From Tired of it: “Re: quality. If I hear one more consultant say ‘quality is the new battleground’, I am going to fire every single one of them. We are right now in four-year process to get paid for implementing an EHR. Last I checked, that makes quality last at this point, economically. Consultants love to sell quality ideas and analytic solutions.”
From Frank Pulver: “Re: NAHAM. Attendance is down 25-30% this year, but lots of hospital representation and some outstanding presentations.”
From Pedro Fumar: “Re: Top Ten American Healthcare Myths (warning: PDF). It is over 100 pages, is kinda pithy, but nonetheless contains a lot in interesting stuff, particularly when looking at European solutions. There is a chapter on IT.” It’s from Pacific Research Institute, a think tank that seems to be somewhere between conservative and Libertarian (right in my sweet spot, in other words). Some pretty good insights: “The sad reality is that as much as we’d like for politicians to be able to create technological revolutions, they just aren’t very good at it … Private businesses are quite good at adopting the right technology at the right time—and finding innovative solutions to improve productivity. When government tries to grease that process, it often gums up the gears. You end up with something resembling a classroom in a D.C. public high school. There are plenty of computers, but not enough textbooks, or even kids who can read … Politicians love to talk about HIT as though it will automatically save costs … A 2005 study by the RAND Corporation concluded that HIT could save our health care system around $77 billion a year … Americans spend $2.3 trillion a year on health care. So potential savings as a result of HIT are only 3.3 percent of our total medical spending. That’s like a family cutting its housing costs by moving from a house with 21 rooms to a house with 20.”
Participation in the “Is CCHIT free of HIMSS influence” poll to your right is high, with 91% saying “no” so far.
Thanks for the couple of folks who posted events to the brand spankin’ new HIStalk calendar. Feel free to click the Submit Event link on that page.
Speaking of the calendar, I Googled to find events I might want to put on it. Big mistake: there are for-profit companies everywhere (many of them associated with the rags) that are shilling conferences. They all feature big-name speakers, who I assume are paid (since it’s a for-profit conference, why not?) and don’t mind missing work. There’s an $800 conference on HIT stimulus money (run by a magazine). There’s an EMR one run by a conference company that urges immediate registration, despite having no posted agenda and a registration form (including asking for credit card info) that nowhere mentions what it costs. There’s a $1,600 version run by a magazine that features the latest in buzzwords: deep dive, galvanize, futurist, and symbiosis. Here’s a radical thought for folks who work for cash-strapped providers (is that redundant?): stay home instead of going to conferences. Radical, I know, but when hospital employees are losing their benefits and even their jobs, I could not sleep fitfully in a $300 a night hotel room and sit in swanky ballrooms listening to peers from places highly unlike mine give their standard stump speech, bracketed by wide swaths of time left open for receptions, recreation, and schmoozing with vendors. More importantly, if the place those speakers work is so darned smart, why are they struggling like everyone else? Encouragingly, a couple of the conferences offered an online version that eliminates all the time and money wasted on travel, so that’s better. But, I’ll stick with the premise that conferences occasionally give you safe, mildly useful information that passes for change, but real innovation is something you have to sweat out on your own.
MedAssets will promote the Web-based, front-end patient access tools (including scheduling, orders and self-service) of SCI Solutions as part of its offerings to improve net revenue.
TeraMedica and its partner Sun Microsystems announce the availability a pre-configured image viewing and management solution that presents images from multiple modalities and providers as a single view.
The Verden Group releases its Q1 Insurer Ranking Report (warning: PDF). Spoiler alert: Aetna drops a few spots, while small market LifeWise Health Plan takes #1.
A VP of the Cox cable company describes (by audio) his company’s interest in healthcare technology, which comprises 10% of its overall business. He talks about telemedicine in rural areas. My short attention span kicked in at the three-minute mark, so there’s 12 more minutes that, like Nixon, I can’t account for. I don’t get the whole podcast thing, which takes 15 minutes to absorb what would be a 30-second read, but it has fans, I guess.
Hospital operator Tenet and physician practice systems/services vendor MED3OOO form a joint venture that will offer services to doctors in Tenet’s service area, including those Tenet employs. The new MED3OOO Practice Resources will offer management services and technology. Tenet owns 20% of MED3OOO. Correction: Tenet owns 20% of the newly created entity, not of MED3OOO itself.
Old news I missed: Emdeon will acquire fraud management company The Sentinel Group.
Elected to the board of medical exam and actuary company Hooper Holmes: Larry Ferguson, former CEO of First Consulting Group and Daou; and Ron Aprahamian, former CEO of Compucare and chairman of Superior Consultant. The announcement didn’t mention that the company did not support their election, which occurred only after Aprahamian led a proxy fight. He’s a big shareholder with 3 million shares, which sounds fantastic until you learn that the share price is $0.49 and market cap is only $34 million.
Microsoft asks Alberta Children’s Hospital for its technology wish list for hospitalized children through its program that provides PCs, software, Xbox consoles, and wireless connectivity. I had a smart alecky comment about asking for Macs, but it felt Scroogish since they’re doing an undeniably good thing.
A doctor in Australia uses his EMR to successfully defend a medical board’s claim that he mismanaged a patient. A family member claimed his exam lasted only one minute, but the medical record showed it took more than seven minutes. His conclusion: “His mother gave evidence to the board of what she thought, but I gave evidence from the computer.”
IT saves the career of another doctor. A hospital ED director accused of sexual assaulting a co-worker as she replaced the printer toner in his office is cleared after IT staff verified that he didn’t have a printer there.
