If you had to answer the question below in one sentence, what would you say?
What is the fundamental contribution of information technology?
My answer — information technology enables complexity.
Our personal financial assets are much more complex that those of our grandparents; savings accounts have been replaced by retirement plans and mutual funds that can automatically shift assets based on a person’s risk tolerance. Handwritten flight manifests have been replaced by the ability of an individual to book air travel involving multiple stops and carriers. Weather forecasting based on seasonal expectations and reports from adjacent states has been replaced by sophisticated models. Complex activities such as sending a satellite to Jupiter, non-invasively observing metabolism in the brain, and simulating the interactions between proteins would not be possible without information technology.
These problems of healthcare cost, safety and quality are based in and exacerbated by the complexity of healthcare. The knowledge domain of medicine is vast and evolves rapidly. Patients with complex acute problems and multiple chronic diseases will be seen by many providers within a short period of time and undergo several parallel treatments. The delivery system is highly fragmented and dominated by small physician groups and hospitals. Standardized care processes have multiple varieties. Managed care contract provisions can fill volumes.
Information technology can be applied to enable the complexity in healthcare. Clinical decision support and clinical documentation applications can assist the provider in keeping up with medical evidence. Results management systems can highlight the patient data that deserves the most attention. Interoperable electronic health records can support the coordination of multiple providers taking care of an elderly patient. Telemedicine can assist patients and providers in joint management of chronic disease.
Maybe that’s the fundamental contribution of information technology in healthcare. It might enable the current complexity to actually work.
John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.
VA plans emerging technology research center
iSoft lays off in England
Children’s Pittsburgh leads peds hospitals in HIT
From Scott: “Re: Joint Commission and nondisclosure. Yesterday’s Sentinel Event Alert provides further support for providers’ rejection of vendor nondisclosure clauses that could limit the sharing of information on software problems that have patient safety implications. The Joint Commission’s previous Sentinel Alert, Safely implementing health information and converging technologies, is also worthwhile reading for providers who might rush to deploy EHR systems in response to federal incentives.” Joint Commission should be all over healthcare IT in the context of patient care. It would give customers a way to collectively pressure their vendors (with regard to design and disclosure, for example). For vendors, it’s still better than having the FDA in your shop. For patients, Joint Commission is the one group that looks out for their best interests as a package, not just how technology is deployed and managed in a vacuum. And unlike HIMSS and its spawn, they have no vested vendor interest.
From Billy Roentgen: “Re: Stanford. Stanford is going live on Epic September 1, replacing Siemens Invision. Palo Alto Medical Group is going live on Epic at about the same time, replacing IDX. Epic is EVERYWHERE, starting in the physician’s office and carrying through to the hospital.” It’s easy to see with 20-20-hindsight why Epic owns the markets they choose to play in: (a) they built new products that reflected that inpatient-outpatient continuum while their competitors kept bolting on marginally useful features and acquisitions onto old platforms that were clearly unsuited for them; (b) they created MyChart before anyone cared about sharing data and PHRs; (c) they didn’t get bogged down in a Viet Nam of unsuitable customers by selling indiscriminately to just anyone; and (d) they ran their implementations firmly and protected customers from their own success-sapping indecision. Nobody else is even close, handing over the entire upper-end market to Epic without much resistance. Cerner had a shot but doesn’t seem to be selling much new business, while the reps from GE, Siemens, and McKesson might as well carry a white flag when they visit hospitals of more than 400 beds. Eclipsys is strong in the traditional inpatient core of CPOE, pharmacy, and nursing, but won’t get a foothold with customers who want a broad application line that covers outpatient in a single database. Epic owes its success to weak competition as much as anything else. In a perfect world, someone would step up to offer an Cadillac alternative, but for now, Epic is running its own Cash for Clunkers program (they get the cash).
From Joce: “Re: Logi-D. Heard a rumor that Stanley InnerSpace might have entered into an agreement to acquire Logi-D. Any truth to this?” I’m probably the wrong guy to ask since I don’t follow either company. Stanley makes carts and cabinets, Logi-D is a Canadian logistics consulting company specializing in the OR.
From The Nuge: “Re: claims. The reader’s comment hit the nail on the head, but that’s only a small part. Look at what happened with Emdeon and Aetna a few years back when they went exclusive (how can that even be legal?) Misys couldn’t send electronic claims to them for months! And what when PCN bought Versyss, declared bankrupty (iirc), was picked up by Medical Manager for pennies, and sold zillions of ambulatory claim events to WebMD? Very well orchestrated.”
From Kwame Mojito: “Re: GE. The nurse call group (formerly Dukane) has been sold internally from GE Security to GE Healthcare under the clinical systems division. It will be interesting to see if they can tie this into their Centricity product in a useful manner. To my knowledge, this will make GE the only EMR vendor who also owns a nurse call system.” And a theme park.
From Curious George: “Re: OSHA. I hear that hospitals are definitely on their toes in case an OSHA inspector drops in for a chat. Do you have any information on how many physician clinics are being targeted by OSHA? Have you heard of anyone who has and what their top five non-compliant issues were?” I’ll take a lifeline. Anyone?
From Ditka: “Re: sales. Greenway, according to a sales rep, is having the best year of their lives. Office Practicum is a small peds EMR with rabid fans and their pendulum is swinging mightily up. I keep seeing eCW everywhere. I’ve run into a bunch of e-MDs sales.” I had not heard of Office Practicum – looks cool (although I’d get those old TEPR awards off the front page). None of the others you listed are surprises.
From Norberg: “Re: sales. What can I say? It’s slow. The problem is that most organizations are almost singularly focused on ARRA. And because of the ambiguity around meaningful use, they’re doing nothing. I would hazard a guess that imaging and all other ancillary (read: non-EMR) solutions are not being given any attention / considerations by providers these days. If it’s not related to ARRA, it’s not getting done. If you’re the incumbent vendor at a facility, it’s probably high cotton for you there. But you can’t even get a meeting at a facility where you’re not the incumbent HIS/CIS vendor. I have some friends in the indy EMR space and they say they’re doing pretty well. I guess there are enough independent practices who are buying that the top 3-5 vendors are making out OK. But the large , monolithic vendors are struggling.”
A funny phony magazine cover from The Onion. Some good headlines: Researchers Quietly Chuckling At Placebo Group, Congress Deadlocked Over How To Not Provide Health Care, U.S. Government Stages Fake Coup To Wipe Out National Debt.
