From Dwarf: “Re: meaningful use. To all of the acronyms (HIMSS, etc.) who claim ‘meaningful USE’ definitions: you are defining meaningful FUNCTIONALITY, not USE. At least be honest about it. The biggest problem most EHR/EMRs have is their poor usability and this just makes it codified and worse!”

From Jack: “Re: Pittsburgh. Pervasive multi-system problems with a Cerner upgrade. The cover-up is on. Reporters will be punished to the fullest extent of medical staff by-laws and employment contracts.” This comes from a hospital I won’t name, especially since I have not verified the anonymous report.

From Carpluv: “Re: ARRA. LOL. Government , which comes up with ARRA, is going to pay doctors for EHRs. Then it does not tell them how they get reimbursed for it. This has stopped the buying cycle again. Morons.”

From The PACS Designer: “Re: CSA. The Cloud Security Alliance (CSA) has been formed by vendors to address Cloud and Internet security issues. The CSA mission statement is ‘To promote the use of best practices for providing security assurance within Cloud Computing, and provide education on the uses of Cloud Computing to help secure all other forms of computing.’ As we contemplate employing public and private clouds, it is good to consider CSA services that promote and educate everyone about security issues within cloud applications.”

Community Health Information Collaborative offers its health information exchange to providers in 18 Minnesota counties.

Virginia state officials admit that the recent hacking of the state’s doctor shopper database for drug abusers has caused doctors to prescribe fewer narcotics, sometimes to the detriment of patient care. Obama’s CTO, the former state technology secretary, put together the sexy $2 billion, 10-year cloud computing contract with Northrop Grumman that all the state’s applications are supposed to run on. At least one state delegate wants to kill the contract, saying nobody even knows whether the new contract will save money over the old one. Grumman is working hard to bag NHIN contracts, so you’d think keeping hackers out of an unexciting state patient database wouldn’t have been all that challenging. It’s still down, so doctors have to call in by telephone.

And in related (and belated) news, Lemuel Stewart, director of the Virginia agency that oversees the Grumman contract, is fired hours after he recommends not paying Grumman’s monthly invoice after a series of missed dates and what he claims were insufficiently documented invoices (not to mention that the agency is out of money). In the mean time, legislative hearings are underway as to why the state held closed door meetings to debate the massive Grumman contract. State employees give Grumman an “average at best” rating in terms of services provided. Even the interim CIO (also getting heat because he is also technology secretary and board member, all of which were supposed to be separate jobs) says Grumman’s “service levels in general are below expectations.” If anyone has an uplifting example of how a government partnership with big, publicly traded consulting firm has saved money or increased service, please send it my way since I can’t think of any.

The director of the Jefferson Regional Medical Center School of Nursing (AR) says its nursing students are benefiting from having Eclipsys Sunrise available for EMR training.

Finding it hard to get an Epic Systems job? There’s a spot for you if you are a talented cook.

Surgical information Systems (SIS) is a new HIStalk Platinum Sponsor, so welcome to them. The Alpharetta, GA company offers best-of-breed, integrated surgical solutions, exclusively focusing on the OR and perioperative systems. They’ve got a client testimonial video here and one on regulatory compliance here. I learned an important fact from the videos: I’ve been pronouncing the name wrong (I say “s-i-s” while customers say “siss”). No matter how you say it, thanks to SIS for supporting HIStalk (which, now that I think of it, has exactly the same pronunciation conundrum: is it H-I-S talk or hizz-talk?

Concerro (the former BidShift) acquires the assets of the CommandAware hospital incident command business from PortBlue Corporation. The press release tries to make a case of why an incident command system has anything to do with shift-bidding, but I wasn’t sold. Still, it looks pretty cool as long as your incident doesn’t involve downtime.

My latest driving-to-work inspiration. Doctors don’t use EMRs willingly because the entire paradigm of PC use assumes that: (a) users are sitting down; (b) they should be navigating with a keyboard and mouse since those work great when you’re sitting down; and (c) PC use requires concentration since applications are loaded with drop-downs, unforgiving edits, and user-unfriendly navigation. Have you ever seen all the available people at an airline ticket counter huddled around one screen and scowling as they try to figure out something as simple as your boarding pass? Or, hotel front desk staff who don’t look at you because they’re struggling with navigation of your room reservation? The PC is a terrible tool for on-the-go use, yet application programmers picture people seated and focused like they are when designing programs for them to use. Doctors are rarely sitting and able to interact intently with a computer (or if they are, they are not very good doctors). I know I say it all the time, but doctors the only highly educated and expensive professionals who are expected to happily peck away on a keyboard all day. Accountants, lawyers, hospital leaders, insurance company bigshots, and EMR vendor executives hardly ever do their own PC work, instead hiring assistants to free their time up for something more strategic. I don’t blame doctors for failing to see benefit since the people who are trying to convince them apparently don’t eat their own dog food.

Sixteen Mississippi hospitals receive threatening state letters for failing to collect mandatory state trauma registry information from their EDs. Some of them say Digital Innovation’s Collector Trauma Registry software, which was designed to work with national trauma databases, isn’t working too well for hospitals, taking up to an hour to abstract a single chart. They prefer the previous product, TraumaOne from Lancet Technology.

Ambulances in Franklin County, PA get connected from their laptops to the hospital for a smoother patient handoff. Why I as a federal taxpayer had to help pay for this is beyond me since I doubt I’ll ever set foot there, but that kind of common sense is hopelessly unfashionable in these feel-good days of having the government being the largest employer, insurance company, and bank.

Ireland’s health services oversight body says patient ID numbers should be rolled out immediately to reduce medical errors and simplify EMRs.

Conflicting findings among Hong Kong’s doctors: 80% say there should be a territory-wide health information exchange, but 80% of them also say their IT knowledge is insufficient to use computers themselves in practice. Nearly that percentage are worried about privacy and security.

