of the economy that doesn’t need the economic help, at least not in this way. If you can do me a favor — show this letter to the honorable President Obama so that he can get an idea of how the other side feels.

Sincerely,

Dr. Borges

Citations:

1) http://www.campaignmoney.com/political/contributions/glen-tullman.asp?cycle=08
2) http://fundrace.huffingtonpost.com/neighbors.php?type=emp&employer=ALLSCRIPTS
3) http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389×4968435
4) http://www.jointcommission.org/NewsRoom/NewsReleases/nr_12_11_08.htm
5) http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090109/REG/301099965/-1/TODAYSNEWS
6) http://medicaleconomics.modernmedicine.com/memag/submitBlogEntry.do#blog_confirmation_anchor
7) http://www.ama-assn.org/amednews/2005/01/24/prsa0124.htm
http://www.jamia.org/cgi/reprint/14/3/387.pdf
9) http://www.nytimes.com/2005/03/09/technology/09compute.html?ei=5089&en=402b792e748d99a2&ex=1268110800&adxnnl=1&partner=rssyahoo&adxnnlx=1150474153-xVix1BcYkvTKJpuLyHStrQ
10) http://jama.ama-assn.org/cgi/content/abstract/293/10/1197
11) http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm
12) http://www.usp.org/products/medMarx/
13) see my 2 slideshows located here (~130 slides full of data)- http://msofficeemrproject.com/Page3.htm

Why Doesn’t Someone Propose a National EMR?
By Winston T. Goode

While I appreciate the commitment to healthcare that "billions a year for x years" represents, I can’t help but think that we’re trying to plug leaky faucets with fistfuls of money. Electronic Health Records are not a goal, Electronic Health Records are a tool, and they will only realize their potential if they are installed in the pursuit of a loftier goal.

The Apollo program was not funded as a $135 billion exercise in building rockets. Knowledge is the most powerful and most capricious tool we can bring to bear on our health. The ethics of healthcare often prevent controlled, double-blind studies, meaning that often useful knowledge can only be attained post hoc and en toto. Sorting through the interactions of multitudinous variables and extracting a modicum of causality to use for the betterment of all is not a challenge that can be met by a single doctor, or often even a single health system.

The barest hints of the potential of EHRs we’ve seen already. How many years did we spend collecting information on tobacco use? How many patients died of Vioxx-related heart failure before we managed to make a
connection? We would have known more, sooner, if we had a nationwide EHR infrastructure.

As the benefits of EHRs are society-wide, so to should be the scale of the tools and projects used to implement them. Providing for the health of a population is not a project that can be funded piecemeal with
earmarks and pork, run through unaccountable cronyism, or bloated bureaucracies. Nor is it a project that can be handled by the private sector, or tax breaks, or ‘small government’ rhetoric. It must be above either party,
and across government agencies. 

We need a national EHR project to realize the benefits of an EHR. Otherwise, EHRs will continue to be yet another false idol of future technology on which we will have squandered our wealth and potential. This should be a grand endeavor, not limited only to healthcare, but spanning industries from agriculture and education, to law enforcement and government. We must exert control on those variables that correlate to our desired outcome,be they chemical,  behavioral or other. This must be a results-focused, not rhetoric-focused enterprise.

Privacy advocates rightfully fear the ways in which this information may be abused. There must be protections and opt-outs put in place, but it should not be a system that people will want to opt out of. No one is forced to use U.S. dollars as a form of currency. No one is forced to open a bank account or use a cell phone despite the obvious privacy risks these present. We should have the healthiest, and longest lived, population in world.  EHR’s can help us with this goal.

I sincerely hope there is someone in Washington with the vision and leadership to harness the vast potential of EHRs to better the health of all. But I’m sure not seeing it at the moment.

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From Brailer’s Revenge: "Re: another non-profit seeking hospital and vendor members. Most hospitals would have to ante up $8-20K for a seat at the table. Not clear what you get in return." Link. The National eHealth Collaborative’s initiatives include prioritizing standards initiatives and NHIN (it’s the AHIC successor, as it was known for awhile). It was just launched last month and John Glaser (who’s on its board) described it right here on HIStalk right after that. It’s a pretty big deal, especially with stimulus money coming and some structure needed around it, and entirely above board. I don’t know why hospitals would join either, but if they’re spending big money on EHRs, they at least get some voice in long-term direction. And, coincidentally, right after I wrote this, I got an e-mail from NeHC communications director Meryt, who sent over a newly released white paper developed with HITSP and CCHIT (fulltext on John Halamka’s blog, which saves me having to post it) that lays out their vision.

