From Francisco Respighi: “Re: Sutter. Massive layoffs soon to be announced (by mid-May) at Sutter Health Information Services. According to an enterprise-wide communication today from Sutter CIO Jon Manis, the poor economy is to blame for the layoffs and the de facto termination of the Epic project. The economic downturn has in turn meant that affiliates cannot fund the adoption of the Epic EHR (an interesting spin, since it was Sutter Corporate, and not the affiliates, that mandated adoption in the first place). Officially, the Epic project is merely delayed at Sutter. However, the announcement then goes on to say that nearly all Epic staff will be terminated. Nowhere in the communication from Mr. Manis is the enormous cost of the Epic project itself cited as a root cause of the current fiscal crisis at Sutter.” Unverified. If you can confirm (say, with an electronic copy of the e-mail) then talk to me.
From Del Fuego: “Re: CCHIT. Bobbie Byrne has updated her LinkedIn profile to indicate that she works for CCHIT now.” Link. The pediatrician and former Eclipsys SVP is now clinical director at CCHIT.
From The PACS Designer: “Re: Twitter brain waves. Mr. H is skeptical about the usefulness of Twitter, so TPD wants HIStalkers to judge and comment about a University of Wisconsin participant in Epicland who used his brain waves to complete ‘GO Badgers’ by focusing on the R and S on the screen to complete the Badgers cheer! To complete the assignment, the participant focused on the letter N to complete the statement ‘Spelling with my brain’. The messages can be sent by focusing on ‘Twit’ at the bottom of the screen. Next, TPD wonders if he can spell a brainy ‘Faulkner’?” Link. At least we now know at least one Twit who thinks before Tweeting.
From Bogo Pogo: “Re: HIStalk. Any plans for a mobile version?” I confess that I don’t exactly know what that means. I can read HIStalk on the BlackBerry Bold and it reads fine, so I assume it’s hitting the WordPress Mobile plugin that’s been in place since the beginning. Is there something else needed to support mobile devices? Say, I could write the whole thing as a series of Tweets!
From James: “Re: Kaiser flash drive. The USB drive is password-protected (I got mine today) and the clerk gave me a wireless keyboard to enter my password twice. The data file is a PDF so almost anyone can view it if you have the password.” I’ve always been a big fan of using scanning and PDFs as a simple but highly cost effective (and paperless) electronic medical record. I like Kaiser’s approach.
Listening: great surf music from The Neptunes.
Just announced: athenahealth’s Q1 numbers: revenue up 41%, EPS $0.12 vs. $0.09, hitting earnings estimates.
Doylestown Hospital is featured on Apple’s iPhone 3G page for rolling iPhones out to docs, including giving them mobile access to Meditech. I got my Consumer Reports today and was amazed at how well Apple did in the computer reviews: #1 in all three laptop screen size categories, #2 in desktops, and #1 in support in both desktop and laptops by far (81% and 84%, respectively, blasting the #2 vendor with 55% and 61%, respectively). Of course, Apples cost twice as much, so you could buy two of anybody else’s and keep one as a spare for the same money.
Medicity and Intermountain Healthcare will host a free Webinar called “A Data-Driven Approach to Improving Hospital and Physician Care Collaboration” on May 14. And speaking of Medicity, the company’s new CMO, Gifford Boyce-Smith, will speak on translational medicine at the Delaware Health Sciences Alliance research conference next Wednesday.
McKesson employees in Carrollton, TX spent time putting together care packages and notes for wounded veterans in VA hospitals last week. Nationally, 14,000 McKesson employees created 16,000 of the packages.
David Blumenthal follows the current administration’s mantra: we believe in the free market in theory, but sometimes it doesn’t work and the government can manage it more efficiently (which generally means: Bush and his cronies were dangerous fools and anything Republicans advocated must be repudiated by expensive and massive retaliatory government intervention). Speaking Thursday about healthcare technology, he said, “It is clear that this field has not advanced (enough) … when left exclusively to the private sector so there is a public role” Sounds good, except when surveyed, the public didn’t give a whit about healthcare IT. Your benevolent government knows best, as it constantly reminds us.
I just realized that it’s almost the end of the month as I write this, so I checked the HIStalk stats (that’s Inga’s territory, so I generally stay out of it). Shazam! Over 90,000 visits and 126,000 page views for April, breaking the record set in March by over 15% and up 66% from a year ago. I can only say thank you for contributing to that number by reading. I can’t imagine the stats going up since surely it’s at the saturation point, but I was saying that a year ago. Maybe the industry is bigger than it looks sitting here alone and staring at a keyboard and monitor for hours.
CERN shares hit a 52-week high today, topping at $54.71 and closing at $53.80. Above is a five-year stock chart that you can’t read because I had to shrink it to fit, but it shows Cerner share price (blue), McKesson (green), Eclipsys (gold), and GE (red). Go Neal (he’s not just doing it for you – he owns $303 million worth himself).