Children’s Hospital of Pittsburgh, says KLAS, is the pediatric hospital IT leader, coming in at #1 of the top five. Of course, it’s only the pre-season poll.
HealthPartners (IN) saved $430K in one year with its implementation of Epic and Merge Healthcare, which the local business paper concludes “is providing some proof for health reform advocates who say that electronic medical records can save providers money.” With a payback period that spans generations, I’d say that particular proof isn’t compelling.
A reader tells me his hospital’s Epic contract has no nondisclosure terms. That’s hard to believe given Epic’s legal lock on everything from employment to implementations, but that led me to a sobering thought: what if Cerner is the only company demanding that language in its contracts? Could this medico-legal brouhaha be over just one overzealous vendor’s contracting practices? A Fan was right in the last issue, though — being legally allowed to talk about known patient-endangering software defects is not worth much if (a) the vendor doesn’t tell you about them until you find them, and (b) the customers who are aware of the problem have no incentive or platform to get the word out to other customers (assuming the vendor isn’t doing it). In fact, some of the IT departments I’ve worked in kept the lid on known errors in a manner little different than the vendor themselves and for the same reasons – vanity, lack of resources to address the issue, and condescension toward end users who shouldn’t bother their pretty little heads with computer topics (which is actually sort of true – if you e-mail any of the big clinical departments about a computer problem, they drive you nuts with repeated uninformed questions and a flood of wildly unrelated problem reports that they suddenly observe and decide are related to the one you mentioned).
Intellect Resources is doing a three-question HIT hiring survey of recruiters and hiring managers if you are one of those and want to chime in .
Institute for Safe Medication Practices weighs in with ample expertise on the Ohio pharmacist’s error that killed a child. If you’ve done FMEA or other root cause analysis, it won’t surprise you that the Swiss cheese holes aligned once again. Contributing issues: (a) the pharmacy computer system was down, causing the pharmacist to be swamped; (b) pharmacy staffing was short that day; (c) they were too busy to take breaks or even eat; (d) the technician who made the IV was distracted; and (e) a nurse called to get the IV early even though she didn’t really need it, causing everyone to rush it out without following the usual cautious procedure. ISMP likens sending the pharmacist to jail to Whack-a-Mole: “Marx notes that this child’s game is a telling depiction of how we set unrealistic expectations of perfection for each other and then unjustly respond to our fellow human beings who inevitably make mistakes. We play the game at work by writing disciplinary policies that literally outlaw human error.” The bottom line: nobody’s child is any safer now than that two-year-old was then.
The board of Phelps County Regional Hospital (MO) approves a measure that mandates physician CPOE usage.
An excellent Wired Magazine article makes a point that companies that can turn out “cheap but good enough” alternatives to expensive products can thrive, giving fresh-thinking startups a big advantage over their Goliath competitors who “believe the myth of quality” and fail to see "the rubric of accessibility”. One example is a Kaiser experiment to put high-tech offices in strip malls. “In 2007, Flanagin and her colleagues wondered what would happen if, instead of building a hospital in a new area, Kaiser just leased space in a strip mall, set up a high tech office, and hired two doctors to staff it. Thanks to the digitization of records, patients could go to this ‘microclinic’ for most of their needs and seamlessly transition to a hospital farther away when necessary. So Flanagin and her team began a series of trials to see what such an office could do. They cut everything they could out of the clinics: no pharmacy, no radiology. They even explored cutting the receptionist in favor of an ATM-like kiosk where patients would check in with their Kaiser card. What they found is that the system performed very well. Two doctors working out of a microclinic could meet 80 percent of a typical patient’s needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist.” Makes perfect sense to me. Wouldn’t electronic triage be a lot more efficient and convenient to all involved?
University of Central Florida launches its 20-month master’s in healthcare informatics degree.
This can’t be entirely good news: iSoft will lay off up to 100 technical employees in England, but brags it will offset that by hiring up to 50 salespeople.
Odd: PACS vendor UltraRAD gets an FDA warning for “failure to validate computer software for its intended use.” The software that drew the warning: Microsoft’s SharePoint portal and the HEAT help desk system.
The VP of human resources at St. Joseph’s Medical Center (CA) is indicted for paying no income taxes in the past 12 years, also charged with altering the hospital’s computer records to reduce her withholding.
My last poll found that the employer of 18% of respondents is using Skype for some business purpose. Pretty interesting, although now the obvious question is “for what?” New poll to your right for providers: how good are your vendors of clinical systems at notifying you of patient-endangering problems and getting them fixed fast?
The VA is soliciting proposals to build a San Diego-based Emerging Health Technologies Advancement Center. Projects to be conducted there involve identity verification, interoperability, and developing an interface for patient consent directives.
Raj Dharampuriya, one of the founders of eClinicalWorks, is interviewed by India Knowledge @ Wharton. He mentions that the company has opened a Mumbai support center to handle US customers that run 24 hours a day, such as a prison. The company will hire 500 people in the next two years, most of them in implementation and support, and will open an office next month in San Francisco. He credits the Indian culture of the founders in helping them focus on their goal of building a business and changing the delivery of healthcare. He still practices medicine part time and says he’s in the top 10% of performers according to BCBS.
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CEO donates $1 billion to create “Bell Labs of healthcare”
Investors seek HIT companies that improve provider cash flow
Organizations partner to create next-generation LIS
From Roger Murdock: “Can you figure out a way to shake the truth out of HIT vendors and consultants? It seems to me that sales and acquisitions of anything HIT have really stalled since the beginning of the year. What do you think? I know vendors are reluctant to say anything other than ‘Sales are through the roof!’, but I don’t think so.” I don’t think so either, in most cases. Some companies, especially those with big market share and some diversification, are doing OK. Most, I’m guessing, are limping along as meaningful use uncertainty and capital constraints keep customers on the sidelines, at least for now. I think you’ll see the rich and the best get richer, while those with mediocre leadership, uninspiring products, and a shrinking war chest will find it hard to keep the vampires away until daylight finally comes. Vendors, please leave a comment (anonymous is OK) about your experience – is it boom times, so-so, or bust?
