Federal agents from the Defense Criminal Investigations Service raided the offices of Siemens Medical Solutions in Malvern, PA today, according to a Philadephia TV station. Agents armed with search warrants secured employee workstations, seeking documents related to the company’s military contracts.

UPDATE: Inga contacted Siemens and received this response:

Statement Regarding Government Inspection at Malvern Facility of Siemens Medical Solutions USA, Inc.

Malvern, Penn., April 22, 2009 — Siemens Medical Solutions USA, Inc., the U.S. operation of Siemens Healthcare, has been served with a search warrant. Siemens Medical Solutions USA, Inc. has and will continue to cooperate fully with the Government’s investigation.

 View/Print Text Only

Sense of Reality
By Greg Weinstein

I have been working on clinical systems and integration in an academic medical center for 20 years now and I am watching with growing concern the frenzy of the standards writers. Prior to going to HIMSS, I took the time to read some of the HITSP specs – specifically. the C32 document sections related to medications. Everyone has a problem with sharing medication lists and everyone wants to do it right. But while C32 has over 30 data elements for each medication record (down to the lot# and bottle cap style) the only thing required was the text of the drug name. When I asked people how they could build a data sharing system (NHIN, RHIO, HIE) with only that requirement, they answer that, within each exchange, the “details need to be agreed on”. This sounds a lot like the failure of HL7 v2, though with a lot more baggage.

I visited the IHE Connectathon at HIMSS. What I saw was not encouraging, but entirely predictable. The scenario demonstrated a patient moving through a series of care facilities with CCDs used to transfer the patient’s record. Naturally one site included only the medication names (actually they stuffed long strings with the names, routes, frequencies, dose all together into the name field) and embedded this in their CCD. The next site expected to receive the medication name, route, dose, etc. as separate fields and was unable to import the data. The demonstrator began manually re-entering the data by reading the long multi-element strings and using the data entry form of his own system. This might have allowed entry of the data into his system, but almost certainly lost the data “provenance” (that it arrived via a specific signed CCD). 

After a few minutes, the crowd became restless and he gave up, skipping the last four medications. He then generated his CCD and transferred it to the next system in the scenario, which, amazingly, only saw the medications from the last CCD, where four medications had been omitted. In fact, the contents of the multiple CCDs reflected the system limitations of the various systems more than they did the actual patient state being represented in the scenario.

Against this background of non-success, we see CCHIT certification scenarios of ever-increasing complexity and new HITSP requirements to include every data function ever conceived. And then we see published research stating that no one has proven that any of this actually improves outcomes.

Regarding CCHIT, the entire focus of application certification is wrong. We ought to be asking providers to support certain functions. The CCHIT approach of application certification implies that a single system needs to do everything. Why couldn’t a provider choose to use more than one piece of software so long as their practice did what was needed?

I sincerely hope that someone will be able to calm the waters, make rational decisions on what data is most valuable to share (medications, allergies, problems, labs, images, and “documents”), and how to go about it.  Without some focus and reasonable expectations, we may waste an entire generation of software development activity, kill innovation, and crush smaller companies, all without tangible benefit.

MUMPS to Java … Caveat Emptor
By Richie O’Flaherty

I couldn’t let this pass un-commented, having had some direct experience in language translations many years back in which the organization I was a part of translated a number of applications (mostly in-house developed) from Meditech MIIS and MaxiMUMPS. While most of the pain occurred in the MaxiMUMPS translations due to extensive non-ANSI standard extensions in the language implementation, a common theme (pronounced "fly in the ointment") became apparent in the implementation of the resulting application.

This was the shocking performance impact of the translated code. Differences between how language components are coded in the source and destination languages can have crippling effect on the translated application. A primitive operator in the source language may or may not exist in the target language. If it doesn’t exist, an equivalent piece of code must be written and invoked everywhere it occurs in the source application code. That may involve many instructions or even many lines of instructions as well as overhead to invoke and clean up every time it is used. 