Bored at work? Try Internet sensation Swinefighter. It’s lame, but addictive.
Jobs: Senior VP of Sales, Technical Project Manager, VP, Finance and Administration.
Consumer Watchdog says it has proof that Google used paid lobbying firms to try to influence the government on the economic stimulus act, which it speculates (without proof) means the company wanted the right to sell medical data. Google says it was lobbying to support healthcare IT standards and to protect consumer privacy. Consumer Watchdog says fine, prove it by releasing your lobbying records. End Act 1.
It’s like one of those cheesy used car companies that offers to loan you down payment money until your tax refund comes: IBM makes $2 billion available to customers who don’t have the patience for their government checks to arrive. Come on in, everybody rides!
Siemens announces Q2 numbers, with revenue and profit up big.
Another doctor criticizes electronic medical records in a national publication, Time in this case in a story called How to Fix Health Care: Four Weeds to Remove (Larry wasn’t one of them). One of the four weeds identified as choking off the medical garden is Computerize Everything. “It’s a complex topic that boils down to this: If we who do the medicine thought more computers would save us money, we’d buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country’s medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time-consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it’s pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.”
Sams’s Club says it’s ready to sell eClinicalWorks (although it manages to spell the company’s name wrong in the headline, putting a space before the “Works” part). I did a Google site search to find the page, which doesn’t come up in the site’s own search.
In Europe, Ronald Verni, former CEO of Sage Software, is named non-executive director of charge master software vendor Craneware.
An Ohio State University medical professor and cervical pathologist says his employer demoted him, cut his pay by 60%, and took away his laboratory after he publicly accused the university of botching tests for human papillomavirus. He’s concerned about the incorrectly diagnosed women, but the $100 million he’s suing for will apparently assuage his anguish. Since every TV addict in America feels qualified to judge people based on a superficial knowledge of whatever’s being judged, I’ll side with him since he sounds sincere and is amply qualified.
E-mail me.
HERtalk by Inga
From Newlywed: "Re: Nobel Prize winner’s survey on women and mood lifting. Heck yeah … I think he is dead on. For me, sex and eating … helllooo? Unfortunately, I travel for my job, so I don’t spend many nights at home for the sex with my perfect, divine husband. But man, do I get to eat!"
From Lynn Vogel: "Re: MD Anderson and facilities. Appreciate your comments re: importance of facility ambiance to patients. Cancer patients face significant challenges and in many cases truly ‘life or death’ choices. Notwithstanding Mr HIStalk’s views about the relationship between the egos of healthcare CEOs and their facilities, it is easy to dismiss the importance of surroundings in providing a supportive and comfortable environment in which such choices can be made. And I would venture a guess that those most critical of healthcare facilities are those who have not had to experience them from the patient’s point of view."
DocuSys and CPSI team up to install DocuSys’ anesthesia solution at at Muskogee Community Hospital (OK). I have actually been to Muskogee, the town that Merle Haggard was proud to call home. I am pretty sure I ate some ice cream from Braum’s. Ymmm.
Silver Hill Hospital (CT) signs a five-year agreement with Medsphere to provide implementation, training, and support of Medsphere’s OpenVista EHR.
Froedtert & Community Health (WI) signs up for Epic Systems’ Care Everywhere network. The Care Everywhere network is designed to connect EMR information between different Epic systems and as well as third-party EMRs. Froedtert & Community Health is the second health system to sign up for the network, which the health system claims cost them $60,000.
McKesson promotes Randy Spratt to the newly created position of Chief Technology Officer. Spratt will also maintain his current role as executive VP and CIO.
Note to all you road warriors: while in a plane, experts recommend you sanitize your hands before eating and drinking, after retrieving something from the overhead bin, or after returning from the restroom. A little Purell and you cut your chances of getting infected by at least 40%.
Virtual Radiologic posts first quarter net income of $1.39 million ($0.09 per share), compared to $2.00 million ($0.12 per share) in the prior year period. Adjusted net income was up 40% from last year, coming in at $2.51 million, compared to 2008’s $1.88 million. Revenues rose to $28.6 million for the quarter, up 23% from last year.
Online learning and survey vendor Healthstream releases their Q1 financials showing net income of $878,000 versus $66,000 last year. First quarter revenue grew 19% over the previous year to $13.6 million.
If you are considering bariatric surgery, here’s some good news. Individuals with bariatric surgery reduce the prevalence of disease by 25%, compared the morbidly obese. Also, the rate of post-surgical complications has fallen 21% since 2002. Overall complication rates have also dropped (from 24% to 15%). Fewer complications also translate into lower cost of care.
Merge Healthcare announces its third straight quarter of positive net income. For the first quarter, Merge had net income of $2.8 million compared to a $7.9 million loss a year ago. Revenue was up 11% from 2008.
Researchers at Brigham and Women’s Hospital (MA) and Massachusetts General Hospital find that the use of integrated computerized medication reconciliation tools and process redesign were associated with a decrease in the number of unintentional medication discrepancies.
