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Monday Morning Update 4/27/09

April 25, 2009 News 25 Comments

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 HIPAA was a pretty good 1.0 effort, but it’s hopelessly outdated, seldom enforced, and watered down by special interests.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?)

mda

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.

dennis 

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.

bw

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.

majorbaker

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. 

flash

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.

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Currently there are "25 comments" on this Article:

  1. I liked your idea for a story – perhaps you could use Senator Dianne Feinstein and her husband as the model. She recently awarded her husbands company a lucrative contract to run some hospitals. Of course, although she finally resigned after years of awarding billions of dollars worth of contracts to her husband’s company, I don’t think anything will happen to either one of them.

    Score another one for the Overlords!

  2. Regarding HIPAA – having worked at 5 different healthcare orgs in the last 10 years, it is clear that there is a wide range of ideas about what HIPAA does and doesn’t mean/require/mandate. Some people take it very seriously while to others it is just an annoyance. Many people think you cannot do certain things (like talk about your own health) that it most certainly does not.

  3. Okay, let’s stop the debate. EHRs can indeed improve the efficiency of healthcare delivery. They can also be huge wastes of time and money. It’s only software, folks! If the organization isn’t ready to take on real change, these projects will fail. I’ve seen REALLY ugly software work wonders where there was commitment by the organization. And really crappy results with so-called “leading edge” software when the organization isn’t bought in. I want my doc to have an EHR, but with the right understanding of what’s required to make it work.

  4. I’ve been in Healthcare Informatics since 1987. 3,000,000 air miles are evidence that I’ve traveled to lots of hospitials across North America.

    When I went to Europe in the last milleneum, I could use an ATM to get money from my (very small) bank located in a Central Illinois cornfield.

    How is it that the finance industry found a secure electronic platform making transactions available worldwide yet healthcare can’t/won’t let my records from that cornfield be available as I travel?

    Having worked with hundreds of hospitals, I find it amusing that the phrase ‘We’ve always done it that way!” is the only constant I’ve encountered! Guess it will take an act of Congress to make something happen, or not.

  5. Re: Business Week Article on EMRs

    Darn, they beat me to the punch. I was thinking the same thing and contemplated writing an article that basically said the same think.

    Re: M.D. Anderson Cancer Center

    The most over-the-top spending mentality in all of healthcare. And it doesn’t stop at the buildings. IT is so bloated and it’s not because they are building v. buying an EMR. You would be amazed at the head count in IT. Lynn, time to start chopping with a big ax!

  6. Kaiser USB…
    It’s bad enough if you loose your credit card, but your a phone call away from stopping misuse. Now what if you lose your USB-EMR??
    If they encrypt it, then how can a doc 100 miles away in an ER get at the info? Oh, I see only you know wthe password, but how can you tell me if your unconcious?
    It’s probbaly better than paper…but still has some problems.

  7. Sun’s acquisition of Oracle cannot be good for two great products. MySQL and Jcaps are both great platforms and lord only knows how Oracle is going to screw that up.

    Let’s see, how many CPU’s times the number of users divided by your clock speed and then halved by your cluster virtualized rack

  8. Re: MD Anderson and UT System…

    It’s a well known fact that the UT Health System has a self serving mission, and the comment about frustrated “quasi-private sector activities among executives” is so well known among their peers…look at how UTMB closed the doors to the under and un- insured…those patients were transferred to houston area hospitals.

    IT is indeed bloated at MD Anderson and Vogel commutes weekly from New York to collect his paycheck there…and add more employees with out purpose…Academic Healthcare IT at it’s best (worst)…

  9. “Nom de Plume” wonders why the banking system has a secure digital network worldwide while the healthcare system does not.

    To find out why, one has to ask who does the data entry and what type of data is being entered.

    In banking, when you deposit a check for $100, a lower wage bank teller and back-office clerk keys in the data. Highly-compensated corporate executives earning as much as $250,000 or more are not taking on the tasks of data entry. So, it stands to reason that physicians, who earn comparable salaries, also would be unlikely candidates for data entry. Yet, it seems that everyone expects just the opposite.

    The type of data being entered is also vastly different. In banking, a $100 deposit is a straight forward, one-dimensional data entry task for any clerk. In healthcare, when we are dealing with the human condition and all of its maladies, data entry becomes complex and multi-dimensional; oftentimes with no clear-cut, easy way to enter the data in a structured manner.