A Harvard Business blog discusses the declining trend of virtualized company management, using Eclipsys as its focal point. On replacing Andy Eckert as CEO, primarily because he didn’t want to leave California to be where the company is (Atlanta), “Pead said this week in an address to customers, ‘You can’t deny how effective it is to be able to sit down and have lunch with another leader and resolve an issue quickly.’ My sense is that he’s right and we all know it. However, many companies seem not to want to acknowledge it.”
I’ve mentioned Natalie Hodge before – she’s the pediatrician who started Personal Pediatrics, a concierge practice that does house calls. Some interesting nuggets from this interview: (a) she says there is no need for an actual office since everything fits in the trunk of her car; (b) she plans to affiliate with other physicians (“a fleet of iPhone Doctors,” the article says) and to offer them iPhone access to company tools once Version 3.0 comes out, and (c) the “old model” of running an office cost her office $200K, while the new one provides the same revenue with only $50K in costs. She’s gone all dot-com: moved to San Francisco, hired PR people (thus the artsy black and white pic above, which I like), and is looking for a startup CEO.
The local paper profiles Geonetric of Cedar Rapids, IA, which is moving from designing Web sites to creating a personal health record or consumer portal type of product. I played around with their Backpack Tool for kids, which is pretty cool.
A huge Northern California IPA announces that it took a surprise loss last year, mostly because of investment losses, but also discloses that it spent $7 million on EHR implementation last year.
A reader called out a typo in Inga’s mention of BIDMC’s cost savings using Nuance eScription. The savings cited was $5 million since 2003.
Amy Rees Anderson, CEO of MediConnect Global, is named to the Utah Technology Council’s board. MediConnect’s site lists several services, but its bread and butter is retrieving medical records for lawyers and insurance companies. “MediConnect specializes in providing medical record retrieval services to the organizations that need them most-law firms involved in mass tort, medical malpractice and personal injury cases and insurance brokers and underwriters … turn soft medical record retrieval costs into concrete billable expenses.” As best I can tell, they simply call up hospitals or doctors, ask to have paper medical records sent to them, and then scan and send them on. That’s an interesting business, especially since she started out selling Web-based physician systems. Smart.
The CBS Evening News runs a piece on BIDMC, whose employees sacrificed to save jobs that would have otherwise been eliminated due to a $20 million budget shortfall.
Fresh off the “most e-mailed” list of articles from the Orlando newspaper is one detailing salaries of the folks who run the non-profit hospitals there, including the CEO of Florida Hospital ($1.1 million) and its parent, Adventist Health ($3.5 million), which the author dryly notes is “not bad for a faith-based nonprofit” since that paycheck is bigger than those for the folks who run Mayo and Hopkins … combined.
Medical diagnostics vendor Hologic will use products from Loftware in deploying Oracle’s supply chain applications. If you’re involved with healthcare labeling or the GS1 standards for global supply chain, they’ve got resources, including a GS1 white paper (warning: PDF), which I had to look at since I’m not very familiar with GS1. I was more comfortable with their Hopkins case study involving lab sample labeling.
I mentioned InQuickER a few months back, an online ED appointment scheduling application that I could find next to nothing about. The Atlanta profile does a short writeup on it. Patients pay $24.99 to scheduled an ED slot online and are guaranteed be seen within 15 minutes of the scheduled time. I’m skeptical, of course: if you can make an advance appointment, why are you going to the ED? Are EDs like restaurants, where reservations trump walk-ins? If EDs are already overburdened, why are they making the experience more pleasant only for those who pay extra? Come on, people, use those retail clinics that are everywhere unless you truly need ED services.
On that theme: if you’re a highly paid executive and don’t want to hang around the sick and underfunded people that hospitals attract, Adventist Bolingbrook Hospital will treat you better for a price, offering executive health coordinators and an “executive health lounge.”
A fire that requiring shutting off power at St. Vincent’s Medical Center and St. Luke’s Hospital in Jacksonville, FL took computer systems down Thursday. They were back up that same evening. I always like this quote: “Patient care has been unaffected,” which seems to imply that those systems weren’t doing much for patients anyway.
iSoft sells to its first hospitals in Italy.
Ralph Webb, who designed LDS Hospital’s lab system and developed the first patient wristband ID, died this week in Utah at 80.
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From Nasty Parts: “Re: Allscripts. They will announce the acquisition of Medfusion and Medem shortly, bolstering their physician connectivity capabilities.” Consider it unverified and, until further notice, untrue. Hypothetically speaking, it seems to make good sense and there’s some history there — Allscripts and physician connectivity vendor Medem have worked together and Allscripts bought 3% of the company and $2 million of its debt in 2004, while the former Misys Healthcare Systems created its consumer portal with Medfusion, which is based in Cary, NC, next to Raleigh.
From Inside Ohio: “Re: Propractica (StreamlineMD CCHIT-certified EHR). Heard rumors that it has gone out of business.” Not so, according to Sean Mullen, president of the company (who, when I called him, started off by brusquely saying he’d never heard of HIStalk, which I tried to overlook). I got voice mail at the listed telephone numbers, but one of the support reps gave me Sean’s cell phone number, saying they have a new phone system. Sean says StreamlineMD was formed May 1 when EMR vendor Propractica merged with Professional Receivables Control, an Akron practice management systems company. Business is stronger than ever, he says (it might be even stronger if humans answered the telephone numbers listed on the Web site – that’s some pro bono advice).
Listening: Anvil, since I saw a VH1 commercial for what sounds like a great new underdog documentary (not “mockumentary” like Spinal Tap, even though the lead guitarist’s name is Robb Reiner) about this early 80s Canadian metal band that went nowhere, but influenced everyone from Metallica to Megadeth and still trudges on today. Ebert gives the movie three stars, calling out funny-sad scenes that led to their obscurity, like their bad, barely English-speaking management booking them in Japan for a 9:45 a.m. concert. I like to see old has-beens finally win, so I’m rooting for them to make a comeback, even though their music is kind of Whitesnake-y at best.