E-mail Inga.
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 to the US Healthcare System: Treat Me Like a Dog
By Peter Longo
I think everyone knows the US healthcare delivery system seems to have more challenges than solutions. From my vantage point, working in healthcare technology,I sometimes wonder if we can ever put all the crazy puzzle pieces together. I never thought that one day, soon after a long overdue physical and a trip to my dog’s vet, I would deem it in so need of repair that I begged to be treated like a dog.
Recently my beloved dog Hamlin’s digestive system grew tired of his “Cowboy Chow” dog food. Without a moment’s notice, my wife quickly went out and purchased him three other kinds to choose from. (I wonder if tonight I complain about dinner, will my wife run out to three different restaurants and find me something I prefer?)
Even the newly purveyed dog food did not settle Hamlin’s stomach. My wife, busy escorting three kids about town, informed me I had to take him to the vet. Since I work for a healthcare technology firm, I assumed going to a doggy doctor would be fun and enlightening; a respite from seeing human hospitals and doctor offices.
Hamlin and I eagerly pranced into the office with me ready for the inevitable “doctor wait”. Interestingly enough, I was greeted at the counter by a smiling receptionist calling out Hamlin’s name. But of course, they were expecting him because he had an appointment! Wow, novel concept here I thought.
Next I had my wallet out, ready to be accosted for money before I could even get a quick question in. Before I could eject my credit card, the side door opened and a smiling “nurse” asked Hamlin to come this way. (I assumed they were smiling because they were going to make a fortune out of me). Guarding my wallet, I followed our escort down the hall. I was still dazed from the fact they were expecting us and recognized Hamlin.
As we entered our exam room, I was perplexed to see a shiny new notebook computer on display. Before I could gasp in shock, the vet walked up behind me, introduced himself to Hamlin (the patient) first, then to me. Casually, he turned toward his shiny new laptop and within two key strokes had Hamlin’s medical record on the screen. My dog’s entire record. Looking like the complete geek that I am, I jumped at the vet asking to see everything on the system.
Eyeing me as though I might be in need of medical help myself, he leaned back to show me Hamlin’s electronic medical record. His life history, his owners, where he was born, any past medications he had, everything. Even his lab results were in there. The polite but guarded vet then showed me three other exam rooms, all equipped with shiny new laptops, all with Hamlin’s record available on them.
After a quick and thorough exam, the vet punched a few more keystrokes. He electronically ordered various lab tests — right then and there! I asked him about the firm that performs the tests and he told me the lab he uses provides great service and is top notch. He said the lab results will be sent back electronically and into Hamlin’s file directly! (In a moment of serendipity, I later discovered it was my company’s software providing the lab with the tools to accomplish this small miracle).
As I left the room and approached the front counter, a nurse had a prescription waiting for me along with three cans of super special dog food. Now I was really confused — is it not the patient’s job to walk the prescription and files to the front counter? Did my paper shuffling job just get outsourced to a computer? Adding to staff’s perception of my total geekiness, I asked how she did that. With a slight chuckle, she showed me the computer screen where the doctor requested it from the exam room. It just angered me to see such efficiency. I know my kids feel Hamlin deserves only the best, but better healthcare service than me? Adding injury to insult, I paid only $55 for the visit.
Hamlin’s enlightening experience really made me think of my own recent medical episode. A few weeks earlier, I went to my annual check-up. I scheduled the appointment and diligently showed up on time. As I checked in to see my doctor, one hand shoved a clipboard in my face, while a second hand went for my wallet. No verbal communication yet. Even though Hamlin theoretically can’t speak, he was treated to verbal communication and a custom greeting. I then proceeded to brush up on pop culture in a six-month-old People Magazine (I did not know Britney had a second baby and broke up with K-Fed?) while waiting 27 minutes for my appointment. If only someone told me how long my wait would be — but hey, that would take the fun out of guessing when I would be home.
I finally entered my exam room to be greeted by a nurse,a sheet of blank paper and a $.25 pen. She took my vitals. Later, my doctor sashayed in with that same high tech paper but a more expensive pen (with a drug company’s name on it) to drill me further. As all checked out fine, he indicated he needed some lab work to complete the exam. Amongst some forms floating on a table (uncomfortably near my half-clothed rear end) he found an order sheet. He checked a few things here and a couple things there then gave me the nod to transport the paper across the hall; then my lab orders and I waited some 18 minutes more.
A couple of weeks after my exam, I received my lab results “in the mail.” Next to each test result, the doc was kind enough to scribble an “OK.” Then a nice hand-written note claiming, “All looks OK, see you next year.” I put that report in a sophisticated manila folder and filed it. Why did I have to have this manual, impersonal, medical experience right before my vet visit?
