HERtalk by Inga

Kaiser Permanente plans to cut 860 workers at its data and IT centers as part of a $500 million outsourcing deal with IBM. Included in the seven-year deal, IBM will take over most of KP’s data operations, affecting about 700 employees.  Most of the affected staff is based in California, though KP also announces layoffs for 160 more employees across the country. KP CIO Phil Fasano says that about 40% of the displaced employees will find jobs within IBM. KP says that the average laid off employee will receive eight months worth of pay and benefits. Our condolences. fds

On HIStalkPractice, we just posted the first in a series of five questions posed to 12 vendor executives.  The topic centers on the HITECH stimulus package and its impact to electronic health record.  This first question:  What changes will your company or area make, both for the short and long term, in preparation for HITECH legislation?

As I was working on our Second Annual HIMSS Information Guide, I noticed that Vitalize Consulting Solutions is teaming up with the Greater Chicago Food Depository to raise food and funds for the Chicago needy. The Vitalize folks tell me they are taking monetary donations at the booth, as well as promoting a virtual food drive. They’ve also sent packages of soup mix to attendees around the country.  If you were a lucky soup mix recipient and bring it by Vitalize’s book (#3055), Vitalize will donate both the soup and one dollar. LOVE it.  Much better than all those trinkets that won’t fit into your suitcase. 

Johns Hopkins chooses the LiveData OR-Dashboard solution.

IBM announces a research project with Brigham and Women’s Hospital (MA) to create an online radiology theatre to allow teams of medical experts to simultaneously make rounds on a patient via a Web browser. Using live streaming audio/video, medical experts will be able to discuss and review patient data and post analysis.

The US DOD Military Health Systems commits to a $2.4 million deployment of VisualDX, a database created by Logical Images that includes 900 visually identifiable diseases and clinical information.

Virtua Health (NJ) selects Microsoft Amalga for its four-hospital system.

Blessing Hospital (IL) contracts with Eclipsys to deploy Sunrise Enterprise revenue cycle solutions and integrate them with Blessing’s existing Sunrise clinical solutions.

St. Joseph Medical Center (MD) brings in an outside “restructuring team” to manage the hospital, after the CEO, COO, and VP of operations take administrative leave. The executives took leave two weeks ago amid a federal investigation involving the hospital’s relationship with a physician group.

Heatlhcare management firm Beacon Partners hires former Poudre Valley Health System CIO Russell Branzell as a vice president.

A Deloitte Services survey finds that 56% of us want access to a online PRH connected to our doctor’s office and 55% want to communicate with our doctor via email. In addition, 68% of consumers are interested in home monitoring devices and 38% are very concerned about privacy and security.

HIE technology provider Accenx is now offering fully managed, remote hosting of Initiate Patient for its healthcare clients. OhioHealth is the first customer to use the combined solution.

Just exactly does this happen? A Shreveport, LA grocer finds stacks of medical records and MRIs in the dumpster at his store. The charts are as recent as 2006 and belong to a local doctor.

Email Inga.

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Virtually all major technology innovations result in good changes in society and introduce new problems.

The automobile opened up the country and accelerated commerce. It also spurred global warming and people died on the highways.

The Internet enabled new ways to find information and forge communities. It also supported new forms of identity theft and eased access to unsavory material by children.

The television brought diverse entertainment and education into the living room and enabled the real-time participation in world events. It also contributed to sedentary lifestyles and the homogenization of culture.

Widely deployed interoperable electronic health records will bring good changes and introduce new problems. While the net impact of EHRs will be positive, we should acknowledge that their use also brings a downside. EHRs are no different in that regard than any other major technology innovation.

Individuals and organizations that point out these problems should not be discounted as Luddites, narrow thinkers, or resistant to change. While some of the con-EHR commentary can be discounted, we need to listen to it.

The point is not to pooh-pooh those that point out problems. The point is to understand the new problems and devise ways to mitigate or remove their impact. Seat belts and emission controls were steps taken to reduce the problems created by automobiles. Various applications have been developed to reduce Internet-based identity theft. The explosion of TV channels enables a wide range of cultures to express their voice.

Those who note that EHRs can hinder the connection between a provider and a patient, add too much time to simple tasks, and result in problematic privacy intrusions are right. EHRs will do these things.

We have to find better ways to make these problems less of a problem.

