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August 25, 2009 News 14 Comments

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.

osu

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.

rfid

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

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.

E-mail me.

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.

phoenixch

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

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.

iabetic

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

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.

inga

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Currently there are "14 comments" on this Article:

  1. Any word about what happened to all the Noteworthy-EHR folks when they moved from Ohio to Arizona? Did they keep most of them, did many of them move?

    I knew a handful of their sales and management crew and lost touch with them last year – I guess I know why!

  2. Was able to confirm that Cape Cod Health System is not replacing Meditech with McKesson, but replacing their HIS with Soarian! This is big news for Meditech to lose Cape Cod Hospital, their first site that signed on back in 1969! Cape Cod’s innnovative and forward-thinking CIO, Sheryl Crowley, is one of the best in the industry!

  3. CrazyRumorMan: Re: Waterbury – For a very strange professional/personal reason, I have been a big fan of WH since the later 90s, in that other century. The facts involved in the WH rumor are supposition and contention only O’toole Group would appreciate and possibly from someone inside the organizations involved. Kind of like the vacillating public information made available on HR 3200 and the no-number Senate Bill for healthcare reform.

  4. I’m not too interested in the definition of open source (beyond that it’s free)

    Do we have any data on how “free” it ends up being? I could imagine the software being free but the army of trainers, consultants, software engineers, etc. needed to implement and maintain it, would eat up whatever savings you may have realized by not having to pay upfront for the software.

  5. I think we ought to look at the real cost of NON-free software. What does it REALLY cost to distribute Windows machines across a health system, especially with all the extra anti-virus and Office software everyone loads…and the inevitable downtime the machines have.

    I mean, look at the State of Vermont’s Health Department:

    http://www.wcax.com/global/story.asp?s=10176161

    …down for days. Some for weeks.

    I’m curious to know if the legend of needing “trainers, consultants, software engineers, etc.” for OSS is at all true or, at least, any worse than it is for non-OSS. Seems like most of the EHR installations *I* know have a massive need for the very same thing. There’s nothing inherent in OSS that requires more consulting work.

  6. “I’m not too interested in the definition of open source (beyond that it’s free)”

    That’s like saying I’m not interested in the scientific method just give me your promise and a shiny package and I’ll swallow the pill…

    Even if you cannot read OSS code you should feel some assurance that a third party can if necessary. This is medicine, not widget manufacturing.

  7. Even if you cannot read OSS code you should feel some assurance that a third party can if necessary.

    That’s the problem! If you buy MEDITECH. for example, and your powerful but crazy Director of Nursing, Cheif Medical Officer, Finance Director says “We need MEDITECH to do XYZ.” You can have a con call and MEDITECH will say, “Sorry, we do it via ABC.”

    If you go OSS your CMO or DON is going to say – “Didn’t we buy an OSS? Why can’t we just code a solution?” Soon you’ll have a room full of 150/hr contract programmers coding away for months on some crazy solution that you, as the IT Director, aren’t powerful enough to put a stop to.

    That’s just one example of a problem I could see. I’d really like to hear about some real world examples and an honest accounting of the cost savings.

  8. xmeditecher, read fredtrotter.com if you’re interested in learning about open source software in healthcare. If you’re not interested, let me just say that your posts read like someone trying to find problems with something they don’t like. If you read up on open source, maybe it won’t sound so terrible and frightening.

    Open source won’t change the fact that if you heavily customize your system, you must commit to re-implementing those customizations with any future upgrades. This is true of proprietary software and this is true of open source software. This is true of good ideas and true of bad ideas. This is true of bugfixes (both discovering and fixing) and true of strategic direction (open source gives you the ability to fork a project). Open source just makes this all easier.

    Open source isn’t pixie dust you sprinkle on your product to makes everything better, but it isn’t the boogie man either.

  9. If you read up on open source, maybe it won’t sound so terrible and frightening.

    From my perspective as a consultant, WorldVistA seems like a panacea. All the money that used to fund the lavish lifestyles of Judy Falkner and Neil Pappalardo will instead go to consultants that can show East Podunk Medical, Haircare & Tire Center how to implement VistA.

    But, before I can sign on, I need some hard numbers and a disinterested, third party estimations as to the true cost/benefit of going with an OS Systems.

  10. Open source just makes this all easier.

    Easier how?

    From the CIO/IT Director perspective it doesn’t matter if I have to pay some contract programmer or pay as part of my contracy with EPIC, Cerner, GE or MEDITECH – I still have to pay.

    How much cheaper and easier is it to go with an OSS?

    And, I need to know how much cheaper it is once I factor in the fact the I no longer, as the CIO, have the abilty to tell the DON that MEDITECH/EPIC/Cerner/IDX doesn’t have the ability to do X.

  11. xmeditecher, why are you confounding all the issues? Are you an M$ shill? All OSS software isn’t the same in the same way that all closed-source software isn’t the same.

    Examples of cheaper and easier to use OSS abound. histalk.com is hosted using Apache and WordPress, for example, two of the most ubiquitous examples. Care to point me to any better, let alone CHEAPER, examples of software to perform those functions?

    “You’re soaking in it.”

    Meanwhile, your position that OSS is dangerous because makes it impossible for you to describe to other folks the possible limits of your software solutions is…mind boggling. “Yes, sir, please sign me up for the self-limiting solution!”

  12. “The small 6×7 closet I live in is comfortable and I’m skeptical the outside world is any better. I refuse to step outside unless I’m given proof–I need some hard numbers and a disinterested, third party estimations as to the true cost/benefit.”

    You can stay right where you are delivering MEDITECH (or whatever) solutions. You can remain successful there, perhaps your whole career. So fine, have a happy career. But don’t try to throw FUD at open source. Fear, uncertainty and doubt.

    Specifics again: yes if your hospital wants large, deep customizations, and wants a fixed-bid estimate, whoever delivers the estimate will take on heavy risk. They could be wildly off in their estimate, either too high or too low. Again, and I’m getting tired of saying this, estimating is risky on both proprietary and open source systems.

    Or, if you rely on an open source vendor for support, they can deny customizations. So long as you want to stick with the vendor, you must abide by their rules, and this is true whether the product is open source or proprietary.

    Also, and this is side-stepping the question a little, but I want to put this out there: everyone should check out and understand what plugin architectures and composable systems are. This may change your whole outlook on what types of customizations are possible, and what types of customizations are ‘good ideas’ and what customizations are difficult to upgrade.







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