Dazed and confused after leaving the vet, I wandered back to our house. Upon opening the door, my three kids showered Hamlin with love. They rubbed his back, gave him endless kisses and asked him easy softball questions. “Have you been a good boy?” My wife brought over doggie treats and “king” Hamlin relaxed on his back as the kids indulged him full of treats. My life quickly went to the store to find him “the best food money can buy.”
I was left standing at the door waiting to even be recognized. I sure did not get any kisses, let alone a back rub. I put myself on the couch and wondered if anyone was going to fetch me a treat. I would have been happy if one of my three kids just pushed the remote closer. As I stared at a blank TV screen, it dawned on me … I really need to be treated more like a dog.
From Ralph Curmudgeon: “Re: Kaiser’s flash drive PHR. Kaiser’s offer of the flash drive has the same inherent problems as shoving a stack of papers and an x-ray folder in the patient’s hands. Unless the drive is encrypted and the patients have the computer skills to use it, it’s effectively worthless. Besides, I’ll wager >50% of them end up getting lost – just like the paper records. The average Joe and Jane out there – particularly the elder ones – aren’t ready to haul around electronic records in the pocket or purse – heck, they can hardly understand their treatment bill. Now injecting them with a re-programmable chip in their upper back – like Rover – that’ll work.”
From The PACS Designer: “Re: Seesmic/TweetDeck. As Twitter gains more popularity, there are enhanced free applications that will manage all your Twitter favorites and also allow you to manage photos and videos to give you a ‘video Twitter’. One of them is Seesmic, created by a French company, which competes with another application called TweetDeck. TweetDeck has had some memory leak problems that are now supposedly fixed according to Adobe, so Seesmic appears to be the better choice to track Mr. H’s, the Candid CIO’s, and Labsoftnews’s Twitter posts along with others.” Link. At the risk of sounding tragically un-hip, I have to admit that I’m already sick of Twitter even though I do basically nothing with it. At least blogs required minimal effort to actually write and post the usual vapid, dull comments. Twitter makes it easy for Twits to expel a never-ending, 140-character flatus stream of “what I’m doing right now” self-indulgent babbling (as long as the activity allows keeping at least one hand on the keyboard) that puzzlingly finds an audience of people willing to read it. People complain that they have no free time, yet they apparently use what they do have screwing around with World Wide Waste of Time applications that provide the illusion of usefulness.
From Leon Poncey: “Re: cyber-attack. Thought this might be interesting to HIStalk readers.” Link. An interesting recap of an incident in California where unidentified individuals crawled into several manholes (they’re never locked, of course) and cut eight fiber cables, causing a loss of 911 service, cell signal, landline telephone, broadband, alarms, ATMs, credit card terminals, utility monitoring applications, and the hospital’s internal network (which apparently had some unexpected dependencies). Repercussions were fascinating: the hospital went to paper, stores accepted only cash, and employees were sent home. The only technology that worked was one of the oldest and least sexy: ham radio (I can say that because, being a nerd, I will admit that I was once a ham radio operator, at least until I noticed that it was like Twitter: the technology was ample to interconnect people from all over the world, but the people using it invalidated the entire premise because they had nothing interesting to say).
From Alter Ego: “Re: Halamka’s blog. I think he’s getting a bit egocentric, kind of full of himself. Does anyone really need to know about the details of his work spaces?” I already assumed he was full of himself, although I don’t know him. I actually kind of enjoyed the post that has pics of his digs at Harvard, BIDMC, and his home office, which is just a chair and a MacBook Air (I certainly enjoyed that post more than those Zen ones where he gets all moist talking about some bizarre flute he has dedicated his life to playing, his tea ceremonies, or climbing rocks). And, I have to defend us bloggers since there’s always some reader who launches ballistically when a couple of sentences didn’t hit his or her interests precisely. I get an e-mail something like this: “Oh my GOD I don’t read HIStalk to get (humor, music recommendations, guest articles, etc.) and I want the time back that it took me to read (the three sentences out of hundreds). Stick to the facts and leave that to the professionals (comedians, music critics, professional writers, etc.)” Apparently just skipping over those few words is too much of a challenge compared to writing out a complaint, so I have no idea how those folks can read a newspaper (“Oh my GOD I don’t follow stocks so please stop running that crap and stick with the sports and leave the investment talk to stockbrokers”). If Halamka wants to write about tooting his flute, then that’s his right, and anyone who can’t stand that should probably just read the personality-free trade rags.