From Vilma Banky: “Re: MUSC. Funny, but I can remember community hospitals and vendor executives saying that they didn’t need anything that one of those big tertiary care or academic hospitals might need. MUSC provides care across a wide spectrum of patients in the Charleston area. I just can’t imagine them not needing everything for clinical documentation or medication administration. There are relatively standard charting requirement or needs (as well as medication administration needs).” I think Frank was saying that he doesn’t necessarily want it all from a single vendor. I’ve interviewed him twice and I really like him, by the way. I can never tell how someone comes across in the written interview transcript, but I can tell you that he impresses me as honest, sincere, and respectful.
From The PACS Designer: “Re: another WebOS. WebOS platforms are gaining more popularity, and this month SourceForge has named eyeOS as project of the month. The eyeOS application was created in Spain and is an open source Web desktop that would be good for testing potential cloud applications.”
From Seeking Truth: “Re: Cigna’s decision to stop receiving electronic claims via the Emdeon clearinghouse. The battle is presumably over the fees Emdeon charges payers to receive electronic claims. Cigna doesn’t want to pay and Emdeon doesn’t want to offer a lower price. Emdeon and Cigna may resolve this price battle, or alternatively, Emdeon may ‘reclassify’ the payer as ‘non-participating’ payer (similar to Medicare and Medicaid, which are prevented from paying clearinghouse fees). This reclassification may allow Emdeon to charge providers a higher per claim charge per their contract terms with the provider. The Cigna e-mail indicates other options available to providers, but those options require a vendor change, which may involve other costs to the provider community. Obviously, the healthcare industry is being hammered to ‘reduce costs’ and this may be a payer response to that pressure. As a publically traded company, Emdeon will try to preserve their revenue, though clearinghouse charges may be difficult to justify. Since the advent of HIPAA Title II – Transactions and Code Sets (TCS), clearinghouses have had growing difficulty justifying transaction charges incurred by both providers and payers (consider how many ownership changes for Emdeon, NDC Health, Per Se’ and other clearinghouse vendors since 2002). The upcoming ANSI 5010 conversion may also influence how payers and providers exchange transactions. Dare I say, ‘never a dull moment in healthcare EDI.’”
From Ex-Cerner Guy: “Re: Waterbury to Meditech. Waterbury hosts site visits and reference calls for Cerner and WH Clinicians are happy. Could be for Patient Financials / Rev Cycle, but even then, I doubt it.” Me too. A reader’s got a line on a source there who may give us the real scoop, which I’m betting is no scoop since I doubt they’re switching.
From A Fan: “Re: vendor disclosure. We’re coming at it from the wrong angle. The real issue here is not what your vendor is preventing you from disclosing, but rather what your vendor discloses to you (whether or not it came from another client). The other thing I wonder is, of the issues that are reported to someone like Dr. Koppel, how many make it to the vendor? There’s no question vendors gear development towards sales, but as we all know, health care has arguably as much bureaucracy as government and the feedback loop from real users to vendors is not great.” I know my vendor doesn’t seem to care much about issues we report, even those with patient safety implications. Their excuse always is: (a) it’s working like we designed it, as suckily as that might well be; (b) nobody else has reported it, so it can’t be much of a problem; (c) you’re doing weird stuff, so stop it; (d) we begrudgingly acknowledge that it’s a problem, but we plan to give you an unrealistic workaround and mark it as a future development project until you simply wear down; and (e) it will take at least a year to get a quick fix into your hands, so that automatically makes it unimportant since you’re stuck with it until then. I’ll also say that none of my vendors have ever been very good at proactively letting customers know about issues reported by others, meaning you go through a ton of testing and documentation to place the neatly tied package into their laps only to be told they already knew about the problem. If your vendor is better than mine, tell me.
All Children’s Hospital (FL)will open its new building in December (a very cool set of daily construction pictures is here – check out the Time Lapse option) and will use the Pediatric Edition of the Patient Life System by GetWellNetwork.
SNOMED Terminology Solutions is offering a free course by teleconference, SNOMED Clinical Terms Basics. New courses offered: Introduction to Terminology and Classifications and Introduction to Mapping.
I’m guesting (is that a word?) at Inside Healthcare Computing with an editorial called Lessons from Shark Tank — Beware of Vendors Borrowing Money or Going Public, where I drew my inspiration from (what else?) a TV show. Here’s a snip: “It also makes me wonder how many dull, average companies got that way because they took someone’s cash, put the founders out to pasture, and set all the fun, smart ideas aside and turned themselves into a bad mutual fund run by second-tier MBA school graduates.” I also worked in a fun reference to, as I call him, Dead Billy Mays.
I guess a wheezing economy has led us to this TV news headline, which refers to temporary jobs at a McKesson H1N1 vaccine center: Swine Flu Brings Jobs to West Sacramento.
Sunquest, Mass General, and Partners will jointly develop a new generation of LIS that focuses on anatomic and clinical pathology. I’ve said for years that if you want to see inarguable success in getting benefits from IT, find yourself some lab people. It’s no accident that the first really useful and clinically-focused hospital systems were LISs, back in the day when “nursing systems” meant online requisitions (aka, “order communication”). The most advanced automation of its kind is in the big reference labs, where you see a lot of computers and not so many people handling pipettes and swabbing agar plates. Instead of complaining about automation, laboratorians embraced it, designed it, extended it (rules capability, standard interfaces, repositories, barcoding, digital imaging, FDA-regulated instrument interfaces, portable data collection, RFID), and are now on the cutting edge of genomics, clinical alerting, and data warehousing. Among all providers and ancillary departments in hospitals, labs are about the only ones that we don’t have to be embarrassed by when talking to people from other sectors that are decades ahead of healthcare. The MGH pathology informatics doc said that tomorrow’s labs will “utilize advanced diagnostic and information management technologies, such as digital pathology, molecular studies, business intelligence and service-oriented architectures to simplify and strengthen the informatics infrastructure.” That ball you saw going over the Green Monster was Sunquest smacking one out of the park in a blockbuster boost to the company.