    Here’s a real-life example of the problem with data entry in medical offices. My company, SRSsoft, has a client in Connecticut that is a 5 surgeon group specialty practice. I was speaking with one of the doctors recently and we were discussing the data entry capabilities of the SRS Data & Reporting module. He said that he really liked having the patient’s past surgeries and procedures entered into the module and having that information displayed neatly in a clinical summary on the SRS desktop when the patient is selected. The surgical coordinator was responsible for this type of data entry and was able to input data that could trusted as accurate. I then asked the doctor about entry of patient problem lists and display on the SRS desktop. He said that they have four nurses and two of them were competent at entering the problems and two were not. Without the confidence of knowing that the problem list was 100% accurate, 100% of the time, the list could not be relied upon for medical decision making… so the practice abandoned entering the problems.

    Data entry on the massive scale envisioned by the government is a non-starter. If simple patient data inputted by an employee of a doctor’s own practice can’t be relied upon, what’s the prognosis for relying upon data entered by someone unknown to the physician?

    The first step toward a nationwide healthcare IT implementation should address the types of data that can be shared on a national scale such that the data is accurate, will be relied upon for clinical decision making and will achieve the administration’s goals of cutting costs by reducing medical errors and eliminating duplicate tests. To this end, I recommend as a starting point, sharing of prescription information, lab reports and radiology test results.

    A patient’s complete prescription history (which requires one-dimensional data entry) is already available to any ePrescribing user via Surescripts. The unified Rx history, combined with interaction and allergy alerts plus formulary checking reduces error and costs. The government now provides incentives for using ePrescribing and recent reports indicate that adoption is increasing.

    Reference labs and radiology testing centers should be required to make all test result data available to physicians in much the same way that prescription histories are made available. This would eliminate a great deal of duplicate testing and result in better, more efficient patient care and system-wide cost reductions.

    Furthermore, as a first step, the government should provide incentives for physician offices to adopt less intrusive, less data-entry intensive EMR systems, like hybrid EMRs, which have easy-to-use ePrescribing and create efficient, all digital enterprises. Initially, the only requirement should be that these systems have to ‘tap-in’ to repositories of prescriptions, lab and radiology reports. Leave it up to the vendors and physicians to figure out how to best digitize, store and display other medical information that comprises the chart.

    Having an all digital office reduces errors and malpractice exposure as medical decisions are always made with access to complete and accurate medical records (including Rx histories, labs and radiology reports from the sources mentioned above).

    Decreased errors, lower costs for all stakeholders, reduced malpractice exposure, better patient care – all without onerous data entry. This is what the healthcare system needs!

  10. Tim-

    You were very insightful today;
    Your analysis of the BW article especially.
    When you think about it, all the gov’t bailouts and stimulus money is going to places that private equity has no interest;
    Toxic derivatives, Electronic health records, etc

  11. My opinion is MD Anderson could cut 25% of the IT staff and IMPROVE service to customers provided they cut the right people – those “politically connected” directors and managers who add no value and spend all their energy protecting their turf.

  12. I know someone that was interviewed for the Business Week article. He feels totally hijacked. Ninety percent of the interview he talked about how the EHR had improved quality and allowed safe clinical work. Ten percent about how hard it was and how there were some mistakes and challenges along the way. Guess which part of the interview these tools decided to run with?

    I left my copy in the bathroom, in case anybody else wants needs it to finish their “business”.

  13. Why are the buildings over the top? Donors giving millions of dollars want to see these facilites because they are monuments to the donors..what kind of monument is a windowless, cinder-block, building ?

  14. Just curious how the stimulus for Healthcare will “reallly” impact the delivery of care with all the embedded caveats not being discussed? I am also curious with the Presidents plans around Nationalized Healthcare if it “means” our politicians and the Predidents cabinate, staff and family will also be subject to a “true” nationalized haeathcare plan and surrender the luxury of their current plans in place? After all… shouldn’t they be voting on something that will “impact” them as well?

  15. HIPAA

    If I want to view my own lab results on our EMR, Medical Records makes me sign a release for HIPAA. No matter how I word that release (like “expires in 10 years”), they make me sign another for every single encounter before I view the data or I have violated HIPAA by looking at my own EMR.

    Meanwhile, the CIO wants me to create a method for patients to automatically get a portible electronic medical record that they can take to doctor appointments and back to the facility. Updates on both ends. The patient can view the information at any time. “It’s their medical record.”

    Do these people talk?

  16. re: Evan Steele, CEO SRSsoft comments

    Evan has it right! To fast track the move to digital record keeping through ePrescribing is an ideal place to start now that physicians are being given the incentive to participate by increased payment from Medicare. Also the benefits gained are immediate when you are looking at a patient’s medication history as you decide what is the most desirable result you want to achieve when prescribing a new medication for the patient.

