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Monday Morning Update 6/15/09

June 13, 2009 News 15 Comments

From HITMan: “Re: EMRs. Regarding the Wharton professor’s comment about the value (or lack thereof) of EMRs, is it possible that our entire industry is missing the point? I admit that in their early years EMRs were sold as differentiators, cost savers, and patient care improvers (is that a word?). Today, however, the benefit of EMRs that no one is discussing is the knothole effect. Essentially, if we pull all physicians and nurses through the same knothole and force them to operate in the same way, we have not improved patient care, but we have standardized care in a way that when the healthcare system makes an evidence-based medicine change, it improves the performance of all clinicians simultaneously. In the old world, modification one one physician’s behavior modified one physician’s behavior. In an EMR world, changes to physician processes force all EMR users to operate in the same way. Variation is the enemy of perfection.” I would agree, other than the fact that medicine as a science is far too primitive to prescribe the “one right way” (as I always say, we’re good at observing, correlating, and creating confident-sounding names for stuff, but tentative and inconsistent on being able to do anything with that information to improve outcomes). I like the idea of getting new research into the field, a problem that hasn’t been improved with EMRs, so I’ll agree that some form of central-oversight-by-EMRs could do that. Or, on a less contentious level, at least fully defining the extent of practice variation in real time and alerting physicians of areas for improvement. That would be a cool social networking app: have docs post cases (auto-populated and de-identified from the EHR) so that peers could weigh in as a mass consult.

From The PACS Designer: “Re: RFID. Coca Cola, one of the best-run companies in the world, has developed an RFID-enabled beverage dispensing machine for fast food outlets and restaurants. The system uses flavor cartridges similar to print cartridges to mix up to 100 drink combinations directly from the mixing mechanism in the dispensing machine. At the same time, it uses RFID to send information to Coca Cola about customer preferences each day for analysis. InformationWeek has an article in their most recent issue explaining how instant mixing for drinks was devised by copying the anesthesia treatment methods used to dispense precise amounts of drugs to patients.”

From Brian D: “Re: WWMR. IntrinsiQ LLC acquires consulting company WWMR out of San Mateo, CA.” IntrinsiQ is the company behind the online chemo dosing application IntelliDose. WWMR is a marketing research company that offers product assessment and economic forecasts to oncology drug companies. Sounds like the idea is to package up all the chemo ordering information collected by IntelliDose and sell it to drug companies. Did you ever get the feeling that the healthcare industry secretly lets the drug companies do whatever they want just to provide a potential purchaser of newly developed technologies and startup companies? Every HIT business plan somehow seems to revolve around getting money from either the government or the drug industry, both of which have the sometimes-abused power to print money.

A reader claiming to be a physician from a Pittsburgh hospital says a recent clinical systems upgrade is causing major problems with medication administration. He/she adds, “I bet you will not publish this because [vendor] is a platinum sponsor of your site”. The reader does indeed seem to be from a Pittsburgh hospital, but I’m not comfortable running the vendor’s name without verification (by the way, the vendor in question is not an HIStalk sponsor). More information is welcome from non-anonymous sources (I’ll leave your name off the posting, but I need to know who I’m quoting).

Miguel Perez III, former IT director at Driscoll Children’s Hospital (TX), is promoted to CIO of its health plan.

Grammatical gripe: “take a vitamin everyday” is wrong. Everyday as a single word is an adjective; otherwise, it’s “take a vitamin every day.” And, when you preface someone’s name with Dr., it is incorrect to put their credentials afterward, such as Dr. John Smith, MD (I call that “academic bookending). Thanks for listening to me vent.

slide

Andy, HIStalk’s official source of odd news, finds this gem: an 18-year-old science student self-diagnoses her Crohn’s disease, finding abnormalities in a slide of her own intestinal tissue that a pathologist had missed.

The Health Services Executive of Ireland gets an injunction against Keogh Software, a vendor of radiology and billing systems that is threatening to cut off support unless the organization pays what it claims are overdue maintenance fees.

White House health czar Nancy-Ann DeParle made $5.8 million in the past three years from big industry players like Cerner and Medco, renewing debate about whether having deep industry financial ties is a good thing (experience) vs. a bad one (bias). One thing about politicians: pretty much all of them got rich working the system, even democrats like DeParle.