From Ex IBM’er: "Re: Healthcare and Life Sciences. Several folks RIF’ed out today."

From The PACS Designer: "Re: Alfresco. Enterprise Content Management is becoming more in demand by healthcare professionals and one free software solution addressing ECM is called Alfresco. HIStalk sponsor Red Hat has some experience with being an Alfresco installer and can help those who are interested in this software solution." Link.

From Cloud Jumper: "Re: alternative to HIMSS. Maybe you could do something like the TED talks, where the coolest people could give their talks to cool savvy people in the audience and it’s all on video so we can watch it later if we were uncool enough not to be invited. You could get the vendors to do tasteful little ads in front of each video, as TED does, to pay for it." That would be fun, although healthcare is so profit-oriented and fiercely protective of turf even on the non-profit side that the cool factor is turned down several notches (kind of like being the heppest cat at HFMA). Still, it would definitely be different than the mainstream conferences, where the same old faces exaggerate their successes with the same old ideas prettied up to seem more daring and contemporary. But, the one article commenter was spot on: HIMSS can only put people on stage who volunteer to be there, so those who have never been a speaker or committee member have no excuse to gripe about the result (I have, so I can). That’s one of my HIStalk goals, though — to showcase the good ideas of people who don’t have the time, money, or ego needed to ride the PowerPoint Podium.

The Senate passes the economic stimulus package and Kaiser Family Foundation has a summary of it (the current version, until a compromise is reached with the House). The Senate’s bill calls for $19 billion for HIT vs. $20 billion in the House bill. Both sides want to give Rob Kolodner’s previously shoestring-funded office incomprehensible amounts of "discretionary" funds, $3 billion vs. $2 billion (is anyone a little scared of that?) Surely up for heated debate: the Senate’s bill punts on privacy, while the House calls for strict privacy protections. Wall Street wasn’t exactly overjoyed with the grim reality of this financial Hail Mary or the worse-by-the-day bank bailout; the major indices all dropped nearly 5% on Tuesday.

Speaking of that, the former lieutenant governor of New York weighs in with Ruin Your Health With The Obama Stimulus Plan. She says senators should vote against what she calls "the handiwork of Tom Daschle": ONCHIT as a big new bureaucracy, government interference with physician decisions, and intentionally slowed development of new drugs and technologies because they’re expensive. Daschle, she says, thought seniors should deal with conditions that come with old age instead of being treated for them, moving dollars to younger people (as cold as that sounds, I’d have to agree at least in general). Here’s the big finish: "The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy."

Add Rush Limbaugh to the list of HITECH haters. From his Monday show: "Your medical treatments will be tracked electronically by a federal system. Now there are arguments back and forth about whether or not this is a good thing. The opportunity for the loss of privacy is huge here … by digitizing and making everybody’s healthcare records computerized … especially having a major federal database where everybody’s health records are." I’m conservative and even I can’t stand that pompous gasbag, so I can’t imagine who’s still listening to him.

The New York Times just published a piece on HITECH, citing a letter that urges not just throwing EHR money at doctors, but also distributing lessons learned via "Regional Health IT Extension Centers" to help out with projects in small medical practices, which sounds like a great idea. You will note that the letter (warning: PDF) has few vendor signatories, unsurprisingly.

Cerner’s Q4 numbers, announced after the market close: revenue up 18%, EPS $0.86 vs. $0.49, thrashing expectations of $0.59. Say what you want about good old Republican boot-strapper and plain-speaking Neal, but the man knows how to run a company better than those big, fancy foreign conglomerates choking on healthcare IT and everything else they toe-dip into. Thank goodness for MEDITECH, Cerner, and Epic, run by the founders instead of hired gun Wall Streeters and sticking to their healthcare IT knitting instead of selling nuclear weapons, theme parks, and jet engines (not to mention toxic assets to taxpayers in one huGE example).