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

The Borderless Office
By Ed Marx

One year ago, I posted Culturally Relevant Leadership. Not a key performance indicator, but a lifestyle. I was so proud of my new office furniture that I posted pics on FaceBook and even bragged, “Look! No room for paper or pen.”

Now I believe even this is passé.

Then I smugly considered myself advanced as an executive who worked at home two days per week. Whoa, what a concept. Lately I’ve wondered why do I have an office in the first place?

I asked the same question of peers and staff and received many reasons why we couldn’t possibly liberate ourselves from the box. I have yet to hear one reason that I couldn’t logically counter. I’m all about forcing myself to learn new ways of operating and leading. I’m also into adopting and leveraging emerging technologies. But now I must commit to expanding self-imposed boundaries. Pushing the organizational culture. Releasing myself—and my staff—from unjustified fears.

A healthy leader spends little time boxed in an office. We’re out visiting our customers and our people. If you’re worried about losing contact with your staff, read Staying Tethered to a Disconnected World. At home or, anywhere outside the box, I get more done in less time. That leaves margin to network with staff, round more with customers, and focus.

Let’s ignore for a minute the actual cost of building out space and look at the operational budget impact. Average office space costs might range from $20-$40 per square foot per year. Assuming your office is 200 square feet, that is $4,000 – $8,000 per year. In the 24x7x365 world we live in, what is your percent occupancy time? It should be tiny, probably under 5%. Now expand this analysis for your staff and your entire office footprint. The amount of waste is self-evident.

On March 31, I’m turning my rhetoric to action and entering a month-long trial with my courageous Chief Medical Information Officer. We will shutter his office and share the space formerly known as the CIO Office. We’ve already eliminated office phones. For the times we do need physical space—or so we rationalize—we will have one. Otherwise, we’ll conduct our business from our “virtual offices.” Armed with mobile devices, we carry with us everything we need. Our office is us. Not some physical space with borders.

Presuming a successful trial, this will become our method of conducting business. I’ll expect my direct reports to follow, and we’ll go from 5 offices to 1. I envision a cascading effect throughout my division. We will save close to a half-million dollars for each floor we clear. Employee satisfaction, productivity, and retention will climb.

You can’t reach a specific benchmark, get the tattoo to prove it, and then stop evolving without losing relevance. If you don’t believe it, reread Tradition.

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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HERtalk by Inga

From: Sundance Kid. “Re: Anthony Rodgers joining the Office of the National Coordinator? Tony is a very HIT-savvy leader currently Director at Arizona Health Care Cost Containment System. One well placed call from Head of Homeland Security to Secretary of HHS and he is in!” Not sure if this means that Rodgers would want the DC gig.

From: Johnny B-good. “Re: Hospital CEO salaries. I hope that the same rules are applied to the Banking Execs who’s salaries I’m paying (unlike these Hosp execs.).”

USF Health and Allscripts initiate a pilot program called Paperfree Tampa Bay that aims to convert 100 percent of physicians in the Tampa Bay area to electronic prescribing. Program leaders view this as a first step toward the implementation of EHR in the region and is expected to create 100 jobs in the region. We chatted with Allscripts CEO Glen Tullman about the initiative, and have posted the interview on our HIStalkPractice site.

President Obama nominates NYC health chief Margaret Hamburg commission of the FDA.

HIMSS claims that total conference registration “parallels” last year’s record-breaking figures during the same time last year. The numbers suggest that those staying home to save money seem to be balanced by attendees making plans to learn more about how to get their share of the stimulus pie.

Here’s a study that many vendors may hope gets swept under the rug. Researchers from the University of Minnesota find that the use of HIT has little or no effect on patient safety. The AHQR-funded study also suggests it may be “too early” to judge HIT’s overall effectiveness.

Surgical Information Systems now integrates with Cardinal Health’s Pyxis Supply Technologies.

According to the local paper, Catholic Healthcare Partners (OH) is nearing a decision to invest $100 million over the next five years for an unnamed EMR. The organization includes 32 hospitals across the Midwest.

KLAS releases a report entitled “The Rise of eClinicalWorks: Separating Fact from Fiction.” KLAS examines why ECW is growing faster than any other EMR vendor and whether if it could sustain the grown and still provide effective support. While customers expressed strong satisfaction on functionality and cost, support was noted by many users as the worst aspect of their ECW relationship. Users also claim that integration with other clinical systems was a challenge.