Cleveland Clinic becomes yet another health system turned software vendor, collaborating with CareMedic to sell patient access management software.

Grocery store company Safeway says “market-based solutions” can slash healthcare costs by 40%, claiming it has held its own healthcare costs steady over the past four years vs. the average company increase of 38% over the same period. How they did it: they followed the car insurance model, where irresponsible drivers pay more instead of being subsidized by good drivers. Employees pay more if they are overweight, if they smoke, or if they have high blood pressure or cholesterol. The company complains that their performance would be even better if federal laws didn’t prohibit bigger discounts: they’re allowed to give non-smokers a rate reduction of only $312 even though smokers cost $1,400 more a year in insurance costs. Great idea, although given the number of folks who wouldn’t get discounts, it’s political dynamite unlikely to be embraced by politicians. The company is a member of Coalition to Advance Healthcare Reform, whose principles are here.

compuware

Inga didn’t mention some of the This Is Spinal Tap moments in Compuware’s Vantage 11 video. The video snap above says it all. I think I need to get involved with something like this since I like satire.

Most of the 97 readers participating in the poll to your right think Mark Leavitt and Steve Lieber should resign their CCHIT roles (75% to 25%). I should clarify my own position: the problem is the appearance of potential vendor influence, assuming HIMSS at least looks like a vendor trade group even though it says (usually) it isn’t. With billions of ARRA money on the line, the ties between the organizations should be cleaved even though CCHIT has done what seems to be a fine job, assuming you like the idea of certifying EMRs for something more than interoperability (which was all CCHIT was tasked to do, but now everyone wants them to become the Good Housekeeping Seal of Approval to make EMR implementations risk-free, which is impossible). Certification hasn’t made much of a dent in low EMR utilization, in case you didn’t notice.

I like the Lemon Law idea: draft a standard, government-approved warranty that requires EMR vendors to offer refunds for products that fail to perform as represented (including implementation services if they provide them). Or, given Obama’s propensity to directly tinker with how taxpayer-owned car manufacturers operate, perhaps he should fire up the currency printing presses and simply pay low-rated EMR companies not to sell software, like paying farmers not to raise certain crops.

New Jersey Assemblyman Herb Conaway, Jr. follows his “make non-CCHIT EMRs illegal” bill with one that would create a New Jersey Broadband and Electronic Health Information Network Authority, which would have the power to issue bonds (and levy taxes to pay for them) and exercise eminent domain to finance broadband infrastructure projects and oversee development of a state-wide electronic health information network. I’m thinking about working with him on a “Click It or Ticket” EMR project in which any doctor found using a pen instead of a mouse could be cited, the New Jersey version of “meaningful use”.

I admit I’m miffed after I think about this timeline. Conaway introduces his “make non-CCHIT EMRs illegal” bill on May 11. Reader Chip tipped me off, so I found the text of the proposed bill and wrote it up on June 5. Other sites and rags started reporting it as hard news on June 6, linking to the bill’s text with the same link I’d used. I think timing makes it obvious where they got their information, but a credit would have been nice. Finding stories is harder than it looks.

Pharmacy automation vendor Talyst, fresh off $8 million in new funding and finding entrenched competitors blocking expansion of its hospital market share, wants to expand into nursing homes and prisons. 

Revenue cycle and software development vendor Apollo Health Street says it has developed an ambulatory EMR for a client and had it certified by CCHIT. I don’t really understand the company’s origins, but it seems to be the BPO and IT arm of India-based Apollo Hospitals. 

I’m interested in PDF Healthcare and asked some folks who are involved to consider putting some kind of short overview together. They overachieved – Steven Waldren, MD, MS, director of the Center for Health IT for the American Academy of Family Physicians, did an 11-minute slide overview (complete with his own casual narration) just for HIStalk’s readers. If you ask me, that’s the perfect way to teach people, not one-hour platform speeches or boring white papers.

McKesson’s Community Days volunteer project will benefit Grady Health System (GA), which will receive 250 packages of blankets and toiletries for patients in its rehab and LTC facility.

Australia struggles with the decision of whether an e-prescribing network will be owned by the government or a private firm.

Striking doctors in India block public streets, annoying the locals.

Odd: a patient being seen in a doctor’s office walks out afterward with the doctor’s laptop. He beat the odds by finding a laptop-using practice in the first place.