A Kaiser article notes complaints of e-prescribing doctors, including security log-outs, inability to prescribe Schedule II drugs, and patient histories that aren’t current. One of the 50 doctors involved in a Shared Health pilot in Tennessee went back to paper. Another practice reports a 20% failure rate of prescriptions sent electronically, meaning patients show up at the drugstore and their prescription isn’t there.

An interesting thought as we move toward Internet-delivered medical applications: news of Michael Jackson’s death took down Google News, CNN, the LA Times site, and Twitter.

The CEO of a United Arab Emirates hospital credits Cerner with providing both access to patient information and management visibility that is helping them be more service-oriented. It’s a Hopkins affiliate, by the way.

RelayHealth, Medfusion, and Medem are mentioned in a Wall Street Journal article on virtual patient visits.

The pathetic soap opera that is Grady Hospital has a new episode. Two of its former CEOs are suing each other. The first CEO sued his replacement, who was head of the hospital authority that fired him, claiming she just wanted his $600K job. She just sued him for slander, claiming he told people she was sexually available and he could have had her if he wanted.

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Vitalize Consulting Services expands its existing consulting services to offerings for ambulatory care clinics. VCS is launching a new initiative that includes consulting services for Allscripts, ECW, GE Healthcare, and NextGen applications.

The privacy rights folks applaud the Supreme Court’s decision to let stand a New Hampshire law preventing prescriptions from being used to profile what each doctor prescribes. Two publishers of healthcare information argue against the NH law, claiming that data mining for commercial purposes is protected by free speech rights. Also, a federal appeals court refuses to block a Vermont law limiting the use of prescription drug data to profile the prescribing patterns of Vermont physicians. Look for more states to pass similar laws prohibiting data mining of prescription data.

New York-Presbyterian Hospital migrates a significant portion of its enterprise-wide IT server processing and storage infrastructure to Eclipsys’ Remote Hosting Services.

The Congressional Budget Office predicts that by 2082, health care will account for 99% of the nation’s gross domestic product at the rate we’re going. In 1960, healthcare spending was a mere 4.7%  of GDP. Last year we hit 16.6%. But why should we worry about that since most of us will be dead by then?

Michelle Obama announces the release of $851 million in community health center grants. The funds are part of the ARRA stimulus package and designated to address facility and equipment needs more than 1500 health centers. Over 650 facilities are expected to use funds to purchase new equipment or HIT systems and almost 400 will adopt or expand the use of EHR. Mrs. Obama made the announcement at Unity Health Care Clinic in DC, and apparently wore a light gray elbow-length jacket with a large silver high-waisted belt and dark gray pants. She accessorized with several silver bangle bracelets and diamond earrings. While I am sure the outfit was fabulous, I would have preferred this “news” article to leave out the fashion statement. That’s the kind of stuff we bloggers are suppose to discuss, right?

Tucson Medical Center markets “birth packages” to wealthy Mexican women coming to the US to give birth. Though the practice of Mexican women giving birth to children in the US is not new, the marketing efforts are. The marketing materials leave out the key draw: the newborn has US citizenship. Obviously, some folks aren’t too keen on the ploy.

Iowa Health Systems selects the Orion Health Rhapsody Integration Engine for message exchange from legacy systems and to make patient information accessible to physicians from the health systems EMR. Rhapsody replaces Sun Microsystems’ eGate integration software.

Siemens Healthcare appoints Michael Reitermann CEO of its US operations. Reitermann has served as CEO of Siemens Molecular Imaging since 2005 and was president of Siemens Nuclear Medicine before that. He will replace Dr. Heinrich Kolem, who becomes the global head of Siemens Angiography, Fluroscopy and X-ray business unit.

Physicians Medical Group of Santa Cruz County (CA), successfully demonstrates the exchange of health information within multiple communities.

CalRHIO announces its selection of RAND Corporation and USC to measure savings resulting from physicians’ electronic access to patient information via the CalRHIO HIE. The first phase will focus on emergency department savings.

Perot Systems’ Government Services Business unit wins a $119 million contract with the CDC to provide infrastructure and IT services support.

Participation in healthcare spending accounts has jumped 46% in the last year, a trend that is expected to continue at least through 2010.

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The Association of Medical Directors of Information Systems (AMDIS) files its response (warning: PDF) to ONCHIT’s proposal for the definition of “meaningful use.” Its recommendations:

• Rewrite the standards from the point of view of patients
• Clarify how ARRA payments will be determined
• Focus on consistent use to capture problems, meds, allergies, histories, prescriptions, and vital signs, plus having that information coded so it can be shared
• Defer quality reporting until 2013 to give doctors time to routinely collect the needed information
• Take out anything that requires CPOE because it’s loaded with the possibility of unintended consequences
• Hold technology vendors accountable for data exchange capability by making that part of certification.

Publicity-seeking missile Jesse Jackson, apparently fantasizing that he was there with Jackie, Tito, Jermaine, Marlon, and Michael as one of the Jackson 6, has insinuated himself into the limelight yet again, this time to dramatically repeat the obvious: the cardiologist who was in Michael Jackson’s house when he died needs to be found and interviewed (duh, Jesse). I’ve already made a bet at work that toxicology results will find at least one each of a narcotic, antidepressant, and stimulant, but the gossip sites say it will be more like a broader, Elvis-type blood-borne pharmacy since MJ was strongly rumored to have been a Demerol and Oxycontin addict in the past and, like a lot of celebs, had found himself some Dr. Nick-like docs willing to write anything he wanted even if it was likely to harm him (a Beverly Hills pharmacy sued him in 2007 for over $100K (!!) in unpaid prescription bills). Like former father-in-law, like son-in-law, sadly. Surely the tabloids are floating around offers to buy illegal copies of his medical records.

The final results of the HIStalk poll on HHS’s meaningful use draft: 20% think providers will achieve it too easily, 42% think the criteria are too hard, and 38% say they are about right. New poll to your right: do you think, as the technology journal article insinuated, that doctors and hospitals have intentionally resisted computerization to keep the public aware of how profitable their businesses are?