You know when a press release says somebody “applauds” some government action, they’re smelling cash. The HIMSS Electronic Health Record Association “responded with enthusiasm” (salivation) to Uncle Sam’s decision to donate $1.2 billion in freshly printed and rapidly devaluing currency to pay for the software its members sell. According to the “About” section, membership is open only to HIMSS Corporate Members. Should a non-profit, advocacy-heavy member organization like HIMSS really be running a vendor trade group while claiming to be impartial and patient-centered? As a provider, should I be paying dues to an organization that sells my information to vendors (mailing lists, HIMSS Analytics survey results, conference information), organizes those vendors to influence government policy, and runs Webinars and sales pitches on their behalf that are aimed at getting us poor provider members to buy stuff from its far more lucrative vendor members? It’s Ladies’ Night – I’m getting cheap drinks, but only if I can stand being constantly groped by those paying full price for that privilege.
Peace Health expects to get $30 million from HITECH.
This is one of those times where I say that I’m a bit behind despite working absurd hours, so if you’ve e-mailed me about something lately, be patient – I read every e-mail and respond appropriately, but it might be a bit slow in coming (working two full-time jobs is sometimes challenging).
Another vendor heard from who does not put non-disclosure language in its contracts: Eclipsys. They join Meditech and Medsphere. So. what say you, Cerner, Epic, and McKesson?
Inga connected with one of our old pals at Noteworthy Medical Systems (they used to be a sponsor pre-CompuGroup) since a reader asked about the Cleveland office. She says it’s alive and well and nobody has moved to Phoenix, although all locations have had some restructuring.
If you don’t read HIStalk Practice, you missed this excellent piece, DrLyle’s Meaningful Discussion about Meaningful Use. Put your e-mail address on that page if you want updates when we write something new on HIStalk Practice – it has its own e-mail list separate from the HIStalk one. We have some fine sponsors, guest writers, and interviews there – like HIStalk, but more oriented toward physician practices.
Sparrow Hospital (MI) kicks off its EMR project.
A sweet deal for Misys PLC CEO Mike Lawrie: his contract requires him to be paid in dollars, so the significant drop in pound against the dollar didn’t cost him loss of several hundred thousand dollars of buying power. With a projected US 10-year deficit now up to $9 trillion, I don’t think he’ll have that problem for long.
In India, Apollo Group of Hospitals has started on its IBM-led “Health Superhighway” connectivity project. It’s also working on a unique ID number project. I’m pretty sure I’ve mentioned both before, but it’s still pretty cool.
A WSJ blog on venture capital says investors are looking for opportunity at the intersection of healthcare and IT (that’s us). It credits athenahealth and its $1.3 billion market cap for increasing investor interest, also juiced by HITECH headlines. As we’ve said here before, though, investors want companies that can improve the cash flow of providers, not those trying to sell a nice-to-have product.
Dayton Children’s (OH) goes live with its $27 million Epic project.
So why isn’t this making headlines? A drug company billionaire CEO/MD is donating $1 billion of the $3 billion he made from the sale of his company “to create the Bell Labs of healthcare”. Some quotes from him: “The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid … The idea is to actually go across the country and bring scientists, mathematicians, computer scientists, engineers, biologists, clinicians, surgeons, oncologists, pathologists, all together. And really integrate, truly integrate, information from the basic science to the bench to the clinic … So I’ve started funding and bringing together computer scientist to implement the grid, in an open architecture for the country … We have now the opportunity to jump-start health care, straight into molecular world. Or having the integrated, open-source software system that allows access to the 200-300 Legacy systems of software. So my great concern is, if we go ahead and implement a plan that just says, ‘OK, everybody just has an electronic medical record, with 200 proprietary systems, that don’t talk to each other by its nature.’” This is truly amazing, fascinating, and inspiring all at once. If anyone has a connection, I’d like to interview this guy (maybe sucking up a little in a quest to become Official Blogger of the Bell Labs of Healthcare at a significant salary).
Everyone thinks Cache’ is a healthcare-only MUMPS thing, but here’s proof that they’re wrong: a private bank for rich people selects it to run its Web-based banking system.
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HERtalk by Inga
Christiana Care Health System (DE) selects Patient Care Technology Systems’ Amelior Tracker system to automate the management and tracking of its hospital assets.
Five hundred doctors with Jefferson University Physicians (PA) will soon be live on Allscripts EHR.
The newly public Emdeon signs a 15-lease for a new data center in Nashville. Emdeon, whose IPO raised $367 million, will rent 34,200 square feet for $39,500 a month, making the lease value more than $8 million.
Thanks to Mike and those crazy guys at Compuware for sending over their latest Youtube creation. This Rockstar CIO interview is definitely worth a 41-second diversion. And since I was amused enough to watch it over and over, I’ll give the company a little pitch for a survey of hospital clinical system users they’re doing that should take about 60 seconds or less of your time.
Covenant Medical Center (IA) agrees to pay $4.5 million to settle alleged violations to the Stark Law and submitting false Medicare claims. The federal lawsuit claimed the hospital paid the five specialists “above fair market value” for their services at rates that were “commercially unreasonable.” The government claims the physicians, who referred patients to the hospital, were among the highest paid hospital-employed physicians in the entire country. Records show the doctors were each paid between $633,000 and $2.1 million.
A couple of traditional ambulatory vendors announce they are now offering HIE functionality. Greenway Medical introduces PrimeEnterprise, which enables a community of Greenway customers to share select clinical and financial data. Also, Rabbit Healthcare Systems implements the first phase of its HIE solution, going live with data exchange between McKesson’s Lynx Mobile Inventory Management System, GenPath Reference Lab, and Docuda’s ERCard patient product (it doesn’t sound like an HIE, but that’s what they say).
The Stevens Institute of Technology (NJ) plans to use a $2.8 million grant from HHS to create an electronic system to boost the care of women of color with HIV/AIDS.
The Northwest Pennsylvania AIDS Alliance was also a recipient of grant money to support their IT projects. The HRSA awarded the alliance $45,188, which will allow it to create a new computer network and permit real time access to the Lab Tracker database.
More consolidation in the medical transcription world: Transcend Services will pay $16.2 million in cash and stock to acquire Medical Dictation Services.
The National Quality Forum endorses 18 standards for measuring quality and safety metrics for over-the-counter and prescription medications.
A friend was diagnosed with the H1N1 swine flu, which got me surfing a bit, just to assess the likelihood that I, too, might end up being bedridden. Fortunately my friend is now fine and I seemingly dodged the bullet. Anyway, I found this cool flu-tracker map that allows you to see the the number of suspected and confirmed cases in your community. Or, perhaps to figure out what vacation spots to avoid.