I ran across the Institute for e-Health Policy, yet another political organization within HIMSS (actually, buried a layer deeper as part of the HIMSS Foundation). It was founded a year ago. Its stated goal: “To be the pre-eminent organization to provide e-health policy education, research and best use examples to key decision-makers, their staff, and other stakeholders within the Capitol Beltway.” I don’t see any accounting of salaries in the Foundation’s financials, so I’m not sure how it’s funded. It runs National Health IT Week, in which providers are somehow convinced to take time off from work to lean on their legislators to pass vendor-enriching laws.

Related: the PHI-containing laptop of an Oregon Health & Science University doctor is stolen from his car parked at home.It was password protected, at least.

The consultant who billed eHealth Ontario for tea and Choco Bites leaves instead of hiring on full time as she had planned. She got shafted if you ask me: her expenses followed policy and they were approved for payment. It’s hard to get excited about a couple of dollars worth of snacks in the grand scheme of what was going on there.

Interesting: a video game executive predicts that fitness games will integrate with EMRs. “The ultimate customization is a video game that you just turn on and it goes, ‘Hey, Ben, I noticed your doctor would like you to eat less trans-fatty-whatever. You go to your doctor’s office and your doctor has your EA Sports Active profile and says, ‘Hey, you’re doing really well.’”

Bayonne Medical Center (NJ) locks out union employees, which the online site calls “flaunting labor laws” (which means displaying them proudly) instead of “flouting labor laws” (meaning disregarding them). Sorry about the grammatical fixation.

Park Ridge Hospital (NC) upgrades its surgery and OB facilities, including adding flat screen TVs so patients can access the Internet and the hospital’s GetWellNetwork for education and communication with staff.

Maryland’s state medical society wants the AMA to convince the federal government to drop plans to penalize doctors for not adopting electronic medical records.

The wife of Senator Chris Dodd, one of the people leading the charge on healthcare reform, sits on the boards of three drug companies and a senior living center and received several hundred thousand dollars of benefit in the last year. His spokesperson says don’t worry about it, her career is separate from his. Named in the same article is Senator Jay Rockefeller, who reported capital gains on his wife’s stock sale of athenahealth and who serves on a board with several executives of healthcare-related organizations, and several other members of Congress who have a financial stake in drug, insurance, or for-profit hospital companies.

Odd legal maneuver: University of Pittsburgh Medical Center, being sued for the death of a woman who wandered from her room and died on the roof of one of its hospitals, defends itself by claiming that it doesn’t run hospitals or employee healthcare professionals. UPMC’s lawyers say it’s a holding company that isn’t responsible for the actions of its individual hospitals, which are separate corporations.

E-mail me.

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Currently there are "15 comments" on this Article:

  1. HITman, you couldn’t sound more like an IT-arrogant, non-clinician if you tried, unless perhaps if you used a some more tech acronyms. “Variation is the enemy of perfection”??? OMG. If you can show one spot on God’s green earth where medicine men (or techies, for that matter) have ever even come close to perfection, then I’ll consider your knothole comment less knotheaded. In the mean time, it is the variants that drive innovation, not the mindless lemmings. And, it is the innovation we need to move medicine forward, not mindless repetition. Praises be for the variations!

    And, Mr. H, Sermo and a few other sites do indeed provide the mass consults via social networking you mention.

  2. Thanks Dr. Waldren for the excellent job detailing all the aspects of the PDF/H! As a member of the ASTM E31 Healthcare Informatics Committee it is gratifying for me that you have taken on the challenge of educating our industry of all the benifits of utilizing the Portable Document Format for Healthcare.

  3. John Q., you are describing a symptom of what I’ve called a cross occupational invasion of medicine by the IT industry.

    Why is it that everyone seems to have a detailed opinion on how delivery of medical care should be conducted, but not, say, the operations of a nuclear power plant?

    Should IT staff at a nuclear power plant be telling physicists how those reactor dials should be turned? Why or why not?

  4. Dear Dr. S – I respectfully agree with your statement describing cross occupational invasion of medicine:

    * Big pharma control / influence of your prescribing products and perhaps your propensity to prescribe certain drugs.

    * HIMSS presence in EMR adoption either by what some feel is “control” of the adoption process or a healthy academic “influence” with vendor support.