Also to your right, in Beta mode to see how many of you enjoy nerd humor like me: Dilbert. You can see the current strip, but also click the date link at the top to pop up a calendar and choose any date going back to 1989 or so (to the Phil, Prince of Insufficient Light days). My favorite is anything with Dogbert Consulting Company.

Justen Deal already told you this a couple of weeks back, but a new Canada Health Infoway report confirms: after eight years and $1.6 billion spent, EMRs contain information on only 17% of Canadians, far short of its 50% goal. Given its apparently failure to deliver what was promised, the organization’s response was: (a) we still might make it by the end of 2010, and (b) what the heck, it’s creating a bunch of HIT jobs, anyway. I guess our countries really are a lot alike. I was interested in the CEO’s educational background, but it’s never mentioned in his bio, which seems odd. 

Sentry Data Systems announces its new Claims Guardian application, which matches pharmacy procurement bills to charges for benchmarking, identifying missed billing opportunities, and documenting costs for submitted claims.

Cerner shares closed at $61.59 on Friday after hitting an all-time high, valuing the company at $5 billion and Neal Patterson’s shares at $344 million. Had you bought $10,000 worth of CERN in 1990, those shares would be worth $1.5 million today, for all us Neal-bashing losers (see stock chart above covering 1990 to now, with CERN in the blue and the Down in the red, no pun intended). Allscripts hit a yearly high Thursday and closed Friday at $14.74, but still way short of 2000 prices that were in the 80s. CEO Glen Tullman, predicting company growth, tells Jim Cramer, “we’re just getting started.” McKesson is in the 40s, way off its pre-HBOC prices in the 90s in 1998 despite paying massive CEO dollars.

But maybe your best HIT stock buy of all would have been NextGen parent Quality Systems. Your 1998 investment of $10,000 would be worth $627,000 today. The graph above shows the Dow (green), CERN (red), and QSII (blue). 

India’s national e-governance project will roll out Web-based telemedicine software called e-Sanjeevani, a .NET-based solution that’s claimed to be “the world-wide leading provider of connected medical devices or medical equipments, peripherals, and software used in telemedicine.” e-Sanjeevani was developed by CDAC Mohali, an ISO-9001:2000 certified R&D institute. I like its goals, which include “To provide multi specialty health care to the common man at the most affordable cost.” Maybe we should use it here to connect to specialists in India since our common man can’t afford it either. 

New York State Senator Pedro Espada owes the state and the IRS hundreds of thousands of dollars from the operations of his medical clinic/medical home, which gets funding from the state health department. The clinic paid the Senator $460K last year, but omitted that payment from its IRS filings. The clinic says it was promised $200K to convert to an EMR, but has received only half that amount. The Senator has been in hot water before, claiming a vacant apartment as his district residence and charged (but acquitted) of using clinic money to pay off his campaign debts.

China will restrict viewing of Internet-based medical research papers about sex starting next month, another step in a series of crackdowns that include requiring new PCs to have filtering software and requiring Google to block politically sensitive results from its searches. Medical information sites will be required to implement technology that will restrict sex-related medical research papers to medical professionals.

I’m torn: Microsoft is selling its Windows 7 Home Premium upgrade for $49.99 for a couple of weeks, temporarily discounted from its insane list price of $120 (Apple’s Snow Leopard will be only $29 and $49 for a five-license family pack, plus their stuff seems to be much less trouble–prone). Reasons against: (a) I have no unmet operating system needs since XP works fine for what I need, which is mostly to use Firefox to get to Google Apps and Gmail; (b) my Vista upgrade was a disaster, with all kinds of flaky behavior and lack of device support, (c) installing it requires a complete reinstallation of everything on the drive; and (d) I keep thinking of that Office 2007 ribbon bar, surely the stupidest and worst-designed software “feature” in recent memory, and wonder what similarly unpleasant surprises might have been tucked into Windows 7. I could load the release candidate version, but it’s just as risky in all those same ways except financially.

Speaking of Apple, I found its site for medicine and clinical practice. It’s a pretty short list of Mac-based EMRs, though, and I’d hope doctors wouldn’t choose a system just because it runs on a Mac. From the screenshots I’ve seen of some of those systems, they’re not much different from the hundreds of Windows-based apps out there.

Thieves in Canada who stole a truckload of computer monitors that a local hospital was donating to impoverished schools in Africa return them after finding out where they had been headed, attaching a note saying “sorry for the trouble, hope you forgive us, hope those kinds in Africa enjoy.”

Great news! Frugal politicians say they can try to fix healthcare for only $1 trillion. Let’s hope the government doesn’t run out of currency-printing green ink before it all turns to budget-busting red ink.

Jeff Amrein, who sold Advanced Imaging Concepts to Allscripts in 2003, moves on to his next venture: an online poker site called Hog Wild Poker Leagues. I thought the whole poker thing was as passe as swing music and pacifier-sucking teenagers, but maybe not.

Imaging vendor Merge Healthcare is added to the Russell 3000. Shares have been on a tear, jumping from around 40 cents in December to $4.30 now following major restructuring and a new private investment a year ago. Timing is everything, though: the share price was at nearly $30 in early 2006.

Odd hospital lawsuit: a heart surgery nurse sues her hospital employer, claiming she was demoted for complaining that a surgeon threw a 4-by-6 inch hunk of heart tissue at her during an operation and joked about it. His humorous line wasn’t mentioned, but I pictured him belting out Janis Joplin’s Piece of My Heart.

The surgeon general under the first President George Bush, who is now (but probably not for long) a VP of Florida Hospital in Orlando, pleads guilty of labor charges at her former New York health commissioner. She forced state employees to work overtime doing tasks such as having security guards move furnishings in her house and publicly chewing out state guards for mishandling her personal shopping bags. The inspector general’s report sand she added “new dimension to the definition of ‘arrogance’ and ‘chutzpah’." She’s also the sister-in-law of Father Guido Sarducci for you old school Saturday Night Live fans.