Another ex-hospital worker is arrested for allegedly stealing personal information from patients. The former Our Lady of the Lake Regional Medical Center (LA) employee opened 46 debit cards and filed fraudulent income tax returns. He also received $20,000 from fraudulent claims.
Researchers now believe that women with stronger thighs might be better protected from knee pain. Surely my thigh abundance is related to strength. Thus, I’m no longer going to obsess about the size of my thighs; rather, I’ll now be thankful that they are helping to preserve my articulatio genu.
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Frank Clark, PhD is vice president for information technology and chief information officer of Medical University of South Carolina, Charleston, SC.
How is the IT world at MUSC?
I think it’s going well. We have about 1,200 physicians that are our own employees — we have a closed staff model. We started deploying McKesson’s Practice Partner, an ambulatory product we acquired a couple of years ago. It’s been in here a long time. We started in 2004 and we finished it up in 2006. We have it in all of the departments and it’s being used pretty well. I think we still need to do some work with some of the sub-specialists and some of their templates, but that’s going well.
We started rolling out the e-prescribing module. It’s part of that package. We hope to have all of that done by the end of the calendar year. As far as catching clinical data in the outpatient setting, we’re doing a pretty good job.
On the inpatient side, we started in 2006 putting in some clinical documentation and meds administration and CPOE. We’ve got two of the four hospitals finished; two adult hospitals are done. We’re starting on the children’s hospital and we’ll do the psych hospital last. But we’re aggregating all of that data into the Oacis or Emergis Clinical Data Repository and Viewer, which our caregivers really like.
Our strategy is to create an enterprise-wide EMR and not separate the outpatient setting from the inpatient setting, to try to give the caregivers an environment in which they can operate regardless of the care setting, and all the patient information is in one place. They can do it, trend it, look at it, all in one.
I think that the nice thing about the Oacis toolkit is that it gives us the opportunity to make changes and cater things to the caregivers’ liking, unlike some other more fixed systems.
So that’s where we are. We have Telus working on meds reconciliation. We’ll do that out of the Repository/Viewer environment. We’ll do discharge summary and inpatient notes, and they’re working on those pieces as we speak.
So on the McKesson side, you’ve got Horizon Expert Orders, I assume, going to Meds Manager, and then you’ve got Horizon Expert Documentation.
Yes, that’s done. So we have that closed-loop medication process. If you look at our clinical IT environment, I guess the center of the universe is the Oacis Repository and Viewer. We’re using a number of the McKesson products. We use Cerner lab. We use IDX radiology, and of course the Practice Partner functionality, which is a McKesson product. We try to pick and choose fast, specific functionality to capture data in the various care settings, and we aggregate that into the repository.
So that’s all of our strategy. The Oacis toolkit gives us a good bit of flexibility to fill in the gaps with the discharge summary, meds reconciliation, and physician inpatient notes.
How does Oacis tie in with the McKesson parts?
We tried to identify certain pieces of functionality that are appropriate in certain care settings, certain areas like the nursing or clinical documentation. Anywhere nurses deliver care with that service, we want to capture that data electronically, and we’re using McKesson’s clinical documentation to do that. The same thing is true for meds administration — we’re using the McKesson piece — and also CPOE.
The key pieces of the closed-loop medication process come from McKesson, but as far as gathering that data and making it available for caregivers, we’re using the Oacis Repository and clinical results viewer. Given that it is a toolkit, that it is an open system technology, we have quite a bit of expertise, so we can go in and tailor those views.
We just did a really nice view for the ICU, what we call the Critical Care Viewer. It’s a view of data that the ICU docs need to look at. We’re pulling all of that data that’s captured with this task-specific functionality into the viewer. We looked at the Portal, but our caregivers said, “That is a step back.” What we have is much more advanced, much more flexible than McKesson Physician Portal.
I implemented the Portal in 2001 or 2002 when I was in a community-based hospital organization. And those physicians, independent contractors, thought the portal was great. But when you come into an academic medical setting in a closed-staff situation, our physicians said, “What we have is much more advanced.”
You had mentioned to me before that both Duke and Vanderbilt are using their own separate versions of a repository and viewer. Would you say that’s a good compromise between not trying to go off building your own clinical systems and yet having the presentation and data retrieval flexibility that you can get from having this third-party tool?
Absolutely. We don’t have the resources that Duke or Vanderbilt have. It’s kind of ironic. We’re going to spend all day with Bill Stead and his people, trying to fill in some gaps, because our strategy is very similar to that of Vanderbilt’s and also Duke’s. You are right — they use their own home-grown repositories, respectively, but they both are using a number of McKesson products in those task-specific areas. We talk to Vanderbilt probably at least two to three times a week trying to understand how they did some things with the clinical documentation.
You know, I think this would be true of any big vendor. It’s been difficult for McKesson to fully appreciate what we’re trying to do because they are used to the community-based setting where an organization just buys all of their products, like I did when I was in Covenant in Knoxville.
But academic medicine is, as you know, a little different. We were saying, “We don’t need all the functionality of what you might have in clinical documentation or meds administration. We want to pick and choose those pieces that we feel would fit nicely into our setting.” It’s been really difficult for them to understand that.
Of late, we’ve been able to work a McKesson individual who works with both Duke and Vanderbilt, so he understands what it is we are trying to do. Finally, it took us a while to get around to getting McKesson to understand that, but I think we are on track now.
We want to get away from buying these complete systems. Vendors want to sell you a standalone ambulatory electronic medical record. Well, we don’t want it to stand alone — we’re trying to bring two care settings together, because many of our physicians see patients in their clinics, and then of course there’s those patients in the hospital. So we want them to have a longitudinal view of their patients’ data regardless of the care setting.
That’s our strategy. So far, it seems to be working out OK. It’s difficult for the McKessons and I’m sure it would be for the Cerners and the Siemens, too, because they just want to sell you their stand-alone systems.
The same thing is true in the emergency room. They all have an emergency room product, but it turns out that a lot of that functionality you already bought when you bought the outpatient system or the inpatient system. They just want you to buy a lot of their functionality over and over again.
Meditech is on the low end and Epic on the top end, but people seem to like them for the same reason — they have everything. The territory in the middle is up for grabs.
You’re right. When I look at the big vendors to see who is probably most attractive to closed-staff model organizations like Cleveland Clinic or Mayo and most of the academic centers, it would be Epic, because they do have a repository strategy. A lot of the others don’t. They’re struggling because the relaxation of the Stark provision and the anti-kickback in this pending healthcare reform — I think independent physicians are going to bind themselves more to hospital organizations.