MedAvant Healthcare Solutions changes its name to Capario to better reflect the company’s revenue cycle solutions and renewed focus on growth. OK, I give up. What does “capario” mean anyway?

Document indexing vendor InDxLogic names Susan Thomas to its board of directors. Thomas is the former Chief Medical Officer for GE Healthcare ITS.

Baton Rouge, LA implements a telemedicine program that allows ED doctors to begin testing patients as they are being transported by ambulance. Funds for the BR Med-Connect program came from the US Department of Homeland Security. Can someone explain the Homeland Security connection?

Ochsner Medical Center (LA) posts ER waiting times online, giving patients the chance to select which of Ochsner’s four hospitals can see them the soonest.

Current and former physician employees of Medical Edge Healthcare Group (TX) file a suit against the company, charging them of improper billing and practices that violate state laws prohibiting corporate control over physicians. The doctors say Medical Edge used “deceptive accounting practicing” and charged them unfairly for taxes, benefits and other expenses.

Fifty physicians are set to receive their first rewards for participating in New Jersey’s Bridges to Excellence Program, which is designed to recognize and reward providers that demonstrate safe, timely, effective, and patient-centered care.

Meridian Health (NJ) selects TeleHealth Services to provide television-based services in the patient rooms of three hospitals.

San Mateo County (CA) pays the federal government $6.8 million to settle charges that the county medical center intentionally inflated its numbers of acute care beds in order to receive bigger Medicare payouts. San Mateo claims that any overstatements were unintentional.

The American Hospital Association reports that 53% of all US hospitals reported overall losses in the fourth quarter of last year. The aggregated overall margin for the quarter was -8%, compared to a positive 5% for the same quarter in 2007.

Third-party benefits administrator First Service Administrators appoints CareMedic CEO Sheila Schweitzer to its board of directors. 

Mr. H is taking a few days off, so the posts this week may be short and sweet. Email me.

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From Six Sigma: "Re: HIMSS keynote speakers. You failed to mention 2004 when HIMSS had hiker Aron Ralston, who cut off his own arm with a pocket knife to escape a fall in a rocky canyon. Now this was classic poor HIMSS programming. And let’s not forget co-keynoter, Tom Wolfe, the noted author and White House fellow for not going home again." I actually was trying to remember the arm-cutting guy but couldn’t think of his name, so I fell back to Dana Carvey as the "why is he keynoting?" example. But, HIMSS likes affordable C-list celebrities (Ben Vereen, for example) who seem hot until you think about when you saw them last in something important. Hold for Mr. Piscopo, please.

From The PACS Designer: "Re: Windows 7 beta. TPD has been watching for Microsoft to offer in its pending operating system Windows 7 Beta more solutions that will be usable by both Windows XP and Windows Vista users. With the addition of the system owner being able to shut off applications, the Windows 7 solution can win more advocates in the business world where having extra bandwidth available for business use is a valuable asset. Also being able to turn off Internet Explorer 7 can allow other Internet solutions to be employed." Link. I still hate using Office 2007 since I can never find Page Setup, Zoom, or Paste because of that damned ribbon, but Vista is OK.

From Andy: "Re: you said you liked weird stuff, right? What exactly is the procedure code for this?" A woman is airlifted to a Maryland hospital after being injured during a romantic escapade involving an electric saber saw. Hospital ED people can tell some bizarre stories (say, they would be great keynote speakers). At least this one’s not on YouTube yet.

From Kiwi Pete: "Re: movement. Or, is it more haste, less speed?" HHS is looking for people to serve on the HIT Standards Committee and HIT Policy Committee, with nominations for both due by March 16.