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From HIPAA Hound: “Re: interesting take on the resistance to electronic medical records. I have to say I agree with much of this reasoning, most especially where HC costs are increased by for-profit insurance companies looking to avoid paying claims by constantly moving the target for approved claims, thus sending admin costs for providers sky high, and the avoidance of any mechanism which might expose any of these practices to the general public. I am amazed that these practices have not been exposed already in our debate over HC reform.” Bet on it: whoever has the most lobbyists wins. This Technology Review (MIT) article is hardly complimentary: it says healthcare could have already gone digital if it wanted to, but resists to keep its lucrative business model out of the public eye. It also hints an another truism: it takes a lot of sick people to keep the big bucks flowing, so there’s not much incentive to lose customers by making them healthier.

From Bignurse: “Re: cheap technologies. I am using a free time clock software (Web-based) to keep track of time working on a part-time consulting job. Just click the timer while working and it records the minutes, later creates an invoice which can be e-mailed to the client. I can even put the timer on hold when the dogs need walking or to take dinner out of the oven. Love it.”

From Dr_Duped: “Re: HCNN. I signed up for a service at www.hcnn.net that promised an FDA targeted alert system based on my primary specialty. Sounded great. However, several FDA alerts did go out that would have been towards internal medicine and I did not receive a notification through HCNN. I called their listed number, and according to the gal that answered the phone, what I signed up for had nothing to do with the FDA. This company is trying to capitalize on the ‘Dear Healthcare’ letters we receive in the mail. The whole operation is deceptive and all my colleagues need to be aware. Those notifications go in the garbage for a reason – the medical community would prefer not to receive them by any communication method from Pharms companies.” I would hope the medical community pays attention, since those ‘Dear Doctor’ letters are related to patient safety, not drug company marketing (I think of them as anti-marketing). HCNN is non-profit and free, is clear about its separation from FDA, (it merely repackages paper FDA Dear Doctor letters into e-mail for faster delivery), does not share subscriber information, and has a ton of endorsements. I don’t know about the missed alerts and I’d keep an eye on them to make sure someone doesn’t try to cash in, but they seem on the up-and-up to me and a good service.

From The PACS Designer: “Re: iPhone. With the ever-increasing population of iPhones, it won’t be long before they are used in everyday hospital activities. The informatics program at Children’s Hospital Boston (CHIP) has embarked on a project to bring the iPhone application selection process into their everyday decision processes by mining their legacy databases to migrate the information to the web for iPhone access. They have listed ten features on their website for anyone to view that could lead to further information sharing in healthcare to improve patient care. Participants of their May workshop believe that an infrastructure based on ‘substitutable’ components is a highly promising way to drive down healthcare technology costs, allow flexibility, support standards evolution, accommodate differences in care workflow, foster competition in the market, and accelerate innovation. Thanks to John at Chilmark Research for the alert.” The NEJM article is here. I like the anti-certification jab in #10 of their platform principles, probably nurtured along by participant and EHR realist David Kibbe (click below to enlarge). Isaac Kohane and Kenneth Mandl (above) are the chief CHIP guys involved.

Misys announces its expectation of a 40% rise in sales for FY2009, although all but 3% of that came from the Allscripts merger and currency values. Allscripts says it expects to slightly beat full year revenue and earnings estimates after a strong Q4.

Farrah Fawcett and Michael Jackson die on the same day, ensuring that the rest of us who remember their 70s and 80s prime reflect on our own mortality. Apple CEO Steve Jobs lives on, meanwhile, although raising a lot of questions about how he was desperately ill enough to jump to the head of the Tennessee liver transplant line (and ahead of 16,000 Americans waiting for a transplant) yet the company disclosed nothing about his condition to shareholders to correct the fact that his claimed “hormonal imbalance” was actually “I’m in complete liver failure and will die shortly without a transplant.”

Some random thoughts as I endorsed the Declaration of Health Data Rights: (a) given the undecipherable nature of medical records to most laypeople, who’s going to explain them? Doctors won’t have time, so it’s a good business for a nurse to start. (b) It will be embarrassing how much misleading and plain wrong information they find there, kind of like when hospitals used to let patients see their error-filled charges and stopped because they couldn’t really explain them either; (c) Patients will be surprised at how much stuff is in there about them as a customer and not a patient (entries created entirely for billing purposes). (d) they may be surprised at the lack of continuity, especially with referrals and records sent from one provider to another.

From Weird News Andy: Reese’s Cups as health food? And, as he says, “a slide show for those not eating lunch” showing X-ray oddities.

I just remember that HIStalk is now six years old as of the beginning of the month. For the new folks, put your e-mail address in the Subscribe to Updates box to your upper right to get instant notification when I write something new (I don’t use that list for anything else, by the way, so it’s guaranteed spam-free). The Search HIStalk box invokes a Google site search to dig through those six years’ of stuff, looking for the name  of companies, people, or obscure rock bands. The sloppily designed Report a Rumor box in brilliant green asks nicely to be clicked when you’ve got something secretive to tell me (it’s secure, anonymous, and accepts attachments). Keep reading down the right column to see what’s on HIStalk Practice, to see what’s been posted to HIStalk Discussion or the Industry Events, and to see what comments have been recently posted.

Markle Foundation says 56 organizations have endorsed its PHR framework.

Inga interviewed QuadraMed CMO Joe Bormel on HIStech Report, covering a lot of ground including translational medicine and taxonomies along with the usual industry-type questions. 

A study finds that the Phoenix area has a high rate of EMR adoption, but also a high rate of EMR deinstallation due to inadequate training, missing functionality, or lack of affordability.

Red Hat’s Q1 numbers buck the tech trend with EPS up 7%, beating estimates.