Hospital organizations can offer these independent physicians more systems, some kind of ASP subscriber model electronic medical record, and they can come together on the data-sharing agreements that hospitals will house the physician office clinical data in a single repository.
I think the people like Epic probably have a product that’s appealing if you don’t want to try to fit it together like we’re doing, piece it together like Duke and Vanderbilt, and also there may be some academic centers that’s pursuing the same strategy. But most of the big vendors — you’re correct, they’re kind of struggling because they don’t have that single repository strategy. They’ve got a separate electronic medical record for the outpatient, one for the inpatient, so it’s kind of bifurcated. But I think those two worlds are coming together.
Do you think you’re well positioned with the core clinicals from McKesson, plus Practice Partner, plus the Oacis Portal that would be the equivalent of MyChart, to do what the Epic folks are able to do?
Yes, I think so. I think it would compare very favorably. We’re really pushing McKesson on the Practice Partner side, because in order to do the kinds of things that I mentioned earlier, we’ve got to have their cooperation. I don’t know how much you know about Practice Partner, but we are really pushing them because of the size. We probably have 2,500 users, and when Andy here developed that product, it was designed more for smaller practices.
We’ve really pushed them to try to make it robust. We’ve gone to the Oracle database. We’ve moved on to Unix servers, both for database and application. But in order for us to do meds reconciliation within the Oacis environment, we have to have a bidirectional interface between Oacis and Practice Partner. So we were really challenging them to kind of open up and let us get down into the details of that system to make it work for us.
I would think that they’re open to understanding what you need, knowing that there are potential other sales just like you out there.
I think so. In my understanding, it was one of the biggest selling products in 2008. They have a competing product, it’s called Horizon Ambulatory Care, and maybe they’ve already made the decision, but they have to decide which of those two products they are going to fully integrate into their enterprise release strategy. I think they’ve made the decision, as best as we can discern, that Horizon Ambulatory Care will be the product they will integrate fully into their enterprise releases.
That was disappointing to us because that would have made it a lot easier for us, I think, as we try to do things, trying to closely knit the two care settings together. But in the absence of that, we’re really working with them to try to let us open up the architecture, because in order to do meds reconciliation through Oacis, we have to have that bidirectional interface.
There’s so many legacy products out there that the architecture of the framework doesn’t really lend itself to interoperability. That’s huge.
Do you think the market’s going to pressure vendors to talk to each other’s systems so that you’re not stuck in your own vendor’s silo?
I think so. If we’re going to achieve any modicum of success as far as HIEs and exchanging data, it’s got to. But it’s going to be a tough, long battle, I think. When you look at “meaningful use”, wherever that will end up, they can’t set the bar too high, because if they do, nobody is going to be qualified in October 2010 to get any of this in use.
Is HITECH something you’re looking forward to and planning around, or is it just “if it happens, it happens” but it’s not really going to be part of the strategy?
It’s part of our strategy. We’ve been thinking about it since the beginning of the year. We’ve been planning, trying to anticipate what will be the final requirements or the initial requirements for October 2010. I think we will be well positioned. I mentioned we’ll have meds reconciliation, discharge summary, and inpatient notes. We’ll have that done in months, all of those. We’re already doing CPOE, we’re doing outcomes reporting, we’re doing health registries, so I think we’ll qualify both for the physicians and the hospitals for that first round of funding starting in October 2010.
When I talk to a lot of colleagues across the country, both in big hospitals and small hospitals, not that many that are doing physician order entry for the closed-loop medication things.
Have you calculated what’s on the table for you if you qualify for all the HITECH requirements?
The finance people have been doing that. The hospital side doesn’t seem to be that much money in the scheme of things. On the physician side, it looks pretty good. For a physician, I guess they’ll have to choose between the Medicaid and the Medicare; they can’t do both. Hospitals can.
So they’re doing the numbers, and we’ve already made the investments, so it’s not that we’ve got to come up with a bolus of money because we’ve already invested heavily starting in 2004.
Other than those three pieces I’ve mentioned a while ago — meds reconciliation, discharge summary and patient notes — we have all the functionality that we’ll need. Going forward, we’ll continue to design it. But I think that’s the nice thing about Oacis, that it gives us the flexibility to fine tune and do some things that otherwise you’d have to ask the vendor to do. It just takes a long time for them to do things as opposed to having the ability to do some things on your own.
Going back to your question a moment ago, we don’t have the resources that Duke and Vanderbilt have, so we’ve had to do it on the cheap, so to speak, or do it in a less expensive way. We’ve had to buy more pieces and parts, whereas Vanderbilt could probably write their own meds reconciliation functionality. And they’ve done their inpatient notes piece, whereas we would have to contract with Telus Health and Emergis to do that.
If you look down at where your time and energy and concern is going to be placed in the next three to five years, what do you think is going to be important?
We need to finish the inpatient functionality, the children’s hospital and the psych. We’ve got closed-loop medication in all of our inpatient facilities. We’ve got to make a determination if the functionality inherent in the Practice Partner piece is going to be flexible enough long term to fit into our enterprise-wide clinical IT strategy, because as you know, 95% of the care is delivered not in the hospitals, but in the clinics.
We want to be as efficient and as effective in the outpatient setting. For instance, like charge capture — right now, that’s manual. We’re doing charge slips; caregivers are writing out the charge slips. We need to be capturing that electronically. So that’s something we will do over this period that you’ve just alluded to.
We’ve got to be as effective and as efficient in delivering care in the outpatient setting to be competitive. Again, we’ll have to make that determination if the functionality that we’re using out of Practice Partner is flexible enough and robust enough to serve us well long term. That’s going to be a primary focus going forward. Does that make sense?
It makes perfect sense, yes. You never know why vendors acquire ambulatory systems — do they really plan to integrate them, or do they just want to latch on to the trend of the moment? Vendors have to figure out how badly they really want to get in the business of tying in and I guess it’s up to the customers to push them.
I’m not sure if they’re any different from some of the other vendors, with the exception of Epic. I think Epic seems to be well positioned as care settings come together and organizations look at acquiring a clinical strategy or solution that scales across both care settings, and Epic is really attractive.