The difference in the number of machine cycles to execute these "equivalent" components can (and did) bring the translated application to its knees, requiring rethinking of hardware configurations as well as targeted application redesign in the resulting language to salvage the very life of the system which was the principal IT solution for a major outpatient clinic.

I am not a Java programmer so I cannot offer perspective on speed and efficiencies that Java may bring to the table, only that this is and was the massive piece of the iceberg in our translation efforts involving MUMPS. It should be noted however, that MUMPS (and MaxiMUMPS) cut their teeth supporting an impressive number of simultaneous users on hardware that had but fractional MIPS ratings. That these outmoded dinosaurs are yet running applications anywhere is a sure sign that the possess a level of efficiency that should be at minimum respected, but more advisedly investigated when seeking to translate them to anything. Iron is certainly cheap(er) these days, but I reiterate — caveat emptor.

Do You Know What’s In Your Medical Record?
By Deborah Kohn, Principal, Dak Systems Consulting

One must go back to ePatient Dave’s main point (albeit difficult to find given all the exchanges and text): "Do you know what’s in your medical record? THAT is the question worth answering."

It doesn’t matter if the data are stored on paper, on analog photographic film, or on a digital storage medium. The only way one will be truly responsible for one’s health is to get copies (analog or digital) of one’s complete, episodic medical record, review the record with one’s provider(s) if necessary, and if errors are are found, correct them. Because one deals with people, processes, and technologies, data inaccuracies occur all the time!

However, since the 1970s, patients have been allowed to access the information contained in their medical records, and since HIPAA "I", patients have been allowed to add addenda to their records. Similar to obtaining and correcting the data contained in one’s credit report, one must ask to do this.

As a health information management professional for over thirty years and long-time member of the American Health Information Management Association (AHIMA) whose banner remains "Quality Information for Quality Healthcare", I never NOT obtain copies of my episodic medical record for review, archive, and information exchange purposes. Hopefully your readership will do same.

For example, as a health information management professional (fortunately or unfortunately) I knew only too well that when I was hospitalized five years ago my clinical records (created and stored in both analog and digital formats) would contain inaccuracies. One operative report contained my correct demographic information in the report header but described me as male (I’m a female) with inoperable colon cancer in the report body. (Either the surgeon or the transcriptionist had mistakenly switched the dictation based on another case that day). Subsequently, these data were coded as such for billing /reimbursement purposes (ICD/CPT) and clinical purposes (SNOMED), making no difference had the data populated a Google or Microsoft or other PHR.

In summary, to answer another question asked in one of the blogs, " Who’s going to validate and correct the data?", the good news is that health information management professionals working in all types of healthcare provider organizations are not only trained but tasked to validate these data. The not-so-good news is that given staffing constraints and other similar issues, it is not and never will be possible to audit 100% of the medical record content in 100% of the cases. Therefore, only YOU, the patient, can and must review and correct the data.

 View/Print Text Only

From Susie Adamo: “Re: CCHIT. Definitely adding headcount. They just hired Bobbie Byrne, who is a pediatrician who recently left Eclipsys, where she ran clinical strategy.” Unverified – not yet reflected on her LinkedIn profile or on the CCHIT site.

From Stella Artois: “Re: Being John Glaser. I love the column. I had dinner with John one night, touched his shirt sleeve, and didn’t wash my hands for days (despite all infection control precautions). He is my idol and I do so love his latest inspirational post that I am handing it out to wannabe CIOs.” John’s postings may be less frequent as he starts his ONCHIT gig in a couple of weeks, so he may be busy and/or muzzled. I replied to his e-mail asking if he’ll get to bunk over in the Lincoln Bedroom, run up a big expense account tab, and enjoy the thanks of a grateful nation. He said he’s not sure about all that, but he’ll be able to to see the Capitol from his office window. Well, that’s fairly cool.