I always enjoy getting the latest Medicity newsletter, so it was even better to see HIStalk mentioned in it (for naming the company’s booth as the coolest one at HIMSS and also your voting its merger with Novo Innovations as the smartest vendor strategic move). It also included results from a survey of 24 Medicity Novo Grid customers, in which more than 60% of those who connected their EMRs said they saw improvements in patient care, staff efficiency, cost, and hospital relationships. Both of the company’s CHIME focus groups received 100% “top box” scores (excellent or very good). They’re also offering 25 customer video case studies on CD that are free for the asking.
McKesson takes it in the shorts for suing a former pharma sales employee who bolted for medical supply competitor Henry Schein in 2004 even though he hadn’t signed a non-compete agreement. The judge dismissed McKesson’s suit, he countersued, and a jury just awarded the former employee $5 million and his new employer $6 million. McKesson says it will appeal.
New poll to your right: is CCHIT free of influence from HIMSS?
Greater Baltimore Medical Center (MD) rolls out ED clinical documentation from crosstown vendor Salar, integrated with its Meditech system.
In the least-shocking news I’ve heard lately, Grady Hospital (GA), like pretty much every large medical center buying clinical systems these days, picks Epic for its $40 million project. Losers: Cerner, McKesson, and Siemens (although I certainly would have put Eclipsys above at least one if not two of those). Oddly enough, Grady chose Epic on price, which must be an industry first since they are invariably more expensive than everyone else. Here’s my prediction: Epic’s honest, but I bet Grady made some estimating error that will cost them at least double that $40 million, probably involving labor, maybe their own since they are struggling and may optimistically think they can do a lot of the work without paying expensive outsiders.
NAHAM (National Association of Healthcare Access Management) is having its annual conference right now in Las Vegas. Our friends at SCI Solutions are there, no doubt, and QuadraMed is showing its new consumer portal for scheduling. Reports from the field are welcome.
New insurer payment rankings from athenahealth: Humana goes to #1 as the best payer. The industry as a whole improved over last year as well, with claims paid 5.3% faster and denial rates down 9%.|
I took action on a suggestion readers have made a few times over the years: there is now an HIStalk Calendar to keep track of industry events (there’s also a link at the top of each HIStalk page and links to upcoming events in the right column). Some cool features: users can submit their own events, it accepts rich text and graphics, and each event has a link to see a map and current weather. You can even download an event to your calendar, e-mail it, or share it on Twitter and a bunch of other online services. Feel free to share your events, although you won’t see them until I approve them (to keep out the inevitable spammers).
Cerner names Michael Battaglioli to the newly created role of chief accounting officer.
Jobs: Health Care Revenue Cycle Consultant, Senior Cognos Developer, Meditech Nurse Informaticists.
Atul Gawande, maybe the best healthcare writer there is, covers McAllen, TX in his latest piece in The New Yorker. The issue: the town is poor and rural, but second only to Miami in healthcare costs per person. Local doctors blamed everything from obesity to lawsuits, but analysis revealed something none of them said: overuse of medicine, especially specialists and implantable devices, sometimes for the express purpose of enriching a hospital or a doctor. “Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.” I’ve been far less eloquent and entertaining than Atul, but my motto echoes his conclusion: people and companies are guided by economic principles that will lead them to the most profitable activities, so you can change their behavior only by intentionally or otherwise redirecting their profit motive to something more desirable. If you pay for procedures, you will get lots of procedures. If you pay for quality (assuming you can define it), you will get quality.
University of North Carolina Health Care and IBM create a data warehouse to support projects related to grants, clinical trials, quality statistics, and the study of diseases.
Health officials in a Chinese province are forced to make a public denial after a widespread Internet rumor suggested that many of its doctors got AIDS after having sex with a female drug rep in return for prescribing her company’s products. The press-unfriendly police “briefly detained” a former patient who was believed to have started the rumor, after which he apologized, even though other doctors said it wouldn’t surprise them since medical bribery is standard procedure. A Chinese economics researcher stated the obvious about medicine in both China and the US: drug companies have access to information to tell them who’s prescribing, so it’s not surprising they try to influence the holdouts.
Former IBMer Walter Groszewski is named VP of business development at Medsphere.
Accenture, always geographically creative in avoiding paying US taxes, moves its “headquarters” from Bermuda to Ireland. If you want to buy American, it ain’t them (which you already knew since many of its employees work in cheap labor countries like India and the Philippines). It’s not just them, of course — I’ve been to the Caymans and all those corporations headquartered there must have short executives since their entire corporate office fits neatly in a standard post office box. Not their fault – Uncle Sam should just close the loophole by saying if you do more than $1 million in business here, you’re taxed the same as a domestic corporation.
A CBC article criticizes eHealth Ontario’s contracting practices, claiming that nearly $5 million in deals were signed with Courtyard Group and Accenture (begorrah!) without seeking other bidders. It also criticizes the organization’s salaries, noting that 164 employees make over $100K and hiring consultants keeps other names off that list (the CEO is paid $380K plus she got a $114K bonus five months after she started). Two consultants listed as SVPs on its site cost $1.5 million a year, including flights from their homes, per diem, and hotels. Most personally, it notes that one consultant listed as SVP was charging $3,000 a day as a consultant, while the company his wife owns got $300K in contracts, billing $300 an hour read newspaper articles and check holiday voicemail greetings. The CEO’s rebuttal: we chose single-source vendors because of urgency and we had to pay market rates to get the best people available. You will want to read at least some of the 200+ comments left, one of which notes, “This is one of the many reasons why we have a 50 billion deficit. We are no better than the US….ridiculously high salaries for top level management, high bonuses, over-priced contracts, unnecessary projects, no accountability and worst of all a government that no one has any respect for.”
