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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Non-Disclosure Agreements

I am weighing in on the recent flurry of activity on HIStalk regarding non-disclosure clauses in software agreements that preclude a customer from discussing or revealing problems with a vendor’s software.

Any worthwhile attorney reviewing agreements for a provider client should flag such an inclusion and require its deletion. Something like that should scream for attention to the savvy IT person, be it the CIO, the consultant, or the attorney.

Executives — when negotiating a contract, really think through the obligations. Where a clause requires education of your entire staff (such as telling them that they cannot disclose a serious software problem), just imagine giving that talk to your chief medical officer. If you find yourself not being able to defend or justify the offending term, you know what to do — get rid of it.

I cannot think of a more self-serving “requirement” in the paperwork that establishes the vendor-client relationship (some would say partnership). Imagine a high profile hospital negotiating with any vendor. The vendor is salivating, not just for the potential sale, but for the huge publicity it hopes to gain at some point by announcing that the high-profile hospital is running its software.

Certainly that vendor does not offer to keep secret the fact that the hospital runs its software in exchange for the hospital keeping errors or defects quiet. I personally find this offensive. I am not speaking for Meditech, but in speaking for myself, in the 20 years I spent negotiating tens of thousands of agreements for Meditech, I never once included such language in any agreement with any customer.

Imagine an ER physician who comes across a dangerous software malfunction. That physician may moonlight across town at another ER. Suppose that hospital has the same software vendor. Assuming the physician knows about the disclosure restriction (which is unlikely), you have placed the physician in a horrible situation. Should he or she abide by a software contract’s egregious terms and risk the health and safety of patients? Or, do what it is right (and required under the Hippocratic oath, I would say) and let the staff at the second hospital know about the software malfunction? In the more likely scenario, if the physician has no idea the restriction exists and divulges the existence of the problem, then the hospital is in breach of its agreement with the vendor.

Also consider the CIO, who you hopefully want collaborating with other CIOs on all things HIT related. You’re putting pressure on them as they sit at a table with other CIOs with the same software system, knowing this problem exists, but not being able (contractually) to divulge the information.

For a little perspective, let’s remember that the errors or malfunctions we are most concerned about are the ones directly involving patient care. A misaligned billing form does not rise to the level of concern as a bad dose amount. However, the non-disclosure terms do not differentiate, I am sure, in permitting disclosure of severe problems and restricting disclosure of minor ones. That makes no sense, which tends to enforce the assumption that the vendors using such restrictions wish to keep critical issues from the public because they fear the negative exposure that may result.

I say boo hoo. The vendor selected the market and designed the software. The vendor takes the profits. The vendor should stand behind its products, bad or good. The profit/loss reports do not differentiate. Neither should disclosures about software performance.

Just as a vendor should be proud of a good endorsement by any customer, so should the vendor permit free disclosure of serious problems. Not in a headline-grabbing, gossipy manner, but in a manner befitting this industry for the care of patients and avoidance of harm to those patients.

Providers should dust off their agreements and check to see if any such language is included. If so, call the vendor and demand an amendment deleting the provision. Better yet, vendors should be able to identify customers with such terms and do the right thing — provide the amendment without being asked.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

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Former VA CIO’s assistant named by OIG for paying unapproved bonuses
Cleveland Clinic wants a new technology-enabled revenue stream
Government’s “Connect” tool to be modified to allow Medicaid data exchange

From Brian Wagner: “Re: Mount Sinai Biden visit. They actually did hold a conference call for reporters and other interested members of the public just minutes after the meeting in Chicago wrapped up. Unfortunately, all the reporters wanted to ask about meaningful use and certification, not about the $1.2 billion in extraordinarily essential infrastructure funding that will be going to regional extension centers and state grants. Read the application materials for the government. The documents are actually really interesting in laying out their vision.” Good information – there’s a lot of detail there. I’m smelling opportunity – the average Regional Center grant will be $8.5 million, with a range of $1 to $30 million. You have to be a nonprofit, but that’s easy to set up (think HIMSS will get involved somehow?) If you’re a shaky vendor or struggling consulting firm, you could fill out the paperwork and see if you win the lottery. I might want to throw in with you. Brian’s with eHealth Initative, by the way.

From @hightechattorney: “Re: Lance Armstrong is getting on the health IT bandwagon. ‘While everyone’s trying to fix the healthcare system in the USA, let’s make all medical records electronic. It is nearly 2010 after all.’ Posted on Twitter today by Lance after finishing a stage at the tour of Ireland.” Did you ever notice that Twitter postings sound eerily like those SNL sketches in which Larry King blurts out stream-of-consciousness non-sequiturs? And since Lance is shining his considerable expertise on healthcare IT, I’ll reciprocate by providing my expert opinion on his field: let’s replace bicycles and people who are paid astronomical sums to ride them with modern technology like motorcycles or cars. It is nearly 2010, after all. See how easy it is to opine confidently about something you don’t understand?