From The PACS Designer: “Re: Oracle buys Sun. Mr. H. and HIStalk readers know that TPD has been fond of Oracle for their focus on the healthcare space. Now, an Oracle-Sun Microsystems combination will bring a powerful offering of open software solutions that prospective customers can choose to meet their upgrade needs. Additionally, Sun Microsystems storage solutions can further enhance the performance when integrating numerous databases within the enterprise to create a neutral archive.”

From Californian: “Re: the data model that nearly killed Joe. It’s from Epic. Would you have the courage to publish this factoid?” Apparently I would. Still, to single out Epic wouldn’t really be fair since the problems he describes mostly involve (a) caregivers who didn’t use the system; (b) caregivers who didn’t deliver patient care all that well; and (c) caregivers who were using a system that they claim wasn’t designed well for their work (or could it be that their work wasn’t all that well designed and standardized that no amount of programming could support it?) and (d) caregivers dealing with patient information stuck in the the never-ending and very deep chasm between outpatients and inpatients (which are actually the same patients, of course) created by different billing rules (they don’t even speak the same language, such as “episodes” vs. “visits”). Nobody puts a gun to the head of a hospital and/or practice group to buy a company’s software, so if it doesn’t work well for their situation, I’d put the blame on the user for voluntarily choosing it. I wouldn’t be able to critique the data model without seeing it and neither would a patient who experienced what they felt was substandard care, no matter how technical their background. I doubt any hospital could say with certainty that they don’t have stories just like that one in their own place.

A Hartford Courant article points out astronomical non-profit salaries even while big company CEOs and Wall Streeters take their public lumps: UPMC’s CEO made $3.3 million in 2006 and hospital CEO Gary Mecklenburg made $16.5 million the year he retired. One state United Way CEO made $1.2 million in a year. From the article: “Every year I sit in editorial board meetings in which CEOs of nonprofit hospitals come to press their case for more public money. They want taxpayers — bus drivers, small-business owners and public school teachers — to send them more to cover the hospital’s charity cases. And every year I can’t help but think: Before you come asking for more public money, you need to reassess your own remuneration. Until top salaries are more in line with, let’s say, the salary of a U.S. Supreme Court justice, a position that currently pays $208,100 and has no trouble attracting top talent, the poor-mouthing is a little too self-serving.”

Is this reasonable? An uninsured man had what he admits was life-saving surgery. He couldn’t pay the bill, so the hospital turned it over to a collection agency. His only asset is his house, so he’s going into bankruptcy but will still have to sell the house to pay up. He calls it a “gross injustice” and wants people to demand “affordable health care”. If the hospital writes it off for him (not unusual when the press runs stories like this), someone else gets stuck helping the hospital make its margin. Should surgeons be paid less, or drug and supply companies, or hospital CEOs ($300K in this case), or nurses? The “healthcare should be cheaper” argument requires a corollary that “someone is overpaid,” so who? If someone asked him before the surgery, “You will die unless you’re willing to sell your house,” wouldn’t he have done it? Healthcare is run like a semi-business, but we seem to want it to be a charity again like it used to be (without the multi-million dollar CEOs plotting takeovers and layoffs, anyway).

HERtalk by Inga

From Large and In Charge: "Re: consultants. I have plenty of consultant names now. Thank you! More than I expected." 

From John T: "Re: ICE. So, now that there is a new acronym in the marketplace, ICA finally has a solid place in the market. We’re an ICE Vendor – pretty cool. Actually, downright cold!" In case you missed it, ICE stands for Integrated Community EHR.

Dr. Lyle, a regular HIStalk commentator has initiated his own blog entitled, The Change Doctor. His initial post focuses on the "Three Is" for EMR adoption. One likely to create some controversy is Dr. Lyle’s take on interoperability: "While many say that we don’t have enough, I’d actually argue that we are so obsessed with this issue that we are losing the forest for the trees. In other words, let’s get doctors using systems first, and worry about interoperability later."

Ontario Systems signs a multi-year contract with Memorial Sloan-Kettering Cancer Center, which includes the purchase of Ontario Systems Revenue Savvy software.