    * Increased likelihood to prescribe certain medical technology based procedures based on positive effects of reimbursement that some might consider the premise for a sound business plan.

    * American College of Medical Genetics, need I say more. Love these guys!

    This post is not a rip upon what you have stated but rather a wakeup call for more of us remedy-seekers who would rather practice academic medicine for the pure altruistic/ultraistic proclivity for perpetual pursuit of perfection.

    Someone must follow the circus elephants if only to clean up things.

  5. Dear Anonymous – Just exactly who are the elephants whose messes you so (self-)righteously offer to clean?

    “Altruistic remedy-seekers” in academic medicine? From the castration of colleagues with differing opinions to the misinterpretation of findings to support funding sponsors (often Pharma) to the almost pathologic promulgation of status quo theories and quirks, the “pursuit of perfection” within academia often seems messier than…well, I’d rather walk behind a whole passel of elephants than most any perfection seeker.

  6. Thanks to both Dr. Steve Waldren and the AIIM PDF Healthcare committee for making such a great overview of “why and how PDF is a GOOD thing” when used to capture health data and reliably exchange it – and view it – with the free Adobe Acrobat Reader or many of the other PDF display tools available. Armed with something as inexpensive as small USB thumbdrive – even a homeless person can view that record on the PC in the public library or the free clinic. If that’s not meaningful use, I do not what is ! This has never been about replacing the need for systems to view and update HL7 data – but it sure is a clever way to capture and exchange it without requiring a call to the Geek Squad.

  7. Thanks for pointing out those grammatical gripes. I was wondering if someone in the medical community was bothered by those errors.

  8. Let’s get a bit of the history straight on CCHIT. It was originally established to give a basic seal of approval for the *functionality* of EMRs, so that small practices with no IT staff could buy an EMR system with confidence that it would be functional. While interoperability was important, it was not the primary focus – it was more like just one aspect of necessary EMR functionality.

    It was only later that the US Gov’t tapped CCHIT for interoperability certification for fed purposes (Exec Order 13410 and Starck Act relaxation), which only had interop (not functionality) requirements.

    There are certainly arguments to be made about the high financial barrier of CCHIT certification, or whether there is indeed a need for functional certification beyond interoperability. However, functional certification of EMRs was always the primary mission of CCHIT.

  9. And as long as you are referencing the “Good Housekeeping Seal of Approval”, remember that that was a benefit designed for advertisers in Good Hoisekeeping magazine; it is a purely commercial tie in between manufacturers and an “independent” certifying organization. And what it guaratees is the purchaser’s money back if the product fails to perform as advertised.

  10. When we ITers build dial controls for a nuclear reactor, we ask a mazillion questions and we voice many pointed and challenging opinions along the way. You should be glad we do.

  11. I think you’ll find that there are only 2 reasons for the staff at a nuclear power plant to touch any dials.

    1. They are training how to handle a problem that occurs when the plant’s computer system is down.

    2. There is a problem and the plant’s computer system is down.

  12. Notice that the Institute for e-Health Policy is run by Neal Neuberger who has been the driving force behind the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics events for many years. HIMSS appears to be looking for even more visibility and influence through a “partnership” with Neal.

  13. ” EMRs. Regarding the Wharton professor’s comment about the value …”

    What for-profit industry relies on paper to capture, display, and archive critical operational data needed in multiple places simultaneously?

    If none, why do you think that is the case?

  14. Thanks to Dr Waldren for his great presentation about PDF Healthcare. We will never get to any ‘meaningful use’ or ANY kind of use of significance of technology in healthcare unless there is more appreciation of things like this. PDF Healthcare is a fabulous example of using ‘off-the-shelf’ technology all around us to do the basic things we need. Unfortunately most HIT vendors are focused on putting fences around their products to shackle the customer to their products.

  15. I disagree with this statement:
    Grammatical gripe:… And, when you preface someone’s name with Dr., it is incorrect to put their credentials afterward, such as Dr. John Smith, MD (I call that “academic bookending). Thanks for listening to me vent.

    Here’s why- in our society, many have the right to call themselves “Doctor”. I believe it is still useful and therefore possibly correct to append with the kind of Dr.; podiatrist, phd, DO, MD, Theosophist…

    back to you







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