From Mr. RIS: “Re: Sunquest radiology information system. It seems they’ve sunsetted it. They let go all the development, support, and the one final domain expert on Friday. Clock is on to see who picks up this business.” Unverified, but we’ll ask. I can see it both ways: I liked the product as a long-ago customer, but it’s a little outside their core business. UPDATE: Not true, according to Sunquest. “The Radiology Information System is, and will continue to be, an important part of Sunquest’s diagnostic information solution portfolio. No one was let go Friday, in fact, we are actively recruiting to fill open positions.”

Listening: Radio Paradise, live, human-hosted streaming radio recommended by a reader. Lots of bands I’ve recommended are on the playlist: Silversun Pickups, Tori Amos, Peter Gabriel, Heather Nova, Leonard Cohen, and The Pixies. Like college radio, it’s a bizarre segue of music that sounds like it was randomly chosen by a wasted DJ: just now, it was Henry Mancini’s Pink Panther Theme followed by Pink Floyd’s Time from Dark Side of the Moon (maybe the next song will be Get the Party Started by Pink, continuing the color theme).

Consulting firm and HIStalk Platinum Sponsor Virtelligence is in the ten-company hunt to be named National Minority Small Business Person of the Year by the Small Business Administration. It’s on the Healthcare Informatics Top 100 list as well.

Inga connected with the CEO of the HIE vendor that people are gossiping about. He said he’s anxious to be interviewed, so we sent some questions Monday, some of them probing (why do we keep getting an answering machine on the 24-hour support line, what’s up with the company’s credit reports, etc.) Nothing heard so far.

The nonprofit Digital Pathology Association announces its formation and its first meeting, September 13-15 in San Diego. I got the notice from Sunquest, a DPA founding sponsor. Personally, I’m sorry that HIMSS outgrew San Diego since it’s a great conference town.

UCSD signs an agreement with a technical school in India to build a 300-bed hospital there.

WTAE in Pittsburgh covers the Health Buddy home monitoring system, which comes as a small appliance that sends information to a Web application. It has a long list of health management programs: CHF with various complications, anticoagulation, CHF, diabetes, etc. It has a USB and infrared connection to medical devices. A simulated demo is here. It’s by Bosch, the spark plug people.

Observations from the video of the Sebelius “paperless hospital” Omaha visit: (a) the nurse educator showing her the tablet PC gets in a couple of unintentional plugs for the C5 computer and Pyxis (b) Sebelius looks kind of snotty to me, never smiling except when she uncorks a tiny one when talking directly to the camera at the end, even looking distinctly uncomfortable while pretending to comfort a patient during the photo op; and (c) I have to decide whether I’m annoyed that the guy talking about industrial engineers referred to “processEEZ” instead of “processESS”, which always makes me think that somebody’s “puttin’ on airs”, as Southerners say. I Googled to see what they are using at the hospital’s parent, Alegent, and it looks like Soarian and NextGen on the inpatient and ambulatory side, respectively. If Siemens wasn’t so darned cold and stodgy, they would be all over this. They should hire me to be their obnoxious yet anxious to please online presence since theirs is about as inviting as a Berlin winter.

The VA’s IT department is the weekend’s top story, and not in a good way: the OIG says the former executive assistant of former VA CIO Bob Howard “acted as if she was given a blank checkbook” in paying “unusual and often absurd” bonuses totalling $24 million over two years (including $60K to herself plus $140K in tuition benefits to family members and friends). The VA also paid $37,000 in travel costs for a woman that Howard admits having screwed around with. Howard, you may recall, was the Bush political appointee and former government contractor executive who demanded complete control over all of the VA’s $2 billion IT program and decided it should dump its acclaimed VistA software in favor of buying commercial applications. His two-year VA legacy will apparently be as uninspiring as most of the people Bush appointed, consisting of disastrous security breaches, floundering IT projects, ill-advised attempts to dump the most successful EMR in history, and cheating on his wife. That’s a shame for a two-tour Vietnam vet and retired major general who should have known and done better for the veterans he was hired to serve.

Philippine hospitals lag in EMR adoption because of the cost of software, but one medical center bucks the trend by using an open source system.

The State of Virginia finally names a CIO to replace the one it fired after he suggested not paying Northrop Grumman’s big privatization contract because it was doing a crappy job even while asking for more money than was agreed on. In what is surely a bad sign, Northrop Grumman praises the new guy.

Best Buy looks interested in getting into the wireless health device business with Microsoft (I missed the announcement, but this guy didn’t).

My most recent survey results: 90% of you think more EMR vendors will increase their promises of future EMR certification and/or Meaningful Use compliance. New poll to your right: is your employer using the Skype VoIP service for any official purpose?

I see the AHA’s for-profit shill AHA Solutions is still out there “endorsing