Montefiore Medical Center’s IT subsidiary Emerging Health Information Technology signs a multi-year hosting agreement with the North Shore-LIJ Health System (NY). Emerging will provide support for a portion of North Shore’s computer network.

The folks at Vitalize Consulting Solutions collected almost $2,000 for the hungry during the HIMSS conference. Vitalize accepted food donations and cash to benefit the Greater Chicago Food Depository. Wouldn’t it be great if more vendors used such creative "marketing ploys?"

2008 was something of an off year for Cerner’s Neal Patterson, who received 8% less compensation than the previous year. His total package — including base pay, stock options, use of the company aircraft, and other benefits — was approximately $3.5 million.

Perot Systems signs a multi-year agreement with The Christ Hospital (OH) to provide revenue cycle services.

RelayHealth introduces FastTrack5010, a online informational resource center to help health insurers prepare for and comply with new HIPAA 5010 transaction standards. The deadline for the new claim version, by the way, is January 1, 2012.

The FCC approves $35.6 million to fund the development for five telehealth networks to link rural hospitals in nine states. The Rural Health Care Pilot Program is allocating the money, plus an additional $10.4 million for the Alaska Native Tribal Health Consortium to connect rural healthcare providers.

EHNAC announces a new accreditation program for application service provider-based EHRs. The new ASPAP-EHR (catchy name) is seeking participants for both its ASP and HIE accreditation programs. Do we seriously need another certification program? And really seriously, enough with all the acronyms already.

The ever-turbulent MedQuist names Dominick Golio as CFO. Golio previously served as North American CFO for D&M Holdings.

The Children’s Hospital of Pittsburgh of UPMC celebrates the grand opening of its new campus with a ribbon-cutting ceremony. The first outpatients are being seen this week and the hospital officially opens May 2nd.

The New York eHealth Collaborative partners with InterComponentWare and Surescripts on a prototype project to facilitate prescription routing and the the delivering of  prescription histories.

Tenet Healthcare announces its preliminary Q1 numbers. Net income is expected to be $178 million compared to a $31 million loss in 2008. EPS is projected to be $.37/share compared to last year’s $.06/share loss.

TeraMedica Healthcare Technology and Compressus partner to offer an enterprise-wide solution to provide comprehensive clinical workflow, data management, and a unified view to the resident EMR system. Teramedica is a provider of enterprise imaging and information management solutions, while Compressus specializes in interoperability and workflow solutions.

The New York State Department of Health selects APS Healthcare and Thomson Reuters to manage its state Medicaid clinical practice utilization review program. The program examines how Medicaid patients utilize medical services and explores patterns of potentially unnecessary care and opportunities for improving patient safety or quality of care.

The LA Times explores the huge industry of outsourced transcription to Asian countries. In the Philippines, 34,000 transcriptionists generated $476 million in revenue last year. Experts predict revenues to exceed $1.7 billion by the end of 2010. Most work costs $.10 to $.15 per line and is delivered within 24 hours. In the Philippines, a fast transcriptionist can earn about $6,000 annually, which is about three times a nurse’s salary. The median income for American transcriptionists is $31,250 a year.

Kentucky Lt. Gov. Dan Mongiardo proposes that Northern Kentucky University become a national laboratory for testing the financial viability of EHRs and is seeking up to $500 million in federal money to get it started. His proposal includes a study of how healthcare providers can set up cost-effective e-health systems. I suppose a good way to make it cost-effective is to have the government give you $500 million up front for an EHR. Mongiardo happens to be running for a US Senate seat that becomes open next year, so one has to wonder if his actions are at all politically motivated. Nothing like working to get a little extra pork for the home state!

I was flattered that Matthew Holt forwarded me an invite to the Health 2.0 conference that starts Wednesday in Boston. I won’t be able to make it, but if you are attending, make sure Matthew wears his Inga 2.0 sash.

E-mail Inga.