From Taxpayer: "Re: stimulus bill. Any thoughts on this? I’m a worker bee that sees so much squandering of good $ in HIT that I’m convinced the same thing will happen to stimulus $. Happy for never-ending employment, though." Link. The article by open source supporters says proprietary systems will turn into "poorly performing, opaque national Health IT at a high price." Maybe, but I don’t see that open source solutions are ready to step in as replacements (except maybe for VistA in specific circumstances), at least unless someone starts up the equivalent of a Red Hat to reduce the risk (real or perceived). On the ambulatory side, free/cheap EMRs exist, but are not dominating the market, which means upfront money isn’t the only problem. Hospitals waste a lot of capital on expensive applications that are woefully underused and fail to deliver ROI, but that’s usually the fault of the hospital and not the vendor (they bought it, superficially installed it, didn’t like it, and stopped using it, all without any serious effort or commitment). I doubt results will be any better now that the goal has changed to a quick selection, a subsidized purchase, and rapid go-live. I’m more in favor of getting the national infrastructure in place and then plugging in whatever appliance you want to exchange information with it. The value is in the network, not market-differentiating bells and whistles running on a local PC (I say that with great hopes for clinical decision support, but I’ve worked with it and it’s not really supporting many clinical decisions except to ignore the constant, unhelpful cookie cutter warnings). On the other hand, products and support aren’t fully commodotized, so as it stands today, there may be strong, valid reasons for choosing one commercial product or vendor over another. If there was a perfect system, we would need only one and that’s not the case.

Speaking of which, I like this quote by Mark Smith of CHCF on the stimulus bill: "It’s the land rush and the gold rush and the GI Bill of Rights all rolled into one."

Inga and I will be taking some possibly overlapping breaks over the next few days. We need to rest up for HIMSS, although I’m not sure that coming back to an inbox full of hundreds or thousands of messages will do it for me.

Riding on some Oprah quotes from Dennis Quaid (which were wrong, since he still thinks bedside barcoding will fix IV compounding errors like the one that affected his twins), Detroit Medical Center puts out a press release touting its own system. It’s actually Cerner’s, which would not have prevented the Quaid error either since it’s not used inside the pharmacy for IV prep, at least not as far as I know. There are hardly any systems that will detect mislabeled products when the barcode doesn’t match the contents of what it’s attached to. The hospital is awfully proud of the pro sports teams it takes care of, rattling them off at the end as though people who wield balls and pucks are more important that regular Joes.

Some folks who missed the HIStalk reception cutoff asked me to post that they’d like to meet similarly situated people at the Trump’s lobby bar during the same hours, a kind of Overflow Reception of the buy-your-own-drinks variety. I may swing by incognito just to see what’s happening there, so be rowdy.

FBI agents raid the offices of Washington, DC’s CTO (the previous job of Obama’s newly named US CIO), reportedly arresting an employee and a contract worker for bribery.

Just about everybody who’s been in the industry for more than a few years knows who George Huntzinger is, but here’s a refresher: he was president of CSC Healthcare for many years and also COO for the gone but not forgotten Superior Consultant, one of the class acts of HIT consulting. He’s now at The Huntzinger Management Group of Plains, PA, which in a remarkable non-coincidence, shares his name. A couple of HMG’s partners are also former SUPC folks who have decades of experience in running businesses, doing M&A work, etc. HMG offers consulting services to both providers and vendors, such as business assessments and planning, marketing strategy services, operations effectiveness, IT effectiveness, and full program management and PMO services. The Huntzinger Management Group is a new HIStalk Platinum Sponsor and I am delighted to have their support.

Listening: Pink Floyd’s Wish You Were Here, an incredible, moving tribute to LSD-fried (and now deceased) founder Syd Barrett. I rediscovered them after watching the Which One’s Pink documentary recently.

McKesson is the latest HIT vendor to pony up to make a patent troll go away. The troll’s strategy: find companies using technologies vaguely similar to a patent it bought with lawsuits in mind, sue everybody and his brother for infringement in a friendly court’s jurisdiction, then generously offer to settle if the target company agrees to buy a license that costs just a little bit less than mounting a legal defense. Everybody caves in every time except Epic, which happily offered to trade legal punches until the weaker fighter hit the canvas.

It’s nine years in jail for the New Zealand health district CIO accused of defrauding his employer of $11 million US by submitting phony IT maintenance invoices paid to himself.

Enterprise Software Development is a new and appreciated HIStalk Platinum Sponsor. The company offers management consulting, supplemental staffing, software services, implementations, integration, and infrastructure support (among other services). Solutions expertise includes Cerner, Eclipsys, Epic, Siemens, MEDITECH, and McKesson. Some familiar client names are here. Thanks to the folks there for supporting HIStalk.

Massachusetts Senators Kennedy and Kerry bring home the pork, getting $143K of federal taxpayer dollars for the South Shore RHIO, among other spending items like sewer repairs and a bus. I guess that passes for cheap stimulus spending these days.

