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News 4/29/09

April 28, 2009 News 19 Comments

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.”

twitterea

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).
 workspaces
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.

 episurveyor

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.

maringeneral

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.

map

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.

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Currently there are "19 comments" on this Article:

  1. Hi Lucy,

    I hope that you do not get cancer…however if you are admitted with that diagnosis bring the best health insurance, and your checkbook, and put your home up for sale…or you’ll be shown the door like many others.

    That was the point I think yesterday.

  2. I fully agree with Inga’s comments about MD Anderson. I had misfortune to see closest family member struggle through cancer and eventually loose them. When you are going through that experience, the surroudings matter for patient as well as the family. You want your family member to get best of the healthcare services, appearances do very much matter in this case.
    Obviously, you don’t want great appearance without quality of healthcare – but that definitely isn’t true for this case.
    The money spent on fancy building is not waste! Is money spent on play areas, toys in childerns’ hospitals waste?

  3. Boy, oh, boy, Mr. H. You are on a roll! Great commentary on numerous fronts, but especially the “140-character flatus stream of ‘what I’m doing right now'” cracks on Twitter. I may be un-hip, too, but I can’t find the allure (nor the time for)Tweets from Twits.

  4. I disagree with Ralph Curmudgeon. An encrypted USB based PHR that is updated with data from each provider visit seems to be a highly portable and private solution. Your trepidations that the elderly don’t have the computer skills to maintain a PHR reminds me of the argument of why physicians won’t use EHR’s. I believe that many of the elderly are ready, willing and able. Let’s start now so that in ten years the nouveau elderly will be well acquainted with the technology. Hell, I couldn’t program a VCR back in 1980, but I sure can TIVo every show I like now. Working from the bottom up may turn out to be a faster solution that relying on the success of a national health record.

    Power to the people baby…

  5. Why would HIMSS require a CDR for meaningful use? Their reasoning: “Such systems are vital as they create the diagnostic information that clinicians require to understand the patient’s status and make effective patient care decisions.” Last I checked a CDR simply stored that information, and created nothing.

    It couldn’t be that all the current EMR vendors use/require/sell a CDR, and are terrified of SaaS, SOA, or anything that could significantly decrease the cost, increase the interoperability, and lower the cost of changing from their systems to something else, could it? If they could slip that little requirement under the radar, that would be quite the little gotcha to anybody contemplating those initiatives. And to think, just above that they mention leveling the playing field for best-of-breed systems.

    Seriously, if we had any doubt that HIMSS lives in a different world than, well, the world, the pretentiousness of them announcing “meaningful use” is overwhelming. Sadly, I fear they might actually be listened to.

  6. I use TweetDeck. I use twitter primarily to share interesting tidbits I find on the internet. I try not to make it totally mindless, saying either something interesting with a good link, or something personal that the people I know who follow me would find interesting. I agree though that much of the stuff on there is just crap.

  7. re: Mr. H’s comment about the cyber-attack

    Mr. H will be surprised to hear the nerdy TPD, early in a working career, worked for the National Radio Company as a QC Inspector for NCX-3 and NCX-5 Ham Transceivers before enlisting in the Air Force. We have something in common that wasn’t known before now! Do you miss saying 10-4?

  8. One comment regarding “meaningful use”. Let’s not lose sight of rural healthcare in our efforts to define who is and who isn’t using technology in a meaningful manner. Many rural facilities are still trying to figure out how to afford the technology. Once that hurdle has been crossed, they have to figure out how to properly install it. While the capital costs can certainly be daunting, the total installation costs can dwarf capital requirements. Most rural facilities are not flush with staff to spend the time necessary defining standards, revising workflows, building applications and providing training.

    I am certainly not saying rural sites are back in the dark ages, but many are not able to stay on the same HIT implementation timeline as their metro counterparts. If the definition of “meaningful use” only takes into consideration the advances made by metro facilities, the rural facilities could lose out.

  9. >> “[Obama is] incompetent when it comes to execution”

    That’s quite a bold statement! You can either be in the camp of the Federal Government should do nothing in response to this economic crisis except cut taxes and regulations or in the camp of the Federal Government should keep the economy from falling off the cliff and for helping out those most deeply affected. I’m OK with the latter, even though I’d love to pay less taxes.

    Will Obama’s actions (stimulus bill, bank support, forced auto industry re-structuring, initiating healthcare reform to address 2020-2050 cost explosion forecasts, investing in new energy sources, extending unemployment benefits by a few months, subsidizing COBRA for the unemployed for nine months, and more) work? Will the country be better off in 1, 2, 5, 10, 20 years? Probably. Will history show he could have done some things better, absolutely. Is he taking action? Yes. Is he working on the tough issues? Yes. Has he done things. Yes. Is he ‘incompetent’? Boy, I don’t even hear Fox News call him that. Sure they call him a Socialist and deride the United States of Sweden (presumably because we’re going back to the tax rates of the 1990s), but they don’t call him incompetent.

    Not sure what you mean when you say he’s incompetent. It’s a bold statement. I don’t really want to hear you elaborate — I don’t want to talk politics on this blog. I just had to respond. I’m glad you say you want him to succeed. I’m not sure I believe you.

    If Obama’s incompetent, what was G.W. Bush? Brilliant?