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HERtalk by Inga
John Halamka claims that speech recognition technology and computer-aided medical transcription have saved Beth Israel Deaconess Medical Center $35 million since 2003 and reduced report turnaround time from five days to less than an hour. They have 3,000 physicians using Nuance’s eScription.
New York City agrees to pay $2 million to the family of a woman who collapsed and died on the floor of the psychiatric ward at Kings County Hospital Center last year. The patient had waited more than 24 hours to be treated and lay on the floor for more than an hour while workers did nothing to help her.
Streamline Health Solutions CEO Brian Patsy admits that overall business has slowed during the current recession, but says its hosting business is picking up. Streamline had 10 major deals in 2008 and eight involved hosting. Only one of four major deals in 2007 involved hosting.
HIT outsourcer Phoenix Health Systems partners with Sungard Availability Services to offer hospitals disaster recovery services.
Mayo Clinic finds that when surgical teams participate in preoperative briefings prior to cardiac surgery, communication is improved, errors are reduced, and costs are lowered. Teams participating in the pre-op briefings reduced miscommunication problems during surgery by 53% and decreased their medical supply waste. I’m now analyzing the amazing parallels between surgery and marriage.
McKesson declares a regular dividend of $.12/share of common stock, payable July 1st to all stockholders of record on June 10th.
Optimum Lightpath signs an exclusive agreement with GetWellNetwork to provide the Interactive Patient Care solution to New York metropolitan area hospitals. Optimum will package the Interactive Patient Care solution technology with its 100% fiber optic network to provide television-based communication systems in patient rooms.
Elsevier Health Sciences appoints Chris Dillon managing director for its Clinical Decision Support group. Dillon is a former VP of marketing for both Misys and McKesson.
Legacy Hospital Partners (TX) enters a 10-year agreement with PHNS to deploy clinical, EMR, and financial applications.
DeKalb Medical (GA) selects MRO Corp. to provide its ROI Online software and services. In case you are slow like me, “ROI” stands for release of information, as in managing the release of medical record information.
Misys reaches a new three-year financing agreement to help repay the debt created from the Allscripts merger. The $335 million deal involves five different banks and includes a term loan and a revolving credit facility. Funds will be used to repay $150 million in bank debt plus $190 million to ValueAct Capital.
IASIS Healthcare (TN) signs a two year consulting agreement with Precyse Solutions. Precyse will provide IASIS medical staff with peer-to-peer training for quality clinical documentation.
A West Virginia woman sues a hospital after a parking gate arm comes down on her head, knocking her unconscious. The woman, who was on oxygen and used a walker, claims the hospital was negligent because traffic cones had directed pedestrians to walk near the parking gate arm.
Here’s a curious quiz. The results suggest I am a liberal (since I like the idea of slapping authority figures and don’t have a problem drinking out of anyone’s wine glass).
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CIOs: Sell Your Board and Executives on the Big Picture
By Ivo Nelson
If you think your IT staff and budget will decline in the next five years, think again. By 2010-2013, hospitals will be in full-scale EMR implementation mode. At the same time, they will be reengineering their revenue cycle processes and systems to accommodate some level of healthcare reform, while preparing for conversion to ICD-10.
All of this activity will be on the same scale as converting to DRGs (1983) AND converting to Y2K (1999) AND implementing HIPAA (2003) times two (or more). And keep in mind, because these changes are mandated by the government, ALL hospitals and physicians will have to comply at the same time.
If you think your vendor contracts will cover all this, think again. If you think you’re at the top of their priority list, think again. If you think you’re going to get a break when you wind down your EMR implementation, think again.
Why?
I’ve met with over 60 CIOs in the last couple of months, looking for insights into their strategies, concerns, and challenges.
The ARRA HIT stimulus bill is on everyone’s mind. Most CIOs have done more PowerPoints in the last couple of months than in the last five years due to inquiries from their CEOs and boards who smell money. The focus is the stimulus money and how their hospital is positioned to receive the maximum amount from the government. They allude to an END, when the EMR is implemented and demonstrates “meaningful use”, some minimal level of interoperability all within the boundaries of HIPAA security and privacy regulatory changes.
The ARRA HIT stimulus is just the start. Healthcare reform will change reimbursement to true pay-for-performance, requiring billing systems to be based on outcomes and quality. Additionally, if bundled payment is adopted, it will require unparalleled coordination to bring the hospital, physician charges, and other services into a single rate. Any emphasis on coordination of care requires a level of interoperability that doesn’t exist today.
On top of all that, the impending ICD-10 coding conversions requires the number of diagnostic codes to swell from 13,500 to 120,000. For inpatient procedures, the number jumps from 4,000 codes to 200,000 codes. The IT implications are huge. The impact on the hospital operations process and analytics will be even greater.
Quality is the new battleground. Once we are required to produce consistent quality reporting as a requirement for incentive payments (and eventually to avoid penalties), the game changes. Quality comparisons among competitors will be posted on the sides of buses, billboards, magazine ads, and on the TV. Quality care will be the first thing patients look for when it comes to the well-being of themselves, their family, and their community.
The usual Press-Ganey patient satisfaction measure will become almost irrelevant. Patients will endure long lines, rude staff, and will sit on the floor if they believe they will receive higher quality of care.
