From Leonard Smalls: “Re: CIOs. The selection of the HIMSS chair best highlights all that is wrong with healthcare IT. He was an X-ray technician, went to work for a healthcare IT vendor, and then to his hospital, where he is now CIO. He was groomed by vendors and HIMSS with little information technology education and experience other than vendor applications. This is what is wrong with healthcare IT. You can’t be just a good manager and join the right organizations to be an effective CIO. You must have information technology education and real-world experience in the layers below the application layer in order to make effective decisions about systems and how to integrate them. If not, you become a vendor-whore (pardon the language). I see this repeated often in healthcare organizations. Those in the industry need to stand up and shout when the emperor has no clothes. Otherwise, sit down, be quiet, and quit complaining about crappy software in the healthcare IT space.” This is the “CIO as the technician in charge vs. generalist change leader” argument that never seems to end. One camp says hospital CIOs should be doctors and nurses, another says they should be the same kind of person you’d want for COO or even CFO, while the old-schoolers says the CIO should know the bits and bytes. I’ve yet to see a convincing correlation between CIO effectiveness and their background since so much depends on leadership style and the organization they work for. I do believe that hospital CIOs are too cozy with the idea that everything revolves around vendor software, often because that’s all they know. Look at how chummy CIOs are with vendors with HIMSS and CHIME – is that an admirable win-win position or is it an incestuous relationship? Either way, that’s why it’s an uphill battle for open source applications, internal development, or simply optimizing the use of what’s already been bought. Those less-sexy efforts rarely get you on the A-list of advisory boards, speaking engagements, and rah-rah magazines. Plus, lemming hospital executives are swayed by vendorspeak, too (“vision centers” are for non-IT execs looking through a gauzy and deceiving lens, for the most part, not CIOs) and not encouraging their CIOs to blaze any trails.
From Svetlana Stalin: “Re: two million visitors. This very intelligent and sometimes bizarre Web comic strip relates to your recent achievement. Congratulations!” Link.
From Bashkirian: “Re: the data model that nearly killed Joe. Heard the vendor was Epic. Can anyone confirm?” I believe ample clues were provided to draw a conclusion about the vendor, although the conclusions about the magnitude of the problem and who’s to blame for it could certainly vary.
From Speedo: “Re: MED3OOO. Heard Tom Skelton has inked a big deal with Tenet.”
From IT Manager: “Re: Carilion. Carilion Clinic’s EMR implementation is going as smoothly as any I have seen at several other health systems. I think we are rolling out Epic at all of our hospitals and ambulatory sites faster than anywhere else in the US. Carilion’s 140-bed hospital implemented Epic smoothly on all applications just a few months after the 800-bed Carilion Medical Center went live.”
President Obama names 36-year-old Aneesh Chopra as chief technology officer of the United States in his Saturday morning radio address. Chopra is Virginia’s secretary of technology, but more relevant to healthcare, was previously managing director of The Advisory Board Company, the publicly traded healthcare consulting and advisory firm, where he led the CFO group. His LinkedIn profile shows no technology experience or education whatsoever (that should drive Leonard Smalls, whose comment about CIOs is above, crazy), although his Democratic party participation is impeccable. Jeff Bezos, Bill Gates, Eric Schmidt, and other big-name visionaries had been touted for the job, so many are scratching their heads as to why he was chosen and what he brings to the table. HIMSS gave him a state advocacy award in 2007, so I’m sure a fawning press release applauding his selection is imminent. I wouldn’t get too stoked: he’s not a member.
Interesting: Gibson General Hospital finds a Russian hacker’s exploit on its e-mail servers that allowed them to be used to forward spam all over the world. Palisade Systems, whose packet management technology was used to detect and fix the problem, ran the press release. One case study involved using the company’s PacketSure Procotol Management Appliance to limit peer-to-peer traffic for a university.
The latest newsletter (warning: PDF) from Intellect Resources has thoughts on how to tell your kids that you’re out of work (advice you’ll hopefully never need). Check in, too, with Traveling HIT Man (their version of Flat Stanley) to see where he’s been. He may find his way to HIStalk Intergalactic Headquarters someday.
Would you please complete my reader survey? I do it every year to help me keep HIStalk on track. Thanks.
A pharmacy technician whose job was the subject of layoff rumors kills the pharmacy manager, a co-worker, and himself at Long Beach Memorial Medical Center (CA).
Anonymous whistle-blowers claim (and press-obtained documents seem to confirm) that the Australian government is rushing its Cerner systems into production without any medication functions working, presumably to get something live to avoid embarrassment in next year’s elections. The $70 million system was ripped by an unnamed health IT expert, who predicts hospitals won’t use it: “No one likes using it because it’s shit. It’s totally inflexible.”
The folks at Digital Healthcare Conference (May 6-7 in Madison, WI) are offering a special $295 registration rate (use code HISDC) for provider readers of HIStalk. It’s a pretty high-powered speaker list and a nice facility (Fluno Center for Executive Education, above). I’d go if I could get off from work.
Those pink-pantsed boys at Voalte have got their marketing on despite being a start-up. This funny video makes fun of an unnamed competitor that should be obvious to everyone, a la Apple vs. IBM (Voalte isn’t a sponsor or anyone I know, by the way, for those who may think I have a hidden agenda – I just find their product interesting and their approach fresh).