  10. I have to agree about the pleasant surroundings when you are going through cancer. I am a survivor myself and it DOES have an impact on how you feel, and your ability to maintain a positive attitude. When my father had cancer and was a great academic facility, but which had really drab, icky, and depressing surroundings, it just FELT like he was going to die there – and he did. I was horrible to have to go visit him every day in that bland, dark environment. So, we would all agree that the care has to be the best as well – but do not diminish the impact of the environment. Just think how the weather impacts your outlook on the day – most of us feel more positive and upbeat and healthy on a sunny, warm day with bright blue skies – and most of us feel depressed, somewhat, by cloudy, chilly, grey days, especially when they go on and on – like ongoing visits to the oncology ward.

  11. It is interesting how much has been written about MD Anderson. Me thinks it has more to do with the inequity in healthcare. While MD Anderson has 5-start facilities and equipment fighting a terrible disease like cancer other healthcare facilities that take care of the sick and dying from routine events like car crashes, shootings, heart disease, and diabetes must make do with much, much, much less.

    The dialogue may have more to do with the sense of fairness in how healthcare dollars are allocated.

  12. Re: Fair and Balanced remarks…
    You say…”I don’t really want to hear you elaborate — I don’t want to talk politics on this blog.” Yet the longest comment thus far is yours, and it’s all politics. Sounds more like you want to do a drive-by hit ‘n run.

  13. ” Deciding on Doritos or Cheetos…hmm, can’t decide”- just thought I’d add some “Twitterization” to your blog.

    Speaking of Sebelius taking office without a team..why am I reminded of John Belushi’s Animal House Scene –when the German’s attacked Pearl Harbor- …
    “Who’s with me? AYYYYYYYYYYY”

  14. Hmm, often agree with you Mr, H but not today.

    First, Twitter can actually be useful if you take the time to learn how to use it effectively. Begin by not following everybody that follows you, focus only on those who provide useful comments. Next, it does not have to be a day long activity, use sparingly ck’ing in every now and then. Third leverage search capabilities to further focus (eg use hashtags). I have found it quite useful to keep tabs on various happenings in the market and now go to Tweetdeck first in the morn then my RSS reader as those I follow have already sorted through the haystanck of info to provide me the silver pins.

    As for the HIMSS recommendations on “meaningful use” I found them to be terribly self-serving to themselves, their close partner (CCHIT) and the legacy vendor community. Nowhere has HIMSS come forth to promote innovation, it’s all about preserving the status quo. The last ting they want to see is any major rocking of the boat, opening of the gates that will actually foster innovation and who knows, maybe even begin seeing applications that doctors will want to use and pay for, without any incentives.

  15. I’ve had the fortune of working with Boston Medical Center in the past, and they just built an amazing cancer center. It is the ‘free care’ hospital in town, and this building (besides being beautiful) brings all cancer care under one roof (surgery, testing, outpatient, offices). Noone can imagine how tough it is to get cancer, but getting it and being poor is a double dose of trouble. Many folks don’t have a car, or $ to park the car, or can’t get off work for treatment, or don’t have anyone to help them through the process. Cancer treatment is an intensive time suck, and unfortunately some poor folks have so many bigger issues that they can’t follow through in their care. It’s not a small issue. So I highly commend BMC for their building and recognition of what this building can do for the patients most in need. Poor people have a right to be treated in a nice environment just like MDA patients do. No problem in my mind that the built a beautiful building instead of a cement block that would have been cheaper. And the BMC nurses rule!

  16. TPD: No self-respecting Ham operator would say 10-4; that’s for CB’ers.
    My dad was a Ham operator from the mid-1920’s until his death in the late 80’s. He, to the best of my knowledge, never used 10-4 and really didn’t care for CB’s either since they didn’t have to go through the testing from the FCC as Ham operators did.

  17. Hammy,

    I stand corrected on the 10-4 question as I never was HAM operator and don’t want to offend Mr. H’s past Ham activities even though I worked in the that field at the National Radio Company. I was a CB’er for awhile when it was hot to be one, so that’s where I got to say 10-4 to mostly truckers. My apologies to any HAM operators I may have offended.

  18. Re: MDA and “The dialogue may have more to do with the sense of fairness in how healthcare dollars are allocated”

    For what it’s worth, NIH research dollars are spent as follows: $2,774 for each AIDS patient, $3,967 per Breast Cancer Patient, $7 per CPOD patient and $39 per diabetic.

    (No I don’t work for the links below or give them money. I just find this kind of info fascinating in light of our current momentum to turn over our individual health care to the government.):

    http://www.fairfoundation.org/factslinks.htm
    http://www.fairfoundation.org/update.htm

    I wish I could find the same data for treatment dollars per disease or illness. Anyone know of one?

  19. I’m also a user of Tweetdeck. I also usually try to only “tweet” news/tips/”cool stuff” but occasionally I do post random stuff about my day too. I think it is somewhat of a fine balance though.

    Someone who is just pushing their product/website/etc. is just as bad as someone that is posting “I’m hungry, I’m going to eat an apple” then 5 minutes later “That apple was good, I’m not hungry anymore” (and the like).

    From news to sports to music, I have found that I visit news websites a lot less because I click on the links when they’re posted on Twitter. While far from perfect, I think it is a very useful tool in communicating with others.







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Reader Comments

  • FLPoggio: What this piece totally ignores is that you and the provider (roofer) dealt directly with each other. Now what if you ha...
  • AC: That's not an apt comparison. Imagine instead if while the roofer was doing his thing, another random roofer dropped by ...
  • HIT Girl: I've worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got m...
  • Joy Goodspeed: So funny about the physician card. I wrote my 3rd HL7 Lab and microbiology interface in my 20-year career this past yea...
  • Anonymous: Did you just compare Healthcare to roofing business ? Imagine a surgeon operating with a body cut open, should they take...

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