Two laptops stolen from Alberta Health Sciences (Canada) contain some patient information, but are password-protected. Apparently no medical institution in the world enforces a policy of storing data only on the network, not on the local device where it can be stolen or lost (nobody backs up PCs across the network, either, although users always have some vague confidence that IT magic is going on in the background).

HIMSS may be non-profit, but it’s looking for a sales jock “to generate sales and achieve revenue objectives for the Organizational Affiliate program,” prospecting hospitals for its all-you-can-eat plan of unlimited individual memberships for one institutional price. Required: to “aggressively solicit new customers,” “be alert to competitive organizations,” and “understand the process or art of selling.”

Speaking of HIMSS, the local paper mentions its office in Ann Arbor, MI. I assume that’s where MS-HUG lives, but I don’t really know.

TriZetto founder, chairman, and CEO Jeff Margolis receives the 2009 National Human Relations Award from the American Jewish Committee for his healthcare and community service work.

Jobs: Healthcare IT Project Managers, Account Executive – South Central, McKesson SQL Consultant.

If you’ve got $4,000 to spend and want to hang out with Goldie Hawn, David Blaine, and some big-name healthcare people, you could go to TEDMED2009 in October in San Diego. It was dead for four years (reason not given that I could find) and revived this year in what looks like a business rather than a love-in, but at least there will be only 400 attendees. I bet the bloggers are falling over each other trying to nab a press pass so they can tweet their brains out to a breathlessly waiting world.

The head of Siemens Healthcare, like all device and drug makers, tries to convince Congress that the company’s technology actually saves patients and insurance companies money, also making the case that most doctors who order diagnostic tests don’t personally profit from doing so (he’s probably right about that, but that still leaves scumbag malpractice lawyers as a key reason for overuse).

Fairview Health Services (MN) is defending itself against a lawsuit over patient information posted on a MySpace page. A woman being treated in a clinic for a sexually transmitted disease was spotted by an employee related to the woman’s husband, who when told another relative at the hospital, who then told the husband. Both employees were fired, but a Web page soon popped up with the woman’s medical information, her picture, and claims that she cheated on her husband and was addicted to plastic surgery. The woman sued the hospital and the employees, but I’m not interested enough to try to understand all the other legal wranglings detailed in the article. What I did find interesting was a claim by the defense: that HIPAA pre-empts state privacy laws and therefore precludes private lawsuits.

Another odd hospital lawsuit: a patient at Memorial Hermann Beaumont Hospital takes a swing at a hospital employee, misses, and instead hits another patient in face, breaking the other patient’s jaw and requiring him to undergo surgery when infection sets in. The broken jaw guy is suing the hospital (but not the non-deep pockets guy who decked him, of course). Oddest of all, his lawyer is a former Super Bowl starting cornerback for the Buffalo Bills.

HERtalk by Inga

Nuance Communications recognizes 20 healthcare organizations for saving one million dollars or more in transcription costs using the eScription platform. Brigham and Women’s Hospital (MA) tops the list, having accumulated $10 million in savings since installing the product. eScription also reports that eight new healthcare organizations have gone live on their platform since the beginning of the year.

Sharp Healthcare (CA) selects Anakam Identity Suite to provide patient access to Sharp’s patient portal.

Nyack Hospital  (NY) chooses McKesson’s Paragon community HIS solution for EHR and financial management.

Medicity and Eclipsys announce a partnership to provide a HIE to Eclipsys clients. Eclipsys will leverage Medicity’s Care Collaboration platform to deliver its new HeatlhXchange solution.

Stephen P. Wood, a senior VP for Ingenix Consulting, is named a Top 25 Consultant by Consulting Magazine in the “Excellence in Healthcare” category.

RCM vendor Capario names Charles Lambert CFO, making him the forth former Misys executive to join the company once known as MedAvant Healthcare Solutions.

HIS vendor Healthland partners with Sentillion to resell its SSO solution expreSSO.

Greenway introduces a new program to extend discounted pricing to physician groups within HIEs. Qualified organizations can purchase Greenway’s PrimeSuite 2008 for discounts of up to 25%.

The state of Vermont was recently recognized by Surescripts as the “most-improved” state in terms of sending prescriptions electronically. Surescripts also honored the nation’s top individual e-prescribing physicians, include three using standalone e-prescribing software and three using EMRs. Interestingly, 44% of Vermont’s e-prescriptions were generated by Allscripts users, as were three of the six top prescribers. A fourth provider uses Eclipsys Practice Solutions.

A University of Iowa official admits that despite spending $55 million on an Epic system, the UI Hospitals and Clinics will not be able to communicate seamlessly with other hospital systems. It’s unclear whether this is a surprise to the school’s Board of Regents or merely to the reporter covering the story in the local paper. The officials also indicated that users have been required to go through an “onerous” training process, which consisted of 12 hours over the last fall and spring. (just 12 hours?) The  medical school representatives also praised the system for its flexibility and wide variety of features.

Opus Healthcare Solutions becomes the second company to receive CCHIT ‘08 Inpatient EHR certification, after Epic.

Diagnostic Center of Medicine (NV) selects Allscripts EHR/PM for its 16-provider, three-location practice, replacing Misys practice management and adding an EMR.

NCQA releases a reporting highlighting the important role of small medical practices, which provide almost three quarters of ambulatory care in the US. The report points out that smaller practices are more likely to lack the resources to improve quality of care, implement EMRs, and serve an increasingly diverse population.

Perhaps Rep. Kathy Dahlkemper read the NCQA report. The chair of a House Small Business subcommittee on health care proposes a bill to create a new SBA loan program to help doctors in small or solo practices to buy and maintain EMRs. The program  would rely on private sector loans of up to $350,000 and $2 million for groups, be 90% backed by the SBA.

And, the AHRQ is considering developing an electronic toolkit to assist small and medium sized practices change their workflow when adopting HIT. The AHRQ issued an RFI to gather information on how clinics and physician groups redesign their workflow when adopting technology.

