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June 30, 2009 News 12 Comments

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.

virginia

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.

 sis

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?

 commandaware

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.

uae

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.

E-mail me.

HERtalk by Inga

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

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.

inga

E-mail Inga.

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Currently there are "12 comments" on this Article:

  1. doctors [are] 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.

    OK, so why don’t they hire “scribes” to type away on the keyboard as they do their “hands on” care of the patient? Some do you know (think Opthalmology, Ortho, etc). No one is saying they have to do this themselves. Some hire an assistant to do this “clerical” type of work. Has anyone costed this out? it would be interesting to see if cost effective, eh?

  2. Ref: “the government being the largest employer, insurance company, and bank”, you forgot to add “car company”. 🙁

  3. Re: 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.

    will you name the hospital when you get confirmation?

  4. Re Kaiser article on e-prescribing

    That was perhaps better identified as
    The Henry J. Kaiser Family Foundation newsletter, not a Kaiser Hospital or Permanente Medical Group article. Although we write a paper confirmation for schedule II’s, all 6000 plus of us do the rest electronically with complete access to the patient’s up to date (if they’re Kaiser patients) medical information. We don’t have any significant failure rate of prescriptions.

  5. “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.”

    I couldn’t agree with you more on that topic and have written about it myself, “Its for those guys over there”. I am a tablet user and I use it in my course of work consulting too, but have seen folks selling them that don’t even know how to use one and it is crazy to have to sit at a keyboard while doing a consult, awkward I think, lose eye contact and maybe miss something. I used to tell anyone getting a tablet to just take it to meetings first and scribble on it, Windows Journal and don’t try to use a program of any sort until you feel you are ready. I have not seen or heard of a CEO trying any speech recognition too come to think of it, but they say how good it is and how valuable the money spent is.

    They do not practice what they preach so how do they know what is good? Actually a CEO could stand to learn from any physician who has mastered a tablet, but they just don’t want to be hands on folks and in turn they miss out and lose credibility that way.

    http://ducknetweb.blogspot.com/2008/12/technology-its-for-those-guys-over.html

  6. 17 % of GDP being spent on healthcare is a big drain. Even if 2 % out of the 17 % is spent on how to remain healthy, it will have long term benefits of longevity and happiness.
    Money saved can be spent on infrastructure which will be generating jobs for the current jobless who otherwise need medication now.

  7. Mr. H, your driving-to-work epiphany should be pasted to the foreheads of every EHRco CEO, CIO, and programmer.

    A couple of addresses to this which I’ve seen include:
    – At the expense of data-mining (which, until we have real adoption and interoperability, seems a trivial price) the PDF/H standard at least allows familiar handwriting, plus information sharing via PDF/electronic connection is far superior to current faxes and snail mail.
    – Medical scribes. I’ve spoken with a couple of docs who rave about the combination of medical scribes and EHRs. Sure would eliminate the need to hunt-and-peck while trying to decipher complex medical, emotional, and psychological conditions. Those who have used them say scribes are well-accepted by patients, provide far superior documentation than the doc alone ever could, and more than pay for themselves in efficiencies gained.
    – Medicomp’s new CliniTalk looks to offer a better way to store searchable data using voice or free text. Still has the PC in the docs hands, but slicker, less intrusive data (usable data) entry.

    Until improved understanding by more folks of the real workflow and mental demands upon clinicians in clinical encounters is more universal, I still say asking DVR-challenged people to go high tech all day long will be an abyssmal failure.

    Mr. H, with such great light bulb moments, you should drive more often!

  8. Whining is right and wrong. Accountants and other execs are doing more and more of their own keyboarding. Admins and temps are filling up the unemployment lines.

    Also from a CPOE hospital: Physicians are hiring rounding nurses and PA’s to assist and to do their computer work. Office scribes are entering admitting orders. Maybe there’s hope for the unemployed temps.

  9. “The Congressional Budget Office predicts that by 2082…”? I simply must disagree. I’m convinced it will be more like 2080. 2081 tops.

  10. Mr H, while I appreciate your “drive time” ideas, I do wonder if your physician uses an EMR or have you sat in on an actual clinical encounter? Most EMRs are used by physicians with hand held tablets, not standard computers. The really good EMRs use hand writing recognition, hand writing capture, voice recognition and drop down menus and keyboards for input, some also use touch screens.

    [From Mr. HIStalk] My doctor (academically affiliated) has an EMR. It’s running on a plain old deskop PC and monitor in the exam room, forcing him to place his back to the exam table where I’m sitting while we’re talking. There’s no way he could use it standing up or while doing anything else, like paying rapt attention to me (although he’s pretty good at simulating multitasking by giving the PC and me equal time slices so that I have the iilusion that his keyboarding is non-invasive). I don’t know the stats (if you do, let me know because I’m curious) but I would have bet that most docs have a similar setup to mine. I know all that other technology is out there, but I’ve yet to see it used personally, except by Canine HIStalk’s veterinarian (ironic, I know).

  11. Some people say it’s lonely being ahead of your time, but it must be increasingly lonely being behind the times.

    http://www.healthcareitnews.com/news/survey-finds-physicians-split-over-tablet-pc

    “The study, conducted from September to December 2004, found that outpatient physicians were buying mobile devices with standalone clinical solutions to access data, assist them in making diagnoses and prescribe medications.”

    “”It really depends on the environment,” Malkary said. “Larger networks such as Partners Healthcare have invested heavily in wired solutions.” Physicians in such environments are likely to be happiest with traditional desktop PCs.”

    What? Physicians polled actually are happiest with traditional desktops? No it cannot be so! Because Mr. HISTalk and a self selecting group of posters say it ain’t so.

    The fact is there are numerous choices out there from PDA solutions to tablet PC’s (held like a chart) with barcode scanners built in. All these solutions are in use and have been in use for years, and it seems that as far back as 2004 (half a decade ago) there are many Inpatient physicians that are very happy with wired as well as none-wired solutions, contrary to localized conventional wisdom. But no two Physicians are the same, which is why we have choice.

    Back in the paper days the Physician could fill out forms or update the record after the patient has left the building. He still has that option. I know I couldn’t fill out a form while keeping both eyes on the patient, so not much has changed in the move from an input device of pen to input device of keyboard/mouse/Dragon/transcription service/nurse/PDA/tablet pc with handwriting or shorthand recognition.

    You do have a point though, the keyboard and mouse are flawed. Multitouch and gesture devices are becoming increasingly available and that’s a great thing. But let’s not pretend to reinvent the wheel that’s already be re-invented.

    I will leave with a few google searches;
    “physicians unhappy with PC’s” – Nope, not much here.
    http://www.google.com/search?hl=en&rls=com.microsoft%3A*%3AIE-SearchBox&rlz=1I7SNYR_enUS315&q=physicians+unhappy+with+PC%27s&aq=f&oq=&aqi=

    “Physician unhappy with EMRs”. – There must be something here? Where are all these unhappy Physicians?
    http://www.google.com/search?q=physician+unhappy+with+EMRs&hl=en&rlz=1W1SNYR_enUS315US316&start=0&sa=N

  12. I went to the link in the above entry for “Physicians unhappy with EMRs” and the #2 entry in Google was . . . . the above entry. Weird.







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