What Will Oracle’s Acquisition of Sun Microsystems Mean for Healthcare?
By Orlando Portale

Reading about the acquisition of Sun by Oracle yesterday brought back some fond memories for me. I recall a discussion that my team had while sitting in the lobby of Oracle’s headquarters in 2003. We were there to meet with John Wookey, the head of healthcare (now at SAP) to discuss how we would continue to align Sun and Oracle’s business development programs. 

While hanging around Oracle’s lobby, my team began discussing how a potential Sun/Oracle merger made a lot of sense. Our products fit together very well and both companies had a strong culture of innovation. We discussed how Oracle had embraced Java as its standard for software development and the many deals we had captured together. Unfortunately, the discussions didn’t go anywhere, although in hindsight, it could have been a game-changer. Better late than never, I guess.

In my view, the acquisition of Sun by Oracle is synergistic for the following reasons:

• Oracle invested millions in standardizing all of its applications to Java. Therefore, outright ownership of Java is a plus for Oracle. IBM has also embraced Java, but Oracle will have increased leverage over them.
• Oracle and Sun already have a large installed base in common. Many of the largest databases in the world run on these platforms.
• Sun recently acquired MySQL, the open source alternative to the Oracle database. Oracle can now control MySQL’s destiny and any negative revenue impact it could have had against its own flagship database product.
• Sun and Oracle have always been in the anti-Microsoft camp. Sun owns Open Office, a robust and cheap alternative to Microsoft’s cash cow. This represents another opportunity for Larry Ellison to stick it to Microsoft. In addition, there are opportunities for tighter Open Office integration with Oracle enterprise applications (e.g. Peoplesoft, Siebel), thereby obviating the need for third party Microsoft licenses.

What effect will the acquisition have on the HIS software vendors?

Cerner has a sizable installed base already on Oracle. Most of these systems are hosted on IBM hardware under the AIX operating system, and NOT on Sun Solaris. Cerner has always refused to support Sun’s Solaris OS. That may change now, if Larry Ellison drops a dime. During my time at Sun, I tried to broker a meeting between Sun CEO Scott McNealy and Cerner CEO Neal Patterson. McNealy was eager, but Patterson said he saw no reason why they should speak. "Open systems, Java, Solaris … who cares.” Hello Neal, it’s Larry calling.

With respect to Cerner and Oracle, here are three potential scenarios:

1. Oracle Wins/IBM Loses = Cerner + Oracle + Solaris OS
2. IBM Wins/Oracle loses = Cerner + IBM DB2 + IBM AIX OS
3. Status Quo = Cerner + Oracle + IBM AIX

Note:  Other vendors such as Epic have a MUMPS installed base and are mostly hardware and operating system agnostic. Therefore, I believe this acquisition will have a minimal impact on Epic.

The other area of interest for healthcare customers will involve the status of Sun’s SeeBeyond SOA/Integration platform. At one time, SeeBeyond held considerable market share in healthcare, particularly for  HL7 messaging and system integration. However, in recent years, Sun has let SeeBeyond slip by the wayside. Oracle could gain considerable traction in the healthcare space by bolstering investment in SeeBeyond. This is a particularly useful platform for enabling HIE/NHIN integration. 

What will Oracle do with Sun’s assets after the acquisition?

First 180 days:

1. Rapidly cut Sun’s sales, marketing and back office functions by integrating them into Oracle.
2. Consolidate the Sun software and R&D organizations into Oracle.
3. Create a separate hardware division. Consider either continuing the hardware business or divesting the assets to companies such as Fujitsu or Cisco.

Post 180 days:

1. Oracle will begin create tightly bundled system stacks which incorporate hardware and software components. Oracle will now have all layers of the systems stack under its umbrella, including the storage, server, operating system, programming language, database, Web services, etc. If Oracle goes to market with integrated system stacks, it could put considerable pricing pressure on its hardware competitors.
2. Integrate Sun’s open source cloud computing solution infrastructure with Oracle technology. These solutions are ideal for startup companies looking for cheap entry level systems.