I got a couple of e-mails suggesting that Medical Records Institute, the folks who run TEPR, have laid everyone off and closed down. I’m sure that’s somehow tied in with their new focus and conference, but perhaps the change was more severe than was hinted. I’m sure updates will follow.

Listening: Seether, South African metallish grunge.

IBA/iSoft gets two contract extensions with Netherlands hospitals.

A surgeon in Australia develops a USB emergency button that, when pressed, sends a message to all PCs on the network along with the location of the sender. He created it after noting that several doctors had been killed by patients.

Allscripts announces that it will sell its Medication Services business (I asked Glen Tullman about it almost three years ago). The company also approved a $150 million stock repurchase plan.

Hospital layoffs: Columbia St. Mary’s (WI), 54; Cascade Healthcare Community (OR), 74.

Jobs: FCP-MS4 Patient Accounting Expert, McKesson Horizon Lab Consultant, IT Director.

Healthcare Growth Partners publishes its Q4 2008 Healthcare IT Transaction Summary & 2008 Year in Review (warning: PDF).

IBM and UnitedHealth test the medical home model, in which a primary care physician (not a gatekeeper) coordinates care among other medical professionals, often by using information technology. I’ll defer to Scott Shreeve, who provides a better synopsis than I can.

Interesting: hospitals that hire doctors often write employment contracts that don’t allow the doctor to contact patients if he or she leaves and also prohibits them from opening a practice within a specified radius. Patient are also charged large amounts to have their paper records copied so they can seek care elsewhere. Noncompetes are standard in business, in case nobody noticed that even non-profit healthcare is one.

A third of Australian healthcare and IT professionals say they’ve experienced compromised patient safety due to IT downtime.

Idiotic lawsuit: an admitted alcoholic on a two-day bender (more like a "breaker" in this case) in a Marriott falls more than 100 feet off a stairway while drunk, causing what he says is permanent brain damage. He’s suing the hotel for serving alcohol to an addict (him) and thereby causing his injury. He’s claiming injury, pain and suffering, anguish, disfigurement, medical expenses, loss of earnings, loss of the enjoyment of life, and aggravation of a previous condition.

A laptop stolen from Parkland Hospital (TX) last week may contain information on over 9,000 employees.

Availity announces the availability of real-time Florida Medicaid eligibility and claims status at no charge.

E-mail me.

HERtalk by Inga

From Ronald Miller: ”Re: Henry Schein. Former MED3OOO VP Keith Slater is now the GM at Henry Schein Medical Systems. Good move for Henry Schein. It was only a matter of time until they figured out they had NO CLUE how to deal with a PM/EMR product after spending all that money on it. Maybe now the button ups at Schein will do a better job than Pfizer did with Amicore.”

From Jerry McGuire: “Re: Great piece today with Allscripts CEO on stimulus. From your piece, it seems the curious angle is identifying when IT does and doesn’t serve as a stimulate function. Maybe a virtual roundtable?” We’d love to hear readers’ opinions on what IT functions could stimulate the economy.

The Washington Post posts a graphic that breaks down the $819 billion stimulus package. It doesn’t say where the $20.2 billion for HIT is going, much less what part of IT is stimulating, but it is a pretty impressive graphic.

Caritas Healthcare (NY) files for Chapter 11 bankruptcy protection and its two hospitals are projected to close this month. Caritas had a net loss of $64 million for 2008, prompting the board to vote to close Mary Immaculate and St. John’s Queens hospitals.

QuadraMed announces that revenue for FY08 will be slightly ahead of the $146-149 million guidance previously provided. The company also expects EBITDA to significantly exceed the previous $15.8 million target. Reading between the lines in the press release, Keith Hagen sounds a bit cautious when discussing 2009 and the company’s potential for new business: “Approximately two-thirds of our revenues are produced by recurring maintenance and term license contracts, and a large percentage of our 2009 revenue is expected to be generated by this recurring base, our project backlog, and our broad set of products and services."

The 25-bed Hiawatha Community Hospital (KS) becomes the 55th hospital to go live on IntelliDOT’s BMA system.

Catholic Health Initiatives names Michael O’Rourke its permanent CIO and senior VP. He’s been interim CIO since August 2008 for the 77-hospital organization.

Capsule announces that 10 new healthcare organizations selected its device connectivity solution during the last quarter of 2008.