  17. Re: HIPAA

    Not sure why we need a law to protect health information — but we have one. Regardless of whether you think it is good, comprehensive, not subject to enforcement its a starting point that every organization should take to heart. You don’t have to stop with HIPAA — come up with some ideas of your own for protecting your patient’s health information and stop standing around whining.

  18. Trust me…the donors don’t donate enough to support those monuments. Perhaps the donation should go to actual research and care.

    and

    if you don’t have money and have cancer – you most likely will not be seen at MD Anderson for long.

    and

    As regards IT staffing “noname” you are spot on…cutting 25% of staff and management starting at the CIO level….will not have an effect on service and probably improve many aspects of it.

  19. I’ve been a HIPAA and Corporate Privacy Officer… I’ve been quoted on the topic, spoken on the topic and been a “victim” of HIPAA violations within the same institution where was was the CPO. People will be people.

    The law is only as good as the policies and procedures but into place to help a covered entity be compliant. Most of us agree, HIPAA doesn’t go far enough and was diluted by special interest groups. But that doesn’t make it a bad law.

    The privacy and security rules are poorly written leaving too much ambiguity. Even today, OCR will answer a question with “that’s a grey area”. So… when in doubt, don’t give it out.

    Far too many people do not understand the law. Most have not even read the entire Federal Register containing the law and published rules. Even my self-proclaimed nemesis, Dr. Peel, mis-states what HIPAA allows and doesn’t allow. Doesn’t mean she’s wrong about HIPAA being too weak. Just proves that way too much is left to interpretation.

  20. Always somewhat amused–and saddened at times–at the uninformed opinions that show up anonymously on blog postings. A couple of clarifications are in order:
    1. 16 anesthesiologists were not laid off at M. D. Anderson; 16 staff members from the Division of Anesthesiology and Critical Care were;
    2. M. D. Anderson’t IT budget has run around 3.3% of operating expenses for the past four years–certrainly on the high end for health care, but hardly “bloated”, by any measure. And this budget has to cover all IT related expenses, including IT supporting administration, clincial care and scientific research–the latter area is one that acute care faciliites never support;
    3. When all else fails, throw brickbats–get rid of “politically connected directors and managers”? Could anyone tell me what this really means?? Does anyone really think that Directors and Managers in any IT organization are “political appointees???
    4. And if the brickbats don’t work, how about personal attacks? I live in and am a voter in the state of Texas; my family does continue to live on the East Coast and I do visit them periodically–at my own expense, I might add. Not sure what this has to do with anything on a health IT blog.

    And MrHISTalk, you have always been above this type of personalization and attacks, and have always asked for factual support for rumors and accusations. What happened this time????? Do you really think that such comments add value to your blog? I’m truly disappointed!

  21. Lynn Vogel, CIO at M. D. Anderson Says:

    M. D. Anderson’s IT budget has run around 3.3% of operating expenses for the past four years–certrainly on the high end for health care, but hardly “bloated”, by any measure. And this budget has to cover all IT related expenses, including IT supporting administration, clinical care and scientific research–the latter area is one that acute care facilities never support;

    An IT budget of 3.3% (high-end, your words) of very high operating expenses, i.e. Anderson is not known for running a “lean” operation, is the very definition of “bloated.”

    And doesn’t MD Anderson’s operating budget include scientific research?

  22. Lynn, ignore all the critics. They’re jealous of your gigantic IT budget. Most people don’t understand that having too much money can cause as many problems as having too little, e.g. keeping track of all those people, keeping a straight face when someone takes a guess of the size of your IT budget and you point out they are off by only one “0”, finding an auditorium that will seat more than 700 for the monthly staff meeting. ☺

  23. Wow, a 20 comment blog entry (that’s a good read). I’m glad Lynn Vogel responded and I think he addressed well a few points (though I think there’s little dispute that MDA has never managed expenses well because, I assume, they always had a robust bottom line — I visited there once and was told by a senior executive that they threw people at problems). A global recession and a stock market crash will hit hard all wealthy organizations, just ask Harvard.

    Mr. HisTalk, what I’d love to see are some interviews with CIOs where you let us readers pose some questions to be asked and answered. This way the questions could be asked and answered instead of the one-way comments.

  24. Dr. Vogel: My reference to “politically connected” is related to internal politics. You know the kind that corrodes morale from the inside out.

  25. Internal politics tends to grow as more staff is hired than needed and have more time on their hands. And those who rise through internal politics tend to compound the problem by putting into practice their belief that more people equates to more power, versus getting more done equals more power. Directors become ranchers protecting and growing their herd while plotting to kick the chair out from under those that are actually getting things done. A real cesspool that is easily fixed by holding the flush in the on position until it disappears down the toilet; and a quick spray of air freshener to complete the task.

    Are you up to the challenge, Dr. Vogel?







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