I must say this report depresses me. Common Cause calculates that so far this year, healthcare industry participants are spending an average of $1.4 million a day to lobby members of Congress. That means lobbyists are on track to spend half a billion dollars this year. Half of the spend comes from the pharmaceutical industry; hospitals, doctor groups, and suppliers of “healthcare products” (which I assume includes HIT items) make up the balance. The reports also shows the amount of campaign contributions received from the health industry to each senator and representative. Arlen Specter wins that contest in a landslide;  Mr. H’s man-crush Senator Grassley is way down on the list. Meanwhile I’m trying to calculate how much healthcare we could buy with $1.4 million a day.

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What Interesting, Light, and Cheap Technologies Are We Using?
By EncoreDiva

We don’t have a single server of our own.  We use hosted solutions for e-mail and SharePoint. 

We have a Web-based accounting system, timekeeping system, and expense reporting application.

We’re experimenting with Yammer to encourage collaboration within a virtual organization (and to cut down on e-mail), we have a page on Facebook, we utilize the status feature on LinkedIn to update our network on what’s new with the company and we utilize Skype for IM and quick calls. 

We use www.freeconference.com for internal conference calls and www.dimdim.com for internal webcasts. We utilize Administaff for our payroll and benefits and they administer (securely) all employee information. Our recruiting system is Web-based and open source (www.catsone.com) and it’s easily accessible from an iPhone. From a desktop perspective, we’re playing with OneNote and so far I’m LOVING it!

Meaningful Use: A Brief History
By Dr. J

13,000 BC: Prehistoric humans decorate their caves with images of herbal remedies used for their medicinal purposes. Unfortunately, these primitive clinical information systems are not CCHIT certified and reimbursement for shamanism drops dramatically. Neanderthals go extinct.

2600 BC: The Egyptian Imhotep describes the diagnosis and treatment of 200 diseases. ICD-10 soon expands this list by nearly three orders of magnitude.

460 BC: Hippocrates, the “father of modern medicine,” writes the first draft of his famous oath. After an extensive public comment period, Hippocrates tones down his commandment to “first, do no harm by taking an extensive medical history, including prior medications, allergies, and surgeries and accounting for the patient’s renal and hepatic function” out of concern that this tough requirement may hamper widespread adoption.

150 AD: Galen of Pergamum, pioneering Roman surgeon, insists on using only papyrus. He refuses to implement parchment in his practice because he finds it so disruptive to his workflow.

1231: Theodoric, Barber of York, proposes standardized terminology for various forms of bloodletting, primarily so he can “upcode” to get increased reimbursement for using leeches.

1427: As the Black Plague sweeps through Europe, self-flagellation is lauded as a pioneering effort for health information exchange. Whole communities get into the act by burning sufferers alive, using the fiery glow as a novel public health reporting tool.

1601: James Lancaster proves that consumption of citrus fruits prevents scurvy in British sailors in the world’s first controlled clinical trial. Unfortunately, in a world without quality metrics for scurvy prevention, Lancaster fails to achieve his pay-for-performance bonus for the year.

1795: After a mere 194 years (and 1 million scurvy deaths), the British navy mandates lemon and lime juice as standard sailor’s rations. Next up, EHR adoption.

1816: Rene Laennec invents the stethoscope, which is subsequently rated “Best in KLAS” over the objections of the Open Source community.

1845: Surgical anesthesia is pioneered at Massachusetts General Hospital. The Federal government sets up “Regional Anesthesia Extension Centers” to assist in anesthesia implementations nationwide.

1854: Florence Nightingale begins a medication bar-coding initiative during the Crimean War, but then realizes it would be preferable to save lives by cleaning the army hospital’s sewage system.

1884: Robert Koch establishes his famous postulates to identify microorganisms responsible for various diseases. Privacy advocates successfully sue Koch, forcing him to go back and de-identify the pathogens.

1889: Sir William Osler creates the medical residency but completely fails to anticipate the headaches his other creation, the co-signature, will cause in 120 years.

1895: X-rays are discovered by Wilhelm Röngten, without the assistance of a PACS. Nevertheless, for years Röngten would claim that his images conform to DICOM standards.

1928: Alexander Fleming extracts penicillin from mold growing on a tablet PC he had forgotten to plug in for several days. He tries to e-prescribe the antibiotic for a patient, but the antibiotic is not in his “favorites” list, so he handwrites the prescription and gets the dosage wrong.

1967: Christiaan Barnard performs the first human heart transplant. No one ever hears about it because Twitter has not yet been invented.

2003: The human genome is completely sequenced. Instead of the expected ACTGs, the genome is apparently filled with strange acronyms like LOINC, CCD, CCR, and HL7.

2008: CCHIT is involuntarily dissolved for the first time.

2009: David Blumenthal, the National Coordinator for Healthcare Information Technology, delivers the government’s definition of “meaningful use” to an immense crowd of jubilant healthcare providers from the steps of the Lincoln Memorial, after an opening concert by U2. Healthcare in the US is saved! The rest of the industrialized world yawns while besting us on nearly every relevant quality measure for the tenth straight year.

The PACS Designer’s Review of Cloud Acronyms
By The PACS Designer

Illustration: Youseff, UCSB

The number of acronyms applied to cloud computing is growing, and even TPD is confused about what they really mean when it comes to providing users solutions for expanding the computing universe of an institution.

Even IBM has gotten into the marketing hype by calling their cloud offering Computing as a Service with their introduction of their Blue Cloud.

So let us look at what the Wikipedia has to say about the types of service renderings related to cloud computing solutions.

The most common term heard is Software as a Service (SaaS).  The Wikipedia definition is:

"Software as a Service (SaaS, typically pronounced ‘sass’) is a model of software deployment whereby a provider licenses an application to customers for use as a service on demand. SaaS software vendors may host the application on their own web servers or download the application to the consumer device, disabling it after use or after the on-demand contract expires. The on-demand function may be handled internally to share licenses within a firm or by a third-party application service provider (ASP) sharing licenses between firms."