From Deborah Kohn: “Re: HIPAA. I completely agree with your reply. Just a history reminder of this complex law. Prior to 1996, the public was demanding two things: 1) greater portability of health insurance between jobs, and 2) confidentiality protection of personal information and privacy protection of the individual – with a focus on health information. Consequently, the 1996 Kennedy Kassebaum Bill (K-2) or Public Law 104-191 or the Health Insurance Portability and Accountability Act (HIPAA) (and, given the 2009 ARRA HITECH Act, this 1996 law could be viewed as version 1.0 or 1.a), was introduced with the following legislative goals: Title I – Portability, which contains only one major component — ensuring that individuals between jobs are able to carry their health coverage forward or obtain similar coverage. Title II – Administrative Simplification, which contains four major components, which are the most publicized: 1) Unique Identifiers (for Employers, Health Plans, Health Providers, and Individuals); 2) Electronic Data Interchange and Coding Standards (the Transaction Set and the Code Set); 3) the Confidentiality and Privacy Standards for analog and digital records / documents (the Minimal Disclosure of Individually-Identifiable Health Information, the Control Over Sharing this Information with Outside Entities, and the Ability of Patients to View Their Information and Receive a Record of Access to Their Information); and 4) the Security Standards for digital records / documents (the Administrative, Physical and Technical Safeguards).”
The last plea of this particular telethon: if you haven’t completed my reader survey, would you? I’m already making my to-do list from the responses so far, but it’s not too late to register yours.
Not willing to take the chance that the government will define “meaningful use” of EHRs in a way it doesn’t like, HIMSS goes ahead and preemptively makes up its own definition and sends it off to CMS and ONCHIT for what they hope is rubber stamping. Its recommendations:
- Name CCHIT to be the EHR certifying body (no surprise there).
- Adopt interoperability per the specs of HITSP and IHE.
- Implement increasingly stringent metrics. For hospital systems, HIMSS wants metrics to be ratcheted down no less often than every two years to allow “health IT companies to make necessary modifications to their products, including the rewrite of legacy enterprise EMRs as necessary.” (Question 1: what enterprise EMRs are not legacy? Question 2: does anyone really expect products to be rewritten?)
- Evaluate best-of-breed and open source technologies fairly in their demonstration of meaningful use (note that HIMSS throws in a half-hearted but still eyebrow-raising acknowledgment that free software that competes with the products of its vendor members, saying “use of open source options can be cost-effective for some hospitals.”)
- For the first two-year phase (FY11), measures include use of lab, pharmacy, and radiology systems, along with a CDR (interfaced to “the patient accounting system” for some reason). Discrete clinical observations (allergies, problem list, vitals, I&O, flowsheets, meds) are recorded electronically, but electronic physician documentation is not required. Auto-capture of NQF quality measures is required. Hospitals exchange electronic information, but it can be in the form of scanned documents.
- For the second phase (FY13), 51% of orders must be entered by CPOE, e-prescribing to outside pharmacies must be in place, and systems follow whatever data output standards HITSP and IHE devise.
- For the third phase (FY15), CPOE goes to 85%, bedside eMAR/barcode verification is in place, evidence-based order sets and reminders are in use, and information exchange is underway with public health organizations and subunits of a statewide or national exchange. There’s a line about analyzing “pharmacokinetic outcomes resulting from patient medication interaction” that makes no sense to me.
- Most of the practice-based EMR recommendations are similar: clinical data display with CPOE capability and doctors entering their own orders, e-prescribing, and quality measures, followed by clinical decision support and interoperability.
My opinion: a pretty nice job. The standards are straightforward and measurable, although the practice EMR document doesn’t get specific about physician usage percentages like the hospital one does. It looks to me like they basically took the HIMSS Analytics EMR Adoption Model and made Stage 3 (minus the diagnostic imaging requirement) the first phase and Stage 5 the second (along with part of Stage 7 – capturing data in CCD format). Fairly ambitious, but it may go back to Obama’s early question about “what would it cost to get all hospitals to Stage 4”.
Microsoft creates a version of its Amalga data analysis tool for life sciences. They claim it connects information in ways that allow researchers to make new discoveries.
Cerner just announced Q1 numbers: revenue up 2%, adjusted EPS $0.52 vs. $0.47, beating estimates of $0.51 by the usual Cerner penny (but light on revenue, so shares are pricing down). Nobody I know is buying Cerner systems, but they are managing their business with great skill, working the recurring revenue stream and managing expenses to keep Wall Street happy.
UK’s NHS threatens to give BT and CSC the boot if they can’t get their Cerner and iSoft systems, respectively, up and running in at least one large hospital by November.
Joel Selanikio of Georgetown University (and of his own company, DataDyne) wins a $100,000 Lemelson-MIT Award for Sustainability for developing the open source EpiSurveyor mobile healthcare survey software.
Continua Health Alliance wins the American Telemedicine Association’s award for innovation. The ubiquitous John Halamka’s quoted congratulations on behalf of HITSP are included for some reason.
Palomar Pomerado Health is offering, without a prescription, the personal genetic testing kits of Google-backed 23andMe.
Southeastern Regional Medical Center (NC) promotes Eric Harper to CIO.
Sutter Health is reluctantly turning Marin General Hospital (CA) back over to the county next summer, so that means it will need new information systems. ACS gets a $55 million contract to install McKesson Paragon and support it through 2017. Former El Camino Hospital CEO Lee Domanico is running the transition team that will take over. The hospital originally said it couldn’t afford to pay him more than $264K, but he will make up to $779K a year under his two-year contract signed in January, a large pile of money for running a 235-bed hospital.