For the CIO, there will be immense pressure to be agile in producing reports to manage and report quality. Many are already coming to the sad reality that, after spending tens of millions of dollars on their EMR, all they have is a transaction system that doesn’t produce information. An entirely new genre of HIT now emerges around healthcare analytics. Remember, reimbursement will likely be tied to this information. Losing revenue because IT can’t produce reports, systems aren’t integrated, or vendors aren’t responsive isn’t going to be a conversation any CIO wants to have with his/her CEO or board.
Interoperability/Community Connectivity? Obama’s view of community connectivity is the sharing of patient information between heathcare organizations regardless of their competitive stance and strategy with each other. Our president greatly underestimates the power of local political will. Connectivity is contemplated, in the short term, only when organizations use it to capture a greater share of referring physicians – damn the community good. Elaborate arguments will justify the self-serving, digital capture of community (e.g. referring) physicians. There is a good chance ‘connectivity’, in the Obama sense, will eventually be defined in the courts.
Most CIOs are aware of the issues around interoperability. Most are participating on some committee on the state or local level as per their boss’s direction. Most roll their eyes at the naïve, non-healthcare participants who see the healthcare exchanges and interoperability as the holy grail.
Most realize they are being required to respond to some government mandate that doesn’t completely comprehend the data complexities that exist within the walls of most organizations. One organization has 92 different definitions for glucose and another has 16 different ways to define death. And they’re going to talk to each other? It’s a good thing there are some smart people on the ARRA HIT Standards Committee.
Of course, all of this is going on while we’re in a recession and CFOs are ratcheting back on capital and asking CIOs when their staff will downsize post-EMR implementation. It is not just that the CFOs are asking for reductions, it’s that the credit markets have tanked and the money simply isn’t there. It’s one thing for a CFO to say we need to reduce expenses; it’s another thing for a hospital to find out they have no credit because the bond market has tanked.
If I were a CIO, I’d be adding a few slides to my PowerPoint presentation to include ALL of the potential changes coming down the pipe, not just the stimulus incentives. I wouldn’t do a full-scale strategic plan, but I would dig deeper into a staffing analysis and make sure I didn’t prematurely reduce or redeploy staff. I’d create some what-if scenarios on the high and low end of change. I’d also take more advantage of the current access to my board and executives to educate and "sell" them on the bigger picture. Yep, and all this needs to be done while you’re trying to get the printer to format labels for the lab accurately.
The budget cycles are starting now for 2010. Make sure you get all of your cards on the table. I know it’s not all defined yet, legislation isn’t passed, and some changes may be a moving target. Like it or not, this is a government that makes decisions. The stakes are high. Now is not a time to be timid.
In the words of the great Wayne Gretzky, “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.” Let’s keep the puck on the ice. Go Red Wings!
Ivo Nelson is chairman of Encore Health Resources, a healthcare IT consulting organization.
From DVR-Challenged to an EHR?
By Gregg Alexander
Bringing real change to healthcare information integration will never happen until the focus is off of the “technology” and onto the training, education, implementation, and ongoing usage support of such complicated tools. Period.
Of course you can force the horse, but he he’ll die of dehydration if he can’t figure out how to drink. Geeks docs get it, but most clinicians are not geeks and couldn’t care less about technology if it doesn’t:
1. Make their lives easier;
2. Strengthen their profit margins;
3. Help them be better doctors, AND;
4. Come with ongoing, easy-to-access, stupid-simple support.
Number 4 is probably the most important, yet most often shortchanged component of these quadrangular conditions. Both the technology and the issues it is trying to support (healthcare issues) are far too complex for the general masses of providers to wrap their brains around all together. Just being a clinician is hard enough. Giant new learning curves for techno-tools which – let’s face it – don’t really hold much fascination for most normal folks are off-putting, even repulsive.
Here’s what I hear: “With pen and paper, I can be a decent doctor (#3), get by financially (#2), and I already, almost innately, know how to use them (#1). Sure, paper has a ton of associated problems, but until there are sufficient helpmates (#4) to hump me over that technological learning curve mountain, I’ll do what I know and spend my extra time trying to get the hang of my DVR. By the way, speaking of computers, what’s this Twitter thing? Is it … (hushed) … sexual?”
Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com. He writes regularly for HIStalk Practice, but we decided to put him on HIStalk this time just for fun.
Blade Server Review – Main Features and Values
By The PACS Designer
There has been a lot of press lately about blade server architectures, so TPD thought it would be a good idea to highlight some of the main features of this type of architecture.
A blade is a plug-in device that is installed in a chassis. Its Wikipedia description reads, "The name blade server appeared when a card included the processor, memory, I/O and non-volatile program storage (flash memory or small hard disk(s)). This allowed manufacturers to package a complete server, with its operating system and applications, on a single card / board / blade. These blades could then operate independently within a common chassis, doing the work of multiple separate server boxes more efficiently. In addition to the most obvious benefit of this packaging (less space-consumption), additional efficiency benefits have become clear in power, cooling, management, and networking due to the pooling or sharing of common infrastructure to supports the entire chassis, rather than providing each of these on a per server box basis."
Blade servers and storage systems generally consume 50% less energy than traditional servers. They also occupy much less floor space, so valuable real estate can be put to better use. They also require fewer cables, have smaller power needs, and fit into 19" slots in a chassis.
Blade servers won’t replace mainframes any time soon, but they will be deployed for Web solutions and cloud computing. An effort to move mainframe software to external users through conversion to SOA and REST solutions would typically be good for installation on blade server/storage systems, provided adequate security methods have been installed.
IBM’s partnership with Sentry Data Systems, which serves pharmacies and hospitals in over 20 states, is an example of a cloud solution that was deployed to reduce power consumption and meet the growing needs for servers in a smaller operating space with less cabling.
Since the genie is out of the bottle, so to speak, for Web 2.0 and cloud computing, we will be seeing more need for blade systems solutions in the years ahead.