Most hospital organizations are not going to do what we’re doing, and that is trying to knit it together to some degree, or they don’t have any development capability; it’s all commercial off-the-shelf. I know Pam Pure and her leadership team, right after they acquired Practice Partner, came down to spend a full day looking at how we were using it. And I think at the time they were trying to decide which of those two horses to ride. Should they continue with the development of Horizon Ambulatory Care or should they look at trying to integrate the Practice Partner product into their enterprise strategy? I don’t know, maybe that’s why Pam’s not there any more. I’m not privy to all the details, but they’re not unlike some of the other big spenders; they’re trying, through a lot of acquired systems, to coalesce and integrate them into a common framework, a common platform. This is a slow process.
Anything else you want to share or mention?
These are exciting times in healthcare. I can’t tell you how many calls I get from vendors trying to sell stuff and there’s just so much money out there around healthcare. It’s like flies around honey. There’s just so much money, so many opportunities out there for vendors, particularly in the health information exchange market.
We’ve got a project here that we’re trying to link eight emergency rooms in the Charleston area across four organizations. We call it the ER Alert System. When a patient presents in one of the EDs, a caregiver can query the other hospital organizations to see if there’s any clinical data about that patient. You know, some people are shocked, they just go to the ER to get drugs. We hope that it will cut down in procedures, if somebody’s already done a CT scan or MRI at one of the other facilities, they can access that, or if they have any labs or meds or anything like that.
So we’re looking at technologies for that sort of health information exchange, trying to decide on which technology to use. We’re looking at Oacis technology, but also this Vanderbilt-developed product that Informatics Corporation of America spun off. It seems a lot of businesses, a lot of companies say they have a product that will do that. I think we’ll see a lot more of those health exchanges. I think that the reform of ONC will push to try to make that happen.
From Limber Lob: “Re: VistA. The key thing about VistA is not that it’s open source, but that the VA developers and users were joined at the hip during VistA’s three-decade long evolution. I worry about today’s vendors who have ‘architects’ in California or Florida and developers in Poland, India or elsewhere who know little about the users of the software they develop. The VA’s process from the outset in the late 1970s was to have front-line users work closely with the system developers to tweak and tune the applications to meet the needs of the caregivers caring for the patients.” Excellent point. I’m not too interested in the definition of open source (beyond that it’s free), but VistA doesn’t seem to fit the model as I understand it. It was built by VA employees at a cost of billions in salaries and other costs and is free only because it’s in the public domain, not because a multi-national bunch of spare bedroom programmers decided to donate their time to a cool project. For that reason, it’s probably a mistake to tout VistA as a shining example of how open source development works. It’s also no coincidence that arguably the two best and most widely used clinical systems ever (VistaA and TDS) were created in exactly the same environment – techies on the ground working with clinicians for years at a time. Vendors don’t do that any more, shipping specs overseas and giving clinicians only limited involvement at the beginning and again at the end. Or, putting a bunch of coding kids together with a Foosball table and letting them talk to the salespeople about what will move on the market. Too bad.
From CrazyRumorMan: “Re: Waterbury. Waterbury Hospital is rumored close to signing with Meditech to replace Cerner. This despite the successful rollout of the majority of the Cerner Millennium suite in just the last 2 years. I would say the IT decision makers at WH may have a screw loose.” Unverified. That’s a lot of wasted money and effort if it’s true, so I’ll presume it isn’t (and if it is, I’d like to interview someone there and find out what led them to that decision).
From Scot Silverstein: “Re: NPfIT. A question I’d like to ask the new head of ONC, Dr. Blumenthal. With all the funds being steered to HIT. how will the US national program avoid the problems that occurred in the UK’s national IT program?” The ONCHIT head (see how I inadvertently mock its regrettably late realization of the phonetic implications of its acronym?) is welcome to respond here. It’s a good question since NPfIT seemingly did everything right (rigorous planning, aggressive bid terms that nearly bankrupted its ‘”successful” bidders, and supercharged project management). The federal government’s track record of big IT projects is pretty bad, especially since it keeps hiring the same underperforming big contractors whose core competency is working the good old boy system.
Kathleen Sebelius visits Ohio State to check out its Epic system. Her father, John J. Gilligan, was governor of Ohio from 1971-75, making them the first father-daughter pair of governors (she from Kansas, of course).
From Weird News Andy: a UK man’s appendix ruptures three weeks after NHS surgeons claimed they removed it. WNA likes this quote: “A spokesman for Great Western Hospital . . . was unable to confirm what, if anything, was removed in the first operation.” The patient must have a black cloud over his head: not only did the rupture leave him with a serious infection, it also got him fired when his employer refused to believe that he needed time off to have his appendix removed a second time. Also from WNA: NHS is so desperate for off-hours doctors that it’s flying them in from all over Europe at hourly rates of up to $165. One of them, a Nigerian working on three hours of sleep, had two patients die on his very first shift – one after he gave the patient a tenfold overdose of morphine, the other who died of a heart attack after he declined to admit her.
Geisinger will implement the eICU program of Philips VISICU.
A Discovery Channel article mentions OpenMRS, an EMR for the developing world, and includes a couple of podcasts. I’ve mentioned it several times, such as the program in Rwanda to train developers for it and a college intern project to develop a touch screen interface for it.
Saint Vincent Hospital (MA) begins using the RFID-based surgical sponge detection system from RF Surgical Systems, which they say costs about $15 per case.
In what must be pretty big news for a vendor of software for chiropractors, Future Health issues a press release to announce that it has hired a former Eclipsys programmer.
New York hospitals line up in a “mad dash for digital cash”, as the headline says. Interesting factoids: (a) Montefiore has spent $200 million on its EMR; (b) the 180-bed New York Downtown Hospital can earn up to $8 million in federal incentive payments, as an example; (c) a Columbia doctor says he had to reduce his patient load by 60% when he first starting using an EMR and even now is only back up to 80% of what he could do on paper; and (d) experts say some doctors see EMRs as “a ploy to find out how much money doctors are making.”