Marshfield Clinic (WI) adopts a new BI solution to make better use of its vast amount of patient data. Marshfield will utilize SAP’s Business Objects XI intelligence system to improve patient care and analyze internal business operations.

Eclipsys announces that Greenwood Pediatrics (CO) has selected Eclipsys PeakPractice (the former Medinotes PM/EHR solution). The 10-physician group apparently chose Eclipsys over Epic, which their hospital offered to subsidize.

A former Queen’s Medical Center (HI) administrator pleads guilty in federal court for defrauding her former employer out of $594,000. Patricia Syling is accused of creating bogus contracts between a company she owned and Queen’s, and charging the hospital for services that were not performed. Syling was hired by Queen’s in September 2001 as the corporate compliance administrator and director of revenue cycle. In an unrelated charge, Syling is also accused of defrauding another former employer, Citrus Health Care of Florida, of more than $1 million and using $320,000 of the proceeds to buy a luxury sky box at Tampa Bay Buccaneer football games.

The McKesson Foundation awards $60,000 in grants to nine Minneapolis-St. Paul-area non-profits. The funds will be used to support health and wellness programs benefiting children and families.

A Texas Medical Association survey finds that doctors worry their financial hardships threaten quality of care and access. Declining payments, claim denials, incorrect or late payments, and administrative burdens are taking time away from patients.

The University of Chicago Medical Center (the First Lady’s old haunt) plans to cut 450 jobs in order to cut 7% off its annual budget. This is in addition to the elimination of 15 senior executive posts, including the one vacated by Michelle Obama (we’ll try not to be cynical about the huge raise UC gave her just before Obama won using the rationale that she was essential and therefore worth every penny).

MRO expands its services to include remote release-of-information processing and remote and staffed services.

HIMSS Analytics releases a list of the top vendors of acute care EHR systems based on total number of installations. For 2008, MEDITECH topped the list at 26.6%, followed by McKesson (14.1%) and Cerner (12.6%). I wonder how the rankings would end up if the list were based on number of total beds?

The octuplet story just gets crazier and crazier. Apparently the mom’s fertility doctor is not as successful as most doctors around the country, with his patients having much lower than average rates of pregnancies and births. Also, at least two former employees have sued him, including an office administrator who accused Kamrava of tax and insurance fraud. The office manager claims the office kept two sets of books, one for cash and the other for insurance, and some cash was never entered into the computer or deposited in the bank. Meanwhile the Kaiser Permanente hospital where the children are receiving medical care is requesting Medi-Cal funding to help pay for the octuplets’ medical care since Mom is unemployed, living on food stamps, and mostly letting her mother raise her first six children.

Compuware’s Covisint subsidiary collaborates with the VIP Health Initiative to provide a secure single point of access to share clinical data. The VIP Health Initiative was formed by Scripps Mercy Physician Partners, SMPP Services and Physician Partners Management Services.

Despite massive financial losses as a result of Hurricane Ike, UTMB Galveston intended to pay $3 million in bonuses until a faculty group discovered the plan. According to the Texas Faculty Association, once the bonus plan was uncovered, UTMB canceled the payments. The largest bonus recipient would have been the school’s executive VP, provost, and dean of medicine, who was scheduled to receive over $122,000 – on top of his $700,000 annual salary. The school claims it was planning to cancel the bonuses anyway.

E-mail Inga.

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The Stimulus Bill Will Change How IT Data is Used in Healthcare

At this writing, the Stimulus Bill has not been passed, but it will change how we use IT. The funding and implementation incentives will get all the press, but it is the fine print that has the potential to change how IT healthcare information is used.

The Stimulus Bill will restrict use of healthcare data. To date, the biggest areas of concern have been:

• The use of patient consent for internal healthcare operations;
• Revised definitions of healthcare operations limiting use of patient information (potentially including use of patient information for quality reporting);
• Accounting for of all disclosures, even for treatment;
• Patient consent for information use by a healthcare exchange;
• Extending privacy and security rules to business associates.

None of these issues may appear in the final bill and additional elements can be added at the last minute. The legislation is moving fast and there will be unintended consequences. How government chooses to enforce the provisions and how our own organizations choose to interpret will determine the impact on our operations.

When the final bill is signed, evaluate the direct economic impact. Also be sure to look for additional provisions that will change how healthcare uses data.

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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