What will be the potential impact on IBM, HP and Dell?

From a hardware stand point, HP and Dell may have the most to lose.  Today, both companies have captured significant revenues from their relationship with Oracle. If Oracle retains Sun’s hardware business and begins going to market with integrated hardware and software systems, it will find itself in a channel conflict with HP and Dell. Will HP and Dell be forced to work more closely with IBM to capture DB2 deals? This is problematic as well, given that IBM already sells competitive hardware platforms and can embrace a similar integrated system strategy. Should this scenario play out, clearly HP and Dell will be at a disadvantage by virtue of not owning the components of the software stack.

IBM will need to revisit its long-held Java strategy, including its heavy dependence on Java for the Websphere platform. IBM will seek assurances from Oracle that it will have equal access to Java in the future. Otherwise, the only other major development platform for IBM to embrace would be Microsoft’s .NET. A shift by IBM away from Java and toward the Microsoft .NET platform would be a monumental and costly move. In years past, when confronted with this situation, IBM would just release its own new proprietary competitive development platform, but IBM no longer has that leverage in the industry. Hello, Sam, it’s Larry calling again.

Orlando Portale is Chief Innovation Officer, Palomar Pomerado Health District, San Diego, CA, and former GM Global Health Industry, Sun Microsystems.

 View/Print Text Only

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.”

Speaking of IBA, it acquires Hatrix, an Australian vendor of eMAR systems.

Alaska, already the most pork-heavy state, zips through a bill pushing electronic medical records, hoping to grab some stimulus money.

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.

E-mail me.

 View/Print Text Only

From Rick Weinhaus MD: “Re: Cheezborger and usability. I agree completely. I also found Dr. Bradford’s special article in January on usability, as well as the comments, right on the mark. The promise of EHRs to improve patient care, reduce costs, and minimize errors will never be fulfilled until the software becomes more usable. As a physician, I have had first-hand experience with several EHRs. On the basis of these experiences and my sense of what mental models I actually use in taking care of patients, I have proposed two EHR design idioms to improve work flow and reduce cognitive load. If any readers would like to see detailed descriptions including graphics, they are posted as threads on the EMR Update website.” Link 1, Link 2, Link 3. Jim Bradford’s excellent article is here.

From Pete Potamus: “Re: war game EMR predictions. How about making EMRs easier to use? This includes personalization by physician or nurse, select versus enter, dictate complex orders in ‘human’ terms; use voice recognition and personalization to present the order for review and approval. Physicians and nurses are busy people. Make it easy and they will use it. Design it so they do more work and they will resist using it. But who wouldn’t respond the same way?” I like the idea, but everybody says the same thing and the products are still never really retooled. Apple creates its own market every time it adds its considerable design expertise to otherwise pedestrian and commoditized products. Why hasn’t it happened with healthcare software? I see only two possible answers: (a) customers are buying anyway, so the redesign isn’t necessary to make sales; or (b) vendors don’t expect to get ROI from doing it even though prospects say they want it. 

From Val Kelly: “Re: Epic layoffs. The last number I heard was about 400 people who were asked to resign in January and February. It’s hard to say for sure since they were told not to talk about it.”

El Camino Hospital gets a second campus and CMIO Eric Pifer gets a hospital president’s job. Interesting financial tidbits: ECH has $400 million in cash and $1.1 billion on the books (note to self: recheck the definition of “not for profit”). Not to worry though – projections are that the new place needs a daily census of only 42 patients to throw off $11 million in annual profits … sorry, margin contribution … starting the third year.

Hedge fund Tremblant Capital discloses that it has taken a 6% stake in Eclipsys.