From Lazlo Hollyfeld: “Re: regional health IT extension centers. They are being passed of as a critical component to assist 1-3 physician practices with EMR issues. Is it just me or does anyone else think that they are going to be a complete boondoogle? I recently heard a prominent official compare their design/purpose to QIOs. If this is the case, ONCHIT is largely going to piss away at least $700M over the next few years with very spotty results.”
From The PACS Designer: “Re: ICU LifeGuard. Baptist Hospital of South Florida has installed an intensive care solution called ICU Lifeguard that can detect subtle changes in a patient’s condition. The system permits 24-hour-a-day monitoring of patients undergoing intensive care at a central work area to improve the chances for intervention should alarms be activated during times when direct care is not present.” Link. I think that’s just their name for Visicu’s eICU.
American Sentinel University, an accredited (DETC) online school, will give incoming students in three Master’s programs up to 18 hours of credit for Cerner Millennium coursework.
The board of Grady Memorial Hospital (GA) will choose a vendor for its $40 million infrastructure upgrade on Wednesday.
A couple of folks have sent articles or comments that have run elsewhere (their own blogs or someone else’s) with the expectation that I will use them. Unlike other blogs, I use only original material. Reader submissions are encouraged if they haven’t appeared anywhere else.
The CMIO of Wheeling Hospital will present a Medicity-sponsored Webinar on June 18 called “Enhancing clinical effectiveness and efficiency through patient-centered care collaboration”. If I have some time this weekend, I’ll be rolling out a new HIStalk events calendar to make it easier to find programs like this.
Intellect Resources will offer a free HIT career search workshop in NYC on June 3.
Cerner will add 40 tech support jobs in Dublin, Ireland by the end of the year.
Kaiser Permanente uses HealthConnect to gather data for a study that found 11% of its patients got whooping cough because their parents didn’t get them immunized. Their chances of getting the infection are 23 times that of children who got all their shots.
Forbes interviews Denni McColm, CIO of Citizens Memorial Hospital of Bolivar, MO. This quote is about the technology being used to monitor patients at home: “We’ve also seen some decline in our admission rates for home health patients. They take vital signs, weight and blood pressure every day, and it’s automatically fed into our system … it’s submitted to electronic medical records through phone lines. It can also remind them to take their medication. They get a reminder to step on the scale, take their blood pressure and put this on your finger. And sometime in the next hour, when their phone isn’t busy, it dials in the information. The sky’s the limit about how much care can be provided at home. One nurse can sit in a room and monitor 40 patients and be alerted to any anomalies, which you can’t do if you have to go through their home or see them one at a time.”
Lee Memorial Health System (FL) gets board approval to spend $68 million to roll out its EMR system (Epic, I believe) to its four hospitals and all employed physicians, although it’s hoping to offset that cost with up to $40 million in ARRA money.
A great answer for hospital overutilization: encourage people to die somewhere else.
A CBS News piece covers electronic health records in the ED at Inova Fair Oaks Hospital (VA), covering (but not by name) Picis ED PulseCheck. Tidbits: Inova spent $200 million over 10 years for its IT solutions. A doctor in a three-doc practice had an interesting comment about ambulatory EMRs: “I’m not doing unless I get a benefit from it, right? Is it going to make me any faster? No. Is it going to make my patient care any better? I don’t see that.”
3M Canada donates patient coding software to the HIM program of a Canadian college.
Patient check-in software vendor Phreesia gets a writeup in a New Brunswick business journal, mostly because it’s doubling its employees in Canada to 100 in addition to 49 in New York.
Natural language processing coding and billing systems vendor A-Life Medical buys out UPMC’s interest in its inpatient coding solution, setting up a new management team.
Three-employee Acuitec, a Birmingham, AL-based joint venture between a local entrepreneur and Vanderbilt University, is marketing a Vanderbilt-developed periop system.
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HERtalk by Inga
Retail clinics in grocery stores and retail chain stores are more likely to be located in areas with a lower population of black residents, lower poverty rates, and higher median incomes. In other words, poorer neighborhoods are less likely to have access to one of the country’s 1,000 or so retail clinics.
NHS patients concerned with privacy risks will now be allowed to delete the electronic summaries of their treatment records from the national database.
Epic earns top honors in a new KLAS report highlighting pharmacy information systems and integration. Epic scored high for its tight integration between EpicRx and its other EHR functions, as well as for customer service and support. Siemens Pharmacy and GE Centricity Pharmacy were the second- and third-ranked products. The report also noted an increased demand for integration between core clinical systems and pharmacy software. The tighter the integration, the bigger the impact to patient safety and the increased likelihood of physician adoption and satisfaction.
The New York Times explores some of the more less conventional ways hospitals are trying to connect with the public to attract patients, donors, and doctors. Twittering from operating rooms, posting surgeries on YouTube, and patient blogging are some of the ways hospitals are trying to stand out among competitors. Remember the good old days when doctors didn’t advertise? Now you have brain surgery on the Web and baseball stadiums named after your local healthcare system.
The former head of a closed Detroit hospital agrees to pay $350,000 for violating state public health code and privacy laws after medical records were found burning on his farm. Dr. Soon K. Kim must also hire a contractor to dispose of any remaining records. Assuming the burning did the trick, the settlement amount sounds a little excessive. But, what do I know?
Mt. Washington Pediatric Hospital (MD) selects PerfecTIME time and attendance software to automate the workforce management process for its 600 employees.
IT employment continues to drop from its 4.058 million peak in November. By the end of April, only 3.87 million workers were employed in IT. Don’t expect things to turn around until at least the end of the year.