Perot Systems will spend up to $60 million on a new campus, stimulating India’s economy instead of ours. It’s also talking to five Indian hospital chains about implementing "hospital software that is available in the US and UK," which sounds like Cerner.

A report says Connecting for Health will lose its standards-setting role to a new group under the Department of Health, opening the door for more NHS organizations to choose their own systems as long as they can interoperate via a common infrastructure. Some have argued that stimulus money will encourage healthcare IT like the UK’s, which aren’t fairing so well, but it sounds like they are actually gravitating more toward our model, with certified commercial products being chosen locally but exchanging information on a common network.

E-mail me.

HERtalk by Inga

From Code Red: “EMRs, ROI, and physician adoption. I think if the market actually realized the savings and efficiencies, there would not be a need for government forced market demand to move these products. I think the reality is that the current generation products do not provide these things, or why would a doctor not adopt them? The current generation of products have low adoption and high abandonment because they force the wrong workflow into the clinic and the doctor. Many EMR products ignore the doctor’s need to enter original thoughts and observations which do not appear on a pull down list. My fear is that the HITECH spending is going to freeze spending and investment on next generation products that would be adopted, and create artificial market demand on old school products certified based on the rules from the old school vendors. So, no better mouse trap for the next few years, just ‘bridges to nowhere’ in HIT.” Hasn’t the industry spent the last 15 years or so trying to come up with the better mouse trap? Maybe it’s time to try something new. Plus doesn’t new business provide vendors increased revenues for product reinvestment?

Thank you for all that sent over the great footwear suggestions. Did I forget to mention that in addition to gorgeous and comfortable, they need to be affordable enough for someone on a blogger’s salary?

UTMB (TX) remains on life support after regents approve a proposal to keep the Galveston hospital and school open. Now the organization needs to find $1 billion from philanthropic and government sources to fund the rebuilding of the hospital, which was heavily damaged in Hurricane Ike.

The FDA clears Sunquest Information Systems’ latest Blood Bank software application.

The HHS creates a new Office of Recovery Act Coordinator to manage the distribution of the $137 billion in ARRA funds. HHS veteran Dennis Williams will lead the office and serve as Deputy Assistance Secretary for Recovery Act Coordinator. That really rolls off the tongue.

PatientKeeper is mentioned in this article about Caritas Christi Health Care (MA) and its $70 million technology project. At first glance, it sounds as if the Caritas IT staff actually created the PatientKeeper technology, which is not the case. I asked for clarification from Susan Worthy, PatientKeeper’s director of marketing. Her reply: “PT Barnum says any publicity is good publicity. Not sure that’s true. I sent a note to the editor regarding the inaccuracy.” I’m with PT.

Greenway Medical Technologies celebrates its 1,000th connection of PrimeExchange, Greenway’s interoperability engine.

Poor communication at US hospitals costs $12 billion per year, according to business school researchers at the University of Maryland. Communication failures result in unnecessarily long hospital stays and account for 54% of total losses. The $12 billion figure is equal to about 2% of hospital revenues nationwide and definitely cuts into the average hospital’s 3.6% margin. Leaders at the school’s Center for Health Information and Decision Systems believe that improved IT would streamline communication among caregivers and reduce inefficiencies.

OSU Pathology Services (OH) selects McKesson’s Revenue Management Solutions.

Some Congressmen take a closer look at the healthy salaries earned by many hospital CEOs. The IRS says the average CEO salary is almost $500,000, with a small group averaging $1.4 million. Republican Senator Charles Grassley would like to introduce legislation that puts more pressure on hospital boards to keep salaries in check.

Beth Israel Medical Center implements Meta’s Electronic Physician Query software to improve clinical documentation.

Availity promotes (warning: PDF) Russ Thomas to the role of President and COO. Thomas joined Availity in 2008 as an executive VP and COO and was previously president of Gold Standard.

PHR provider HealthTrio will leverage Dossia’s technology platform to advance the clinical data integration within HealthTrio’s PHR and EHR products and increase online record access.

The Rochester RHIO goes live with eHealthConnect Image Exchange, a service by eHealth Global Technologies to automate access to patient images. The service ingrates with Rochester’s Axolotl Elysium system and connects to the PACS imaging services at eight radiology providers.

As Mr. H mentions, I once again have the opportunity to take charge of the blog while he taking a break in some Internet-less location. Feel free to drop me a note. It makes me feel important.

E-mail Inga.

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