BIDMC CIO John Halamka says sending clinically unreliable administrative data to Google Health for PHR use was a mistake in retrospect, as evidenced by the head-scratching conclusions e-Patient Dave found when he viewed his own records there and found a long list of medical conditions that he mostly didn’t have (but had been tested for). BIDMC is shutting down the ICD9 feed and trying to map their homegrown software’s data to SNOMED-CT instead of sending free text. e-Patient Dave, who is the public face of the problem, is advising Google and BIDMC. Not to minimize his contributions, but couldn’t Google have spent a few of its gazillion dollars to actually talk to one of the many informatics experts in the industry instead of just happily blowing in whatever data BIDMC said it could send and calling it mission accomplished? Honest to God, we’ve got real-life doctors, nurses, informatics PhDs, and nomenclature and taxonomy experts everywhere and nobody ever asks them, instead just sending off a bunch of marketing types and programmers to hack out something that looks cool even if it is somewhere between medically useless and medically wrong. Show of hands: who out there would have told Google that it was a fantastic idea to use claims data as a clinical tool? (like, “The doctor tested you for cancer once, ergo, you must have cancer.”)
If top dogs Google and Harvard’s BIDMC (and Uncle Sam, who’s putting a lot of faith in aggregating data from iffy and undocumented sources) can’t figure out this data quality issue, what does that say about an industry that’s about to spend billions on a national data exchange? Who’s going to validate and correct EMR data that’s being whisked electronically all over the country? (or, more importantly, who will use it knowing its limitations, which is the reason that PHRs are of limited value today?) Here’s what e-Patient Dave wisely said about the fiasco: “I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry. And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.” I was talking to Robert Connely of Medicity (formerly Novo Innovations) and we agreed that interoperability is a piece of cake compared to the next mountain to climb: semantic interoperability (I’m getting this data element from you, but tell me what it really means). Vendors don’t always document that even in their own databases (see the healthcare data model critique that I wrote about earlier).
The Australian Business Journal profiles the resurrection of IBA Health, parent of British software company and NPfIT vendor iSoft. Some fun talk from IBA’s chairman about that iSoft acquisition, which initially was going the other way as the much larger iSoft was to acquire IBA, but then iSoft’s market cap dropped from $3 billion to $300 million. “It had lost 90 per cent of shareholder value and its management team and we ended up as the underdog bidder — the pissy little Australian company — wanting to take over a British institution. They did not treat us seriously. I guess there was a bit of colonialism involved. They had hoped an American company would take them over. Instead, I came back with a slingshot and we took it over.”
A Huffington Post article by Deane Waldman (a doctor) decries poor usability in clinical systems. “I can access my Excel spreadsheets on either MAC or PC but I cannot see a chest X-ray and lab results using the same program. Inpatient files are coded (and secured) separately from outpatient records making it impossible easily to compare them … The Obama administration is encouraging the development of EMR and that is wonderful. The scary part is that I know they will do it wrong. They will do ‘business as usual’ … As a colleague on Twitter wrote recently, ‘IT tends to focus on back-end programming and loses sight of the front-end [the users]. Without usability, software is [and EMR will be] useless’ … the screen in the hospital on which I am supposed to electronically sign my letters: it has 74 icons! Talk about incomprehensible. The needs of the end-users must drive the design.”
CCHIT takes the first step toward its expansion to certify long term care systems, putting together a LTCS Advisory Task Force. The CCHIT apple didn’t fall far from the HIMSS tree: keep the paid headcount down, use volunteers to do all the real work, keep expanding, and figure out multiple revenue streams. None of that is bad, necessarily.
GE’s Q1 earnings sucked less than expected: EPS $0.26 vs. $0.43, but the GE Capital news just keeps getting worse: its earnings dropped 58% to $1.12 billion, but without a favorable, one-time tax treatment, it would have lost $153 million. GE Healthcare wasn’t exactly a bright spot, with revenue down 9% and profits off 22%.
Reading Hospital (PA) will lay off 250 employees.
Turns out the cure for the nursing shortage was a recession. The RN position vacancy rate in Massachusetts is only 4%, with new grads scrambling to try to find jobs. Mass General has a 2% vacancy rate, BIDMC is laying off some nurses, and Children’s has nothing for new grads.
Top military doctors in Iraq aren’t happy with its new tracking system for wounded soldiers. The new system, Theater Medical Data Store (TMDS) replaced Joint Patient Tracking Application (JPAT). I wrote about JPAT awhile back, citing this article and others. Lt. Col. Mike Fravell was a Landstuhl Regional Army Medical Center CIO and VA fellow who built JPAT himself, where it found a wide and appreciative user audience, but his initiative annoyed top brass determined to spend big money on the TMDS replacement system. He was transferred out to his own Siberia. The main complaints about TMDS involve data loading time (it’s run from servers in Virginia) and multiple information links for each patient, making easy interpretation difficult. An army vascular surgeon sounds like his civilian counterparts: “I know JPTA is dead, but our current system is not functional. As we do more with less putting the administrative burdens on the doctors is ludicrous.”
Odd lawsuit: a woman is suing Boulder Community Hospital (CO) and nearly a dozen doctors, claiming that the hot water bottle placed underneath her while she was in labor exactly two years ago left third-degree burns on her buttocks.