The University of Nebraska and the technology transfer organization of its medical center are suing Siemens Healthcare Diagnostics for patent infringement, claiming that Dade Behring knowingly sold laboratory testing systems that used technology the university had patented and licensed exclusively to Abbott Laboratories. Siemens AG bought Dade Behring in 2007.
Kathleen Sebelius is confirmed to become HHS secretary, but none of HHS’s 18 other key positions have been filled. I want Obama to succeed, but so far he’s just a cooler version of Jimmy Carter – lots of lofty goals, but incompetent when it comes to execution (how many times has he apologized for one gaffe or another in just his first 100 days or so?) Anyway, she’s in, but without a team.
A new study published in Archives of Internal Medicine found that computerized medication reconciliation reduced medication errors by 28%.
Total margins for Pennsylvania’s hospitals have dropped 12% in the past two years to –6.3% due to portfolio losses and more uninsured patients.
E-mail me.
HERtalk by Inga
From Old Coot: “Re: John Wennberg. ‘Too much acute care today/wasted money spent at end of life – need to redirect those resources to community health initiatives.’ In other words, let the old folks die off peacefully – and quickly – and spend more money handing out condoms to kids who won’t use them. Wennberg, who is no spring chicken, better watch out. His kids will be slipping that potassium chloride mickey into his Metamucil one evening. I wonder how Wennberg’s parents are doing these days . . ."
From Hair on Fire: "Re: insecurity. Glad you got back at Mr. HIStalk for his snarky comments about your insecurity (or was it his?) with your comment about the Code Blue band :> We chicks need to stick up for ourselves – and one another!” Thanks for the chick support. However, Mr. H created his comments after mine, so I didn’t really have a chance to get back to him, although I did chastise him for letting the world know I was insecure (am I insecure about that?) The secret is now out. Will the adoring fans be disillusioned?
From John d’Glasier: "Re: Twitter. Doonesbury says it all: Tweets for twits. Twitter is adolescent narcissism.You can’t possibly said anything worth reading in 140 characters unless you believe American Idol, Survivor, and Are You Smarter Than a 5th Grader? represents the zenith of American entertainment – preparing you well for pop culture acceptance of anything without meaning, gravity, or importance." Here’s the strip. I was totally with you, John, right until the subtle slam on American Idol, which happens to represent the most entertaining three hours of my week (after reading Mr. H’s posts, of course.)
From Lucy Padovan: "Re: shoes. At the height of the dot-com era, some well-meaning but alcohol-befuddled colleagues thought I should be nicknamed e-babe, odd since I’ve never bought or sold anything on eBay in my life. Nonetheless, a friend sent this link to me and I wanted to pass it on. This is just shoe lover to shoe lover." What is there not to love about sexy crocodile pumps that retail for $2,650 that you can steal for a mere $630?
Clara Maass Medical Center (NH) successfully implements Axolotl’s Elysium Exchange, enabling ER, inpatient, and outpatient records to be shared electronically across the health system.
I have enjoyed reading the various posts about fancy hospital building, bloated budgets, etc. Here is my two cents. I visited a friend once who was at MD Anderson. If one day (God forbid) I wind up with cancer, MD Anderson is where I want to go. It felt comforting, current, and everyone was efficient, friendly, and supportive. The pretty building made a difference. Another time during my traveling days, I had the unlucky chance to spend the night at a hospital in a major city. At the time I didn’t know this, but it this hospital is considered one of the best in the country for the type of emergency I was experiencing. While the staff was great, the hospital itself was old and tired-looking and my room was dreary. I actually knew enough about healthcare to understand that such things don’t affect the quality of care, but, the lack of aesthetics didn’t aid my overall comfort level. So I am of the mindset that if someone wants to donate millions on pretty buildings, I’d like to say "thank you" on behalf of all of us average patients who rather be sick in an attractive facility.
United Hospital System (WI) selects Eclipsys Sunrise Enterprise clinical solutions for its multiple hospitals and clinics.
Medfusion names Bill Loconzolo chief technology officer. Medfusion provides online communication tools for healthcare practices.
A Nobel Prize winner finds the top five mood-lifting activities for women are: sex, socializing, relaxing, praying or meditating, and eating. (No mention here if the Nobel Prize person is a man who believes in the power of suggestion, but it’s not a bad guess.) Exercising and watching television followed closely. Near the bottom of the list were cooking, “(day-to-day) taking care of my children,” and housework. If you are in need of advice on how to be happy, Dr. Lobe has some tips for you. And if you are a woman, let me know how well these these five activities are working to increase the joy in your life.
Hard to miss finding information on swine flu, especially with all the tweets, podcasts, and up to the minute postings by the CDC/HHS, WHO, and every news agency out there. Personally I prefer the Google map that displays confirmed outbreaks by location (helpful for planning my next vacation.)