Another cloud computing term is Platform as a Service (PaaS) which is defined as:

"Platform as a service (PaaS) is the delivery of a computing platform and solution stack as a service. It facilitates deployment of applications without the cost and complexity of buying and managing the underlying hardware and software layers(1), providing all of the facilities required to support the complete life cycle of building and delivering web applications and services entirely available from the Internet(2)—with no software downloads or installation for developers, IT managers or end-users. It’s also known as (cloudware).  PaaS offerings include workflow facilities for application design, application development, testing, deployment and hosting as well as application services such as team collaboration, web service integration and marshalling, database integration, security, scalability, storage, persistence, state management, application versioning, application instrumentation and developer community facilitation. These services are provisioned as an integrated solution over the web."

The next cloud computing term is fairly new, and is Infrastructure as a Service (IaaS) and is defined as:

"Infrastructure as a Service (IaaS) is the delivery of computer infrastructure (typically a platform virtualization environment) as a service. These virtual infrastructure stacks(3) are an example of the everything as a service trend and shares many of the common characteristics. Rather than purchasing servers, software, data center space or network equipment, clients instead buy those resources as a fully outsourced service. The service is typically billed on a utility computing basis and amount of resources consumed (and therefore the cost) will typically reflect the level of activity. It is an evolution of web hosting and virtual private server offerings."

Lastly, IBM’s term of Computing as a Service will most likely be used as a marketing tactic only as their already is a CaaS which stands for Communications as a Service!

Hopefully posting all of these terms in this entry will help users understand solution offerings by vendors, and be a guide to everyone contemplating using cloud computing structures as solutions.

(1) Google angles for business users with ‘platform as a service’
(2) Comparing Amazon’s and Google’s Platform-as-a-Service (PaaS) Offerings | Enterprise Web 2.0 | ZDNet.com
(3) IT as a Service is a model ripe for adoption
https://spaces.internet2.edu/download/attachments/8817/ComputingAsAService08.pdf?version=1
http://en.wikipedia.org/wiki/Software_as_a_service
http://en.wikipedia.org/wiki/Platform_as_a_service
http://en.wikipedia.org/wiki/Infrastructure_as_a_Service

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From Don Duck: “Re: new CCHIT certifications. Does the EMR-S, which certifies home-grown, single-user EMRs, include groups that have developed an EMR and then sold or loaned it to other groups with common ownership or interest? It seems odd that some EMR companies might go out of business for lack of certification while homegrown versions could live on.”

Here are CCHIT’s slides (warning: PDF) on the topic. It sounds to me that EHR-S sites (which pay only $150-300 per licensed provider and are certified via a “virtual visit”) can be any provider group as long as their product meets requirements for federal standards, security, and meaningful use. The grid says even vendors of comprehensive EHRS with multiple customers can go the EHR-S route, although the per-provider cost would make that unattractive for all but the smallest vendors (although it would let them turf the whole certification issue off on their customers, assuming anyone would buy under those terms).

Microsoft signs with Sentillion to provide single sign-on and context management services for Amalga. Kudos to Microsoft for recognizing the value of offering that level of user experience integration early in the game. I interviewed Sentillion and co-founder Rob Seliger not too long ago (and my sixth question about vendors making their products CCOW compliant was especially relevant, if I do say so myself). My hospital has both SSO and context management in limited deployment, but has finally seen the light and is adding new apps. I’m pretty sure we will avoid some clinical mishaps my keeping the screen-fumbling to a minimum, not to mention improving clinician satisfaction. It’s a nice nod to Sentillion that Microsoft came knocking.

Healthcare Management Systems announces GA of what it says is its largest release, which contains functionality to meet figure CCHIT criteria and to qualify provider users under meaningful use.

A widely reported Cornell study finds that providers don’t tell patients about clinically significant lab and rad findings seven percent of the time. The study methodology isn’t the best, but it’s one of those “sure, it happens” issues in which results are lost in the shuffle or don’t raise the appropriate flags.

Sage Software India announces the launch of a couple of new products for hospitals in India. They have ERP in their name, but that must mean something other than Enterprise Resource Planning since the press release talks about bed assignments and physician notes. ERP sounds more like a product line, according to this page.

Listening: Eric Clapton and Steve Winwood, brand new on Live from Madison Square Garden and recommended by reader Bill. I’m not a fan (Cocaine and Wonderful Tonight are immediate dial-changers for me), but this one’s a keeper, a couple of guys in their 60s sounding better than they did in their 20s. Their cover of Hendrix’s Little Wing is about as good as music gets, with an old-school Hammond B3 keyboard and Clapton doing great stuff on the guitar instead of just noodling around.

Welcome to new HIStalk Platinum Sponsor Keane, more specifically, its Healthcare Solutions Division (HSD). The Boston-based company provides solutions to hospitals and long term care facilities all over the US, including Keane Optimum (hospital information suite), Patcom (patient management), and Keane NetSolutions (browser-based medication management). I’ll let them tell you more: “Keane’s solutions help U.S. healthcare facilities modernize their operations by using technology to prevent medical mistakes, provide better patient care, and implement the most effective treatments, while at the same time achieving cost-saving efficiencies and meaningful returns on health information technology investments. Keane Optimum is especially well suited to help healthcare facilities accelerate the adoption of EMRs in response to the Healthcare IT provisions in the recently approved American Recovery and Reinvestment Act. Specifically, Optimum allows providers to enhance quality, maintain privacy, support clinical decision making and begin to move to a more interoperable environment for improved health care delivery.” Thanks to Keane for supporting HIStalk and the people who read it.

Saint Vincent Health Center (PA) credits Sunrise Surgery (which I think is Surgical Information Systems when Eclipsys sells it) for its compliance with regulatory requirements and quality reporting.