Listening: The Cliks, an outstanding hard-rocking Canadian band (which happens to be all-LGBT). I’m desk-drumming to Oh Yeah (seventh song down in the player). And I admit I don’t watch much TV, but I’m liking 30 Rock (smart women like Tina Fey are hot, yes?) and I’m enthralled with Brit talent show singer Susan Boyle (while the cynic in me says it could be a stunt since she surely had to audition in front of someone to get there, but watching the sniggering, superficial audience and judges reduced to slack-jawed awe and near tears is still priceless). I could get pop culture if I had more time.

The son of British TV magician Paul Daniels, an IT support manager with an NHS trust, is charged with fraud for allegedly engaging a company to perform phony IT work and skimming a fee in return for approving the invoice.

JPS Health Network (TX) mulls over a potential $150 million project to implement electronic medical records, hoping to suck up some stimulus money but still worried about the upfront cost. Nobody wins those deals except Epic, so you know they’ll be calling Judy if they get their nerve up.

South Nassau Communities Hospital (NY) goes live on the Forerun ED dashboard application commercialized from BIDMC.

It’s reader survey time! It’s a quick, non-annoying way for you to let me know how to make HIStalk better for you. Here’s the link. Thank you.

A reader asked if the HIMSS presentations can be downloaded yet. They were giving a link at the conference, but the member pages don’t show the 2009 files yet.

TeraMedica will partner with Compressus Inc. to create a workflow and data management tool that will make all of an enterprise’s imaging systems and databases available from a single worklist and will support data exchange.

Natividad Medical Center (CA) hires Kirk Larson from Cerner as CIO, intriguing the local paper because he stands to make more than previous CEO ($185K and up to a 30% bonus). Seems kind of rich for a 172-bed county hospital to pay up to $240K for a CIO to run what must be a fairly small IT shop.

Two companies selling MUMPS-to-Java conversion try to convince the DoD and VA to give them a big contract to turn VistA into a semi-new system that will run on something newer than aging DEC Alphas. The estimate to develop a new system: $15 billion (!). The estimate to convert VistA to Java: $125 million over 2-5 years, including replacement servers. The problem with that kind of porting is that all the internal expertise has to start over with a new language and database (and the fact that the resulting source code is next to unreadable and free of comments to provide documentation, at least in my limited experience). And I miss the Alphas, personally.

The local health district is trying to figure out who will help Petaluma Valley Hospital (CA) pay to replace its retired A4 hospital system with Meditech. Perot told them Meditech was a logical fit, which seems kind of self-serving since it owns the former JJWILD and needs work for those people. The hospital’s parent company has Meditech and PVH can jump on for $2.8 million, but they’re worried about parting ways when the hospital lease is up.

Bad Philips numbers have investors worried about GE’s, to be reported Friday. I’m not sure how anyone could expect good GE numbers given their big exposure to bad markets (construction, manufacturing, big-ticket healthcare equipment, aviation, and of course albatross GE Capital), but maybe they will surprise positively. The stock price is at 1995 levels, but then again the Dow itself is at 1997 levels.

Backup tapes from Penisula Orthopaedic Associates (MD) containing information on 100,000 patients are stolen from a courier’s vehicle.

This is an excellent first-person story by a technologist about how bad healthcare data models nearly killed him in facilities with supposedly state-of-the-art EMRs, leading him to conclude that any kind of nationwide health network will never work. HIT people should read every word since it dashes the notion that having an EMR means improving care. “Medical personnel at urgent care and the hospital who interacted with me all used a version of the same electronic health information system (the ‘system’). It became clear that everyone was fighting that system. Indeed, they wasted between 40% and 60% of their time making the system do something useful for them … I was in ER for 20 hours before being admitted to the intensive care unit (ICU) where I spent another 28 hours. Throughout my stay, I was hooked to network attached monitors that incessantly sounded alarms to which no one responded. I was asked 11 times to repeat my medical history, medication, and allergies to as many different medical professionals. I was seen by seven doctors each of whom asked me similar questions. Five doctors were never to be seen again. All doctors mumbled something about putting their findings into the hospital’s electronic records system – most did not according to ICU nurses. No one read my allergist’s detailed report about my condition and health history.”