MED3000 gets a mention in a Wall Street Journal article that looks at various tactics by employers and insurers to motivate people to make healthier choices. Money, by the way, seems to be a good incentive.
Picis announces that the VA has selected Picis Critical Care Manager for its Veterans Integrated Service Network 12, aka the Great Lakes Health Care System.
Let’s hope that the US health crisis never gets this bad. A Japanese woman with headaches during labor is turned down by 18 hospitals that refused to accept her due to overcrowding or overly busy doctors. She had a brain hemorrhage and went into a coma, but a hospital that finally accepted her delivered the baby by Caesarean before she died eight days later. The Japanese ER crisis is blamed on a number of factors, including the aging of the population, economics pressures, and professional and legal issues. ER doctors are overworked, poorly compensated, and risk criminal prosecution (not civil) over malpractice issues. The government estimates that currently Japan has half the number of ER doctors required to serve the population (about 2,500 to serve 127 million people.)
E-mail Inga.
From 13th Floor Elevators: “Re: traffic tickets covered by HIPAA. The clerk must have consulted our hospital’s HIPAA officer, who says employees who have babies can’t use hospital e-mail to tell their colleagues as it would be a HIPAA violation. This HIPAA thing needs a lot of rework. And, when was the last time you heard anything about the ‘portability’ in HIPAA?” HIPAA was a pretty good 1.0 effort, but it’s hopelessly outdated, seldom enforced, and watered down by special interests. Pre-Internet privacy laws and information systems are relics that really should be rewritten. As for portability, I don’t see much improvement, especially if you have a pre-existing condition (does “pre-existing” mean before you were born?)
From KitKat: “Re: MD Anderson Cancer Center. Layoffs Monday, with 16 anesthesiologists getting the pink slip.” MDA is looking for $280 million in budget cuts and will start cutting employees within a month. The best thing about the article was this reader comment: “I’m STILL trying to figure out why the new buildings at MD Anderson had to be so over the top lavish; almost like a shrine to cancer.” It’s not just MD Anderson. Lots of hospital executives I’ve known love building fancy structures as a substitute for the imaginary careers they gave up in private industry, always daydreaming that they would be running big for-profit businesses and flying around in corporate jets if they weren’t so selfless. It’s always rationalized that the community wants those magnificent edifices, despite the evidence that suggests what the community really wants is easier hospital parking, reasonable rates, a chance to get in and out of the ED without taking six hours, and interacting with employees who at least pretend to be empathetic. Unfortunately, those big buildings seem to make all of those attributes worse. I would trade all that architecture for a couple of good nurses (especially since you can’t see that imposing facade from your room anyway). Like financial institutions, when you’re selling an intangible, you have to convince customers that it’s real by spiffing up the storefront.
That reminds me of that consumer survey early in the stimulus talks about where they wanted to see healthcare money spent. IT was dead last. Fancy buildings would probably have been there, too, if respondents were asked to rate their importance. So why don’t we give our customers what they want instead of what we think is good for them? Maybe that’s more of that good old paternalism, where you just tell the patient not to worry their pretty little heads because the doctor knows best. You and I are healthcare consumers and patients, so if asked what we would really like to see changed, I bet it would be the easy stuff like what I mentioned above and not buying new IT systems. We want to be respected, informed, consulted. We don’t want to be inconvenienced, harmed by medical error, or infected. We would like to be able to afford the care we need. If IT (and those fancy buildings) can do any or all of those things, consumers will love it, but just having the IT without delivering the results won’t impress anyone except nerds.
I think I need to write a novel since I have this great story idea stuck in my head. Here it is. A fictional foreign industrial conglomerate, despite a generations-long history of shameful behavior (using death camp labor, bribing prospects to get business going back 100 years) wins a huge government contract. Champagne corks are popped back in the home office, stiff executives clumsily attempt fist bumps. Now comes the key scene: at that moment, dozens of unsmiling federal agents crash through the office door, armed with search warrants and evidence boxes. The big government contract had been a sting operation! The conglomerate has been caught red-handed after decades of improper government contracting! I’m trying to decide whether to portray the company’s competitors has having set up the sting, but I need to give that more thought. I’m picturing Dennis Quaid as the humorless government agency head, Maureen McCormick as his love interest, and maybe Rod Blagojevich in his big-screen debut as the conglomerate’s ranking executive. I dunno … not very believable, I guess.