HIMSS gets a page devoted to it on the Citizen Media Law Project for sending a semi-threatening letter to two bloggers back in February, demanding they take down unflattering comments left by an anonymous poster (and also asking them to turn over information that would help it identify that individual). Both bloggers declined to comply but offered HIMSS equal time, which it didn’t take advantage of. I still think HIMSS believes the poster was a former or current employee given that the lawyers doing the pressuring (respectfully, I should add) are labor attorneys. You may also remember that the comments that got the HIMSS corporate panties in a bunch made some pointed (and sometimes bizarre) comments about what the poster perceived as HIMSS influence over CCHIT.

From Weird News Andy: a man sent home on Tylenol from an Australian hospital with what its ED diagnosed as a headache turned out to have a broken neck. The patient said he was told they couldn’t do an X-ray because the radiology department was closed for the night.

I like this article, which says budget-strapped CIOs are turning to “lite” corporate IT using free Web-based tools, open source applications, and software from little-known vendors to meet IT needs. The article cites this blog, which says the average person has more IT capability in their den than at their job: “The new expectations of corporate IT should also turn into an opportunity. If you and I can buy storage at 10c a GB, why are corporations paying hundred times as much? If at any given time, if millions of consumers are talking to each other around the world on Skype for free, why are mobile companies charging you exorbitant roaming fees? If any one can call the Geek Squad and get a one time PC repair visit, why is your desktop outsourcer not charging you on a per usage basis, rather than some monthly charge? Why is your software vendor UI still so 90s – and why do they deliver a truckload of user manuals and documentation? And why do they still need schoolbuses of consultants to help implement? Consumerization of technology should be a broad manifesto for change in corporate IT and enterprise vendors. Let’s face it – we are  slower, uglier, exorbitantly expensive, obsessed with security and compliance. Time for a makeover. An extreme one.”

So, with that article as inspiration: what interesting, lightweight, and cheap technologies are you using? I’m really curious. If you’re a provider, what are you experimenting with?

And in that vein, know any CIOs or CMIOs who are innovative and interesting? We’d like to interview them, so hook us up if you can.

I admit it: I have a man crush on Senator Charles Grassley and his fearless probing into how government money is spent (and misspent). His latest target: UCSF’s medical school, of which he is demanding more information to determine whether taxpayer dollars are being wasted on research projects and mismanagement.

The Senator would like this: the VA’s $3 million combat-related brain injuries lab in Texas hasn’t tested a single veteran in its three-year history.

I endorsed the Declaration of Health Data Rights here. What it says: you have a right to your medical information, each data element should be tagged with where it came from, whoever has your information should give you a copy for very little money (and in electronic form instead of paper if that’s how they have it), and you can share your data with anyone you want.

The New York Times covers the medical home concept, highlighting a Duke University project that assigns a primary care specialist to coordinate a patient’s care, also providing a patient portal for making appointments and checking lab results.

Heart failure patient readmissions at Sentara Virginia Beach General Hospital were reduced by 74% by using a heart failure care plan deployed via GetWellNetwork’s interactive patient care system.

Apollo-Bramwell Hospital in Mauritius will be the first Indian Ocean hospital to go live on PACS.

E-mail me.

HERtalk by Inga

Right after Apple announced their new phone, I bemoaned the fact that I had JUST upgraded from the 2G to the 3G. Fast-forward (after lots of advice and  lots of time on hold with Apple and AT&T and never talking to anyone) to Sunday: I went to the Apple store and was told I was out of luck, there is no way to get the new phone without paying another $199. I suppose I could have argued the point further with some mensa (or whatever they call the managers), but I had no interest in standing in the 20-deep line just to attempt getting a new phone for a better price. If you purchased a 3G2, please tell me it really isn’t worth standing in line for two hours. I did upgrade to the 3.0 software and am SO happy to have search capabilities on my e-mail, cut and paste, and the ability to view email in landscape. I really am a low-maintenance kind of woman.

The Glacial Ridge Health System (MN) reduces its costs 50% by replacing its film-based PACS with 7 Medical’s on-demand PACS.

Baylor Medical Center at Frisco (TX)  selects Orchestrate Healthcare, in partnership with Vitalize Consulting Solutions, to perform a readiness assessment of their current systems, provide an analytical review, and present a roadmap for the strategic roll-out of clinical and technical architecture.

NextGen is now a CMS-qualified PQRI patient registry for 2009 and will help eligible physicians submit PQRI quality measures directly to CMS.

RelayHealth and LightHouse1 announce a new partnership to help providers automate payments for patients with healthcare spending accounts and consumer driven healthcare plans. RelayHealth will integrate its EasyCDH solution with Lighthouse1’s OnDemand  platform to create the SAS OneCard solution.

Medical tourism in Korea has grown 41% in the past year. Officials attribute the increase on new laws permitting aggressive marketing to attract overseas patients.

Massachusetts takes top honors at Surescripts’ Safe-Rx Awards, which recognize the top e-prescribing states. Massachusetts providers send 20% of prescriptions electronically, followed by Rhode Island at 17%. Vermont was named the most-improved state.

Sarasota Memorial Health Care System (FL) selects the Medicity Novo Grid solution to electronically exchange health information between the hospital and physician practices.

Contra Costa Regional Medical Center (CA) plans to replace its discontinued Mediware Information System with Unibased ForSite2020 periOperative Resource Management System.

Tufts Medical Center (MA) contracts with WaveMark to provide RTIM technology to track physician preference items in its Cath, EP, and interventional radiology departments.

KLAS churns out another report, this one entitled, "Infection Control: Improving Patient Care and Reimbursements.” The study highlights the leading infection control software vendors and their solutions. The featured products are the top-rated Cardinal Health MedMined, Premier SafetySurveillor, and TheraDoc Infection Control Assist.

More medical records are found dumped in the trash, this time finding their way to an Alabama landfill. It’s ironic how much attention is spent ensuring our electronic records are secure while paper medical charts continue to show up in public dumps and recycling centers.

The Trizetto Group introduces a free PHR available to qualified payer customers for providers.

E-mail Inga.

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