Groups line up against the Australian government’s plan to use patient medical records to detect Medicare fraud. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see.”

Tech Mahindra acquires Satyam for $578 million, giving it 425 acres of land, 48,000 employees, and a big footprint (not to mention a reputation sorely in need of repair, but not unsalvageable). It’s hard to believe IBM didn’t beat that bid.

Odd lawsuit: a woman microwaving hair removal wax and apparently not following instructions overheats it, then spills it as she tries to take it out of the microwave. She was burned on the thigh and chest. She’s suing the wax manufacturer for $160 million.

E-mail me.

HERtalk by Inga

From Deborah Peel: "Re: stolen laptop at Moses Cone. The new security protections for health IT in the stimulus package require encryption of data, which will help prevent thieves from being able to use personal data in the future. But that is not enough to prevent future privacy violations like at Moses Cone. Strong state laws and medical ethics that require patient consent before medical records are disclosed were violated, but victims will have to go out and hire their own lawyers to sue hospitals and vendors to enforce these rights and protections. The stimulus package empowers state AGs to defend citizens’ privacy rights in HIPAA, but in 2002, HIPAA granted rights to hospitals like Moses Cone and over 4 million other ‘covered entities’ to disclose YOUR personal health information to outside vendors like VHA for any ‘healthcare operations’ or business use like ‘improving care’ or ‘reducing costs’ without your informed consent. Congress should have closed this giant privacy loophole in HIPAA, too."

From Large and In Charge "Re: EMR consultants. My large practice in the Midwest is looking at EHR options. Can you recommend any consultants?" If you are a consultant and/or have any names to recommend, let me know and I will forward to Large and In Charge.

The County of Los Angeles signs a contract for iMedConsent, an informed consent and patient education system by Dialog Medical. The product includes thousands of consent forms and patient education documents, plus provides digital capture of signatures and other annotations.

Allina Hospitals & Clinics settles a lawsuit with the state of Minnesota over high interest rates charged on medical debt. The not-for-profit Allina will pay patients $1.1 million to settle a dispute over whether the health system broke state law by charging patients double-digit rates on certain outstanding medical bills. Allina maintains its actions were legal.

Utah implements a new task force to stop the state’s pharmaceutical drug problem. The Utah Pharmaceutical Drug Crime Project will work to eradicate the selling, buying, stealing of prescription drugs. Utah, by the way, has the country’s highest rate of non-medical painkiller abuse. (Who’d a thunk it?)

The for-profit HCA expects its Q1 profits to much better than last year’s, in part due to higher inpatient volume and better controlled expenses. Pre-tax income is projected to be $600-$650 million for the quarter compared to $344 million last year.

I am wondering if Twittering is going too far? Do we really need our doctors Twittering during surgery?

Regardless of the answer to that question, I am loving Twitter and have decided there are really two types of users: The Tweeterers (those who use Twitter to send out information) and Tweetees (those who primarily follow others to glean information.) I suppose there are also in-be-Tweeters who do a bit of both. I am primarily a Tweetee, though I do send out the occasional pearl of wisdom. IngaHIStalk if you want to follow.

IASIS Healthcare (TN) contracts with McKesson for the Horizon Medical Imaging PACS solution. IASIS is a 16-hospital system with approximately 2700 beds.

QuadraMed announces an agreement with e-MDs to provide QuadraMed’s hospital clients with the eMDs EHR/PM software for its affiliated physician groups. Sounds like e-MD is looking for a way to compete head-on with ECW for the hospital-supported physician EHR deals.

Gateway to Care, a large FQHC system in greater Houston, selects Sevocity EHR as the system’s only funded EHR solution. Five of the organization’s health centers will implement Sevocity by August for over 200 physicians and other users.

So far this month, it looks like five new ambulatory products have achieved CCHIT 2008 certification.

I nominated Mr. H for this award, though its doubtful they would accept an anonymous blogger. But they should, don’t you think?

E-mail Inga.

 View/Print Text Only