The new BusinessWeek says EMRs may be a waste of government money in The Dubious Promise of Digital Medicine. Points: evidence that EMRs improve patient safety is scant, vendors like selling off-the-shelf systems that are hard to implement and maintain, and HIT special interests have kept government oversight to a minimum. Individuals are called out: Newt Gingrich for playing a heartfelt futurist when he’s getting paid by vendors, Nancy DeParle for having high-dollar Cerner connections, Glen Tullman for working his Obama connection, and McKesson’s lobbyists pushing policy ideas on members of Congress and of the Administration to reward clients for using their aging systems. Several negative hospital EMR experiences are cited. Also mentioned: vendors are pushing for CCHIT as the certifying body, knowing that a group led by a former vendor executive and started by HIMSS will provide a friendlier audience than FDA. OK, the article is all over the place and certainly sought out whatever high-profile negative stories it could come up with, quoting only those who had a bad EMR experience (who never blame their own organizations for choosing or implementing it poorly, of course – everything is the vendor’s fault). Worth a read, but only because lots of people will see it. Its conclusion, however, is entirely reasonable: we’re spending billions on systems developed even before the Bush administration (HW, not Shrub) that haven’t exactly lit healthcare on fire so far. As a taxpayer, you’re taking a bet with billions that a prudent gambler wouldn’t. Water under the bridge, though, so there’s no point pontificating about it now.
Is Apple developing a Mac Tablet and would it be a great platform for EMRs? Good article, good reader comments.
An interesting article on 12-employee Precept Health, a New Zealand startup struggling financially but winning big business over companies like Philips for ICU monitoring.
New poll to your right: what’s the impact of Oracle’s acquiring Sun? From my cheap seat, it looks like the showdown to be king of the technology world will be between Oracle and Google. The worst aspect is that Oracle gets MySQL, Oracle’s main (free) competitor that powers much of the Internet (including HIStalk). Oracle hates Microsoft, which is already wheezing, and can inflict serious damage on it by attacking its Office and SQL cash cows with Sun’s free alternatives. Since Oracle is still buying everything in sight, what if it picks up Red Hat? (IBM better strike fast if it still wants to be a playa). Microsoft hasn’t made a good acquisition in years. Proclarity in 2006, maybe, but that’s niche; I can’t think of anything else other than Visio in 2000 since the Great Plains deal didn’t make sense to me. Everything else seems to be add-ons to fix holes in existing products, not anything innovative.
Interesting in the definition of “meaningful use” of EHRs? The VA will provide a live audio broadcast of Tuesday’s NCVHS meeting, which will attempt to create one.
Fujitsu announces its new EMR in Japan: HOME/EGMAIN-GX V2 (don’t they have marketing people over there who could come up with a name that might actually be remembered?) The only Web pages I could find were in Japanese, but it appears to do orders, meds, bed management, and diagnostic imaging.
Reader survey. Important. Complete, please. Thanks.
The economy may be wearing you down a little, but at least nobody’s moving you to a desert and planting bombs in your front yard. Major Patrick Baker is a citizen-soldier and chief nursing officer at Madison County Hospital in London, Ohio, deployed since January to Balad, Iraq as Flight Commander, Flight Clinical Coordinator Team of the 332nd Expeditionary Medical Group, the largest trauma center in Iraq. He organized a charity marathon in Iraq to coincide with one in his hometown, recruiting 400 airmen, soldiers, and sailors to help raise $8,400 for the American Heart Association in honor of his six-year-old daughter Ellie, who was born with multiple heart problems. Tired of manufactured “heroes” like shallow TV stars and exorbitantly paid athletes? You can e-mail a real one. HIStalk Practice contributor Dr. Gregg Alexander knows him and sent me a link to the video.
Senator Jay Rockefeller (D-WV), chairman of the Senate Finance Subcommittee on Health Care, introduces legislation that would create an HIT Public Utility Model that would provide grants to safety net providers that would cover the cost of implementing open source systems plus five years’ maintenance. It would also create a HIT Public Utility Board within ONCHIT to over see the program. He says, “Open source software is a cost-effective, proven way to advance health information technology – particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field – by making health information technology a realistic option for all providers.” I like it. Jay’s kind of doing his own thing here without being steered by lobbyists and HIMSS, proposing a solution that could put more HIT in the field without just dropping big dollars on private companies. I just wish that, when we talk about open source, it covered more application ground than VistA. It’s good, but not exactly cutting edge, and the number of potential community members is limited to those who happen to know MUMPS programming.
Kaiser Permanente offers members a $5 USB flash drive containing their basic medical information and recent encounter data. A secretary downloads the patient’s data while they wait. But, they have to show up in person to get it. The article omits the most important fact: how do doctors access that data in case of emergency, which is the whole point of getting the USB drive in the first place? Hopefully it is easy, does not require loading anything on the doctor’s PC, and doesn’t require a password if the patient is brought in unconscious. Maybe someone should invent a hardware or software token that would positively identify a PC user as a doctor so they could be given elevated privileges to open the medical files of patients.
Forbes profiles Steve Schelhammer, a former teacher and yearbook salesman who formed disease management company Accordant Health Services, sold it for $100 million, and is now CEO of Phytel, which analyzes EMR data to find non-compliant patients and sends them messages asking them to schedule a visit. Practices pay for the service, but benefit from increased visits.
E-mail me.