AT&T is partnering with device monitoring companies and other high-tech firms to advance telehealth applications.
HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announce the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The HEAT team will focus on investigating Medicare fraud, including investing in new technology for fraud detection.
Seattle Radiologists deploys Corepoint Integration Engine to monitor its IT environment and enhance its radiology workflow and application environment.
Why do we women have to suffer so much for fashion? Experts are now finding that women who wear too tight jeans run the risk of suffering a nerve problem called meralgia paresthetica. Seriously, what man would possibly look our way if we were wearing jeans that look like maternity pants from the 1980s?
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From Deborah Kohn: “Re: ONC’s deadline to publish guidance on Regional Extension Centers. I can’t speak for the Secretary of HHS nor the National Coordinator of HIT, both of whom as you know officially took office only a few / several weeks ago, respectively. However, in Monday’s (May 18, 2009) published Implementation and Operating Plan ‘in fulfillment of the 90 day deadline established by Division A, Title XIII of ARRA’, ONC added that a notification for funding availability for the regional extension center grants will be published by the end of FY 2009, and that awards are anticipated to be made in early FY 2010. (That’s the federal gov’s FY, October 1).” Here’s a little plug for Deborah (which she didn’t ask for) for her contributions.
From The PACS Designer: “Re: RIS/PACS integration. Smaller hospitals need to find solutions that make them more cost efficient and competitive, and what better way than to employ a fully integrated RIS/PACS solution?Chinese Hospital of San Francisco has just made such a move recently by installing a RIS/PACS from the same vendor, gaining better coordination of its scheduling to enhance the flow of patients for its MDCT procedures.”
From Kelly Greene: “Re: why the feds should stay out of healthcare.” Link. NIH spends $178K to determine why Thai prostitutes (both women and transgender) get HIV, $400K to figure out why Argentinian gay men engage in risky sex while drunk, and $2.6 million to teach Chinese prostitutes to drink less while working. Imagine what they’ll do with the billions in stimulus dollars headed their way.
From Fish n’ Chips: “Re: Sutter. $1B spent, Burlingame is live on Epic, and this by any measure is a successful EHR implementation? Sounds more like the Fed dumping megabucks into the economy and announcing all is well.” I doubt they spent anywhere near the full billion the project was rumored to cost, but I’ve not seen numbers one way or another. I bet most of it was on labor after the initial hump of hardware and licenses, so stopping early probably saved a big chunk.
From CDiff: “Re: Wolfram Alpha. If you have not played around with Wolfram Alpha yet, you can explore all sorts of things and the response time is pretty good. The extended overview screencast on the far right side is impressive. Unfortunately, when I asked for some basic data on healthcare, HIS, and women’s shoes, the program could not provide it, but perhaps some day soon.” I lost interest when searching for HIStalk turned up no hits. I’m finding no deficiencies in Google that would lead me to look elsewhere for search, but maybe those folks will come up with a better mousetrap.
Listening: Guster, witty and melodic Boston-based alternative rock.
Cerner says ARRA could boost its revenue up to $600 million a year, a 33% increase.
Industry long-timer Bob Restagno, who worked for Florida’s Dynamic Control and all the companies that it became all the way through McKesson, died last weekend at 69 after a long fight with cancer. Condolences.
A reader asked if I would consider putting HIStalk on Amazon’s Kindle. I aim to please, at least if there isn’t too much work involved (there wasn’t), so here you go. Amazon sets the price without author involvement, unfortunately, so I see they’ve pegged it at $1.99 per month instead of the “free” that I would have made it. I admit the new Kindle is pretty cool: thinner than a pencil, holds 1,500 books, downloads directly over WiFi, and costs $359. If you try reading HIStalk on it, let me know how it works out. I’m a little bit tempted to get a Kindle – the $9.99 price for books seems like a good reason to go paperless (except you can’t buy used books like I do). You roadies would probably love it.
The Washington Post follows up its somewhat critical HIMSS piece with another that goes after CCHIT. The title is more exciting than the article: “Group Seeks Sway Over E-Records System — Health Association With Ties to Stimulus Lobbying Effort Pursues an Oversight Role.” All it says is that HIMSS created CCHIT, lobbied for big stimulus dollars, and now recommends CCHIT as the EMR certifying body. “Critics in the health-care industry have expressed concern that the certification commission is too close to information technology and health-care companies to be the best judge of what equipment doctors and hospitals ought to buy. Although the group is funded through a contract with Health and Human Services, it is run by a former HIMSS executive and one trustee also is the president of the trade group. Several board members work for technology vendors.”
In the UK, NHS Wandsworth passes on Cerner Millennium, saying it’s not suitable for the clinic model there.
IBM announces real-time data analysis software called System S (Stream Processing System) that helps users recognize patterns in huge amounts of data, making it useful for the financial and healthcare industries. A company example is monitoring all of a hospital’s databases in real time, including monitor data, to let caregivers know about emerging patient problems (if you trust your data and your own ability to interpret it, anyway). I think a better use of it (which they didn’t think of yet, apparently) would be healthcare fraud detection.
Some big-name healthcare people form the Institute for Interactive Patient Care, which will advocate for patient engagement via bedside technologies as a way to improve quality and decrease cost in the context of healthcare reform. Among the members of its advisory board are David Nash (Thomas Jefferson University), Leah Binder (The Leapfrog Group), Michael O’Neil (GetWellNetwork), and Barbara Summers (MD Anderson).
I was thinking about ARRA as I read the press release above since nobody’s talking about anything except EMRs. ARRA puts all the financial eggs in one basket: electronic medical records for providers. It funds nothing that benefits patients directly, like consumer information and tools to manage wellness. In other words, it encourages automating the treatment-focused model that is responsible for putting the US healthcare system right up there with those of Slovenia and Cuba. We lead the world in sophisticated interventions, but those are expensive compared to avoiding the need for them in the first place.