The usual housekeeping reminders: your lifeline to breaking news and smirky humor is your e-mail address in the Subscribe to Updates box at the top right of the page (I don’t send anything except update notices to that list of 4,578 confirmed subscribers, even though companies ask me all the time). Please take a moment to peruse and possibly click the adverts (isn’t that very Continental-sounding?) of those brave sponsors who convince their financial guardians to send checks to an anonymous blogger’s PO box that could be forwarded to Lithuania for all they know. You will find a Search HIStalk box to your right that will invoke the power of Google to effortlessly search the 6.5 years and millions of words of HIStalk. Inga and I love rumors, news, guest articles, new sponsors, and shameless fawning , so you can click the hideous green Rumor Report box just below the search box or just e-mail me. And here’s the magic secret I keep forgetting to share on how to get a list of previous postings: just click the Archives link at the top of the page (I bet there are readers who think I purge all but the five most recent postings that make up the front page, so I’ll take the blame for that). Most importantly, thanks to the real stars: our commenters, guest writers, sponsors, and readers (that’s you). You have no idea how important you are.
Blessing Hospital (IL) signs with CareTech Solutions for its Web content management system and BoardNet board of trustees communications portal.
A Seattle public radio station’s investigation finds that 15 non-profit executives in the area made at least $1 million in 2007, seven of them from Swedish Medical Center.
Paging Dr. Halamka: VeriChip, smelling stimulus money, will try again to sell medical records-containing implantable RFID chips readable by an ED hand-held scanner. I see nothing to make me think that turkey will fly the second time around, especially given that they proudly state that only 500 people have signed up so far. Not that it’s a bad idea (pet chips are big business), but they didn’t market it well (or to the right audience). As an indication of just how committed to healthcare the company is, it also wants to invest in green energy.
Creighton University files a patent for “a novel, electronic program to coordinate patient health care.” It’s some kind of daily diary that’s monitored electronically by caregivers. They even made up a word for the people who meet with the patient monthly – an “ambulatist”.
An English teaching hospital is reviewing its ED system after discovering that someone altered patient records to make it appear that they were seen within government’s standard of four hours.
Odd malpractice award: a “rogue dentist” treating a 28-year-old woman’s cracked tooth removes all 16 of her upper dentia for some unstated reason. The jury awards her $2 million.
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HERtalk by Inga
A coding error leads the VA to mistakenly notify 1,200 veterans they have Lou Gehrig’s disease. Whoops. The panicked veterans were later informed of the error and assured they were not suffering from the generally fatal disease.
PatientKeeper announces that its user community has grown more than 60% in the last year. In addition, the company has increased staff 23% and is planning to add another 20-30% over the next six months.
Phoenix Children’s Hospital achieves 99% CPOE adoption with its Eclipsys Sunrise Acute Care system. The hospital’s CEO says that during their go-live, they reached a 95% adoption rate and are now placing an average of 3,250 orders electronically each day.
Another pediatric hospital is just getting started on its EHR project. Children’s Medical Center of Dallas is embarking on a $60 million project will eventually allow them to connect their Epic EHR to three other hospital systems in the Dallas area.
Next time you are depressed, you might consider sending an instant message to your therapist. Researchers conclude that “online cognitive behavioral therapy” (which sounds like a fancy way of saying you are IM’ing with your therapist) is an effective means of treating depression.
This might make you depressed: the cost of health insurance is skyrocketing. Between 2000 and 2009, the cost of a family premium provided by an employer increased 95.2%. And, plans today have higher deductibles and co-pays. Unfortunately, our incomes have only grown an average of 17.5% over the same period.
No less depressing: the White House and CBO project a $1.5 trillion budget deficit for 2009. That figure is 11.2% of the country’s GDP, making it the highest deficit since WWII. OMB director Peter Orszag says fixing health care costs is critical because “the federal government simply cannot be put on a fiscally sustainable path without slowing the rate of health care cost growth in the long run.”
Not feeling sorry for him if he’s depressed — Neal Patterson. The Cerner CEO cashes in on $320,600 worth of company stock. That’s on top of his $65,000 sale earlier this month. Stock is trading about $10/share higher than a year ago and closed at $64 on Tuesday.
St. Cloud Surgical Center selects Wolters Kluwer’s ProVation EHR for perioperative documentation and patient charting.
Ulrich Medical Concepts becomes the first Certified Integration Partner for ICA.
NaviNet offers its HIE solution at no charge to all state governments and US territories. More than 770,000 providers use NaviNet (formerly NaviMedix) for claims processing.
A Princeton junior and his recently graduated brother are awarded a $100,000 grant to expand an iPhone application to monitor diabetes. Their iAbetes Web 2.0 Diabetes Management System allows patients to record food intake, blood sugar readings, and insulin injections. The application interacts with a Web site that can be accessed by patients and their providers. The only award I won as a college junior was runner-up in a fraternity’s Miss Toga contest.
The state of Ohio seems to think its healthcare workers are bigger bigots than the rest of the population. The state senate is considering legislation requiring nurses, doctors, and other healthcare professions to take cultural competency training. Other states apparently have similar laws on the book. Why target just health professionals?
The FTC finalizes its rules for reporting data breeches for personal health records. Beginning September 24th, PRH vendors and entities that offer third-party EHRs must notify consumers when the security of their PHR data is breached.
Advocate Health Care System (IL) implements CPM Marketing Group’s physician relationship management system. The application will help Advocate manage its physician relationships and provide analytics and reporting.
Tuality Healthcare (OR) celebrates its first complete year live on Cerner’s EMR. The 167-bed hospital says the system has strengthened patient safety and improved the quality of interactions between patients and providers.
iMedX, a transcription provider and developer of TurboRecord and TurboScribe, purchases competitor Worldtech. The combined entity serves several thousand physicians in hospitals and medical clinics nationwide.
EMR vendor Noteworthy Medical Systems internally raises $4 million to smooth the transition after its partial acquisition by CompuGROUP. The company also moved its headquarters from Cleveland to Phoenix, which is apparently closer to the bulk of its clients.
Sparrow Health System (MI) officially announces the launch of its multi-million dollar EHR project. Last year JohnnyReb tipped us off that Epic was the vendor of choice over McKesson. Sparrow says its $10 million phase one will start with physician offices by early next year.
Physician adoption and achieving meaningful use requirements now dominate purchasing decisions for community hospitals, according to a new KLAS report. In the under-200 bed market, cost and infrastructure requirements are no longer the top priorities. Instead, executives are now considering more complex and expensive options. Though Meditech and McKesson dominate this market, community hospitals are now considering Cerner, Eclipsys, Epic and Siemens — all vendors that traditionally paid them little attention.
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