The money guys who funded Premise got an internal rate of return of 79% when Eclipsys bought the patient throughput company for $38.5 million in cash on December 31. Their current holdings, some of which are healthcare-related, are here.
CareTech Solutions wins medical marketing awards for creating a virtual Wall of Hope for MetroHealth (OH) and a content management system for the Chris Evert Children’s Hospital (FL).
Hotel Dieu Grace Hospital (Ontario) rolls out Bosch Security Escort to all of its 2,200 employees. Its wireless fob lets employees send an immediate “code white” to security staff and tracks their location until help arrives.
A Florida ophthalmologist hopes to make money from his sideline business, QuikView Medical Records, software for eye doctors.
Germany’s CompuGROUP increases revenue by 36% in Q1, the headline blares, making it clear the real story will be in much smaller print: earnings were down, with EPS $0.05 vs. $0.13 (I assume that’s Euros, not that there’s anything wrong with that). The company bought 51.6% of EMR vendor Noteworthy Medical Systems in February.
An Ohio health department executive is being investigated after complaints that he was selling drugs over the Internet, which he denies. The probe has already uncovered the fact that he doesn’t hold the degrees he claimed when hired, however.
White Pine Systems gets a $225,000 early-stage investment from a State of Michigan-supported fund. It’s a PHR vendor running under the name SPINN (Secure Personal Information & Notification Network).
St. Luke Hospitals (KY) goes live with IntraNexus SAPPHIRE Patient Financial Management.
Enjoy the Memorial Day holiday. Please don’t forget that its purpose, other than to give you a long, pre-summer weekend, is to honor those military members who died in service to our country.
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HERtalk by Inga
Sentry Data Systems releases a new mini-site for the Deficit Reduction Act (Section 6002). The site includes detailed explanations of the compliance requirements issued by state Medicaid directors, an overview white paper, and additional resources.
I like most everything we post on HIStalk Practice, but I found the recent post by Dr. Joel Diamond to be hilarious. Entitled “What’s Wrong with ICD,” it will likely relieve any 300.4 that you might have.
Axolotl appoints Robert Scarbrough director of IT operations. He’s a former VP of IT for Swope Community Enterprise Services.
I visited the Huntzinger Management Group’s website today and checked out their “First Quarter Highlights” page. It was flattering to see that their HIStalk Platinum sponsorship made the top of the list! Other top Q1 happenings included a HIMSS Gold Sponsorship and the securing of several key engagements, including multiple not-for-profit, community-based, and academic healthcare organizations. That’s George Huntzinger, of course, formerly of CSC and Superior Consultant.
If you are attending MUSE International next week, send us some updates from the field. This year’s meeting is in one of my favorite cities, Vancouver, which I expect is especially beautiful this time of the year. A few of our sponsors will be exhibiting, so stop by their booths and tell them thanks for supporting HIStalk. Those listed on the exhibitor’s guide include API, Vitalize Consulting, PatientKeeper, MEDSEEK, Ingenix, QuadraMed, and Stratus Technologies.
Docusys announces a partnership with Medusind Solutions, an end-to-end revenue cycle management service company.
The Buffalo, NY-area HIE HEALTHeLINK negotiates special EHR pricing on behalf of its physician members. HEALTHeLINK is also setting up a demonstration lab that includes demo EHR software for each of the participating vendors. Area physicians looking for EHR solutions will have access to the lab to evaluate the different EHR products.
Mediware signs an agreement to acquire SciHealth, Inc., the designers of the Insight business and clinical intelligence software package.
As many as 29% of Americans would consider traveling abroad for medical procedures, even if they are routinely performed in the US. If the quality were equal to what you get in the US, but significantly cheaper, as many as 40% would consider treatment abroad. In case you are wondering, 30% of us would go abroad for plastic surgery, if we were without insurance and the procedures were cheaper and quality of care was good.
St. Luke’s Hospital (MO) extends its use of Thomson Reuters’ Micromedex solutions with the addition of the Micromedex physician portal and medication reconciliation tools.
Nine St. John Health System (MI) employees file a $1.5 million lawsuit against their employer, claiming the hospital owes them for unpaid sick days. Last year the hospital announced it would no longer pay employees for sick days accumulated prior to 1995 because it could not afford the $4 million-plus cost. Attorneys are seeking class action status, which could extend the suit to 1,400 employees. The lawyers are also claiming age discrimination since all the affected employees have at least 14 years tenure with St. John.
Over the next few months, healthcare HIS recruiter Intellect Resources is offering free career management workshops across multiple US cities. The 45-minute "Managing Your Career Search" presentations are designed for HIT professionals who need to organize their job search. First stop is NYC on June 3rd.
The ONC extends a $102K grant to the American Hospital Association to measure the adoption and use of EHR by hospitals.
Coordinated Health (PA) selects Allscripts Enterprise EHR and PM for its 50 physicians an 50 mid-level providers and PTs.
Ochsner Health System (LA) selects MedAssets to provide revenue cycle services.
For the first time, HealthSouth founder and federal prison inmate Richard Scrushy testifies under oath that he did not know about the $2.7 billion accounting fraud that put his company into financial jeopardy. That fraud led to the shareholder lawsuit that put him in the witness box.
Check out the cool Webinar coming up May 27th from the folks at Hayes Management Consulting. Topic: physician adoption of EHRs.
UnitedHealthcare and CalRHIO partner to facilitate the transfer of patient information to EDs. UnitedHealthcare will pay CalRHIO to deliver the clinical data of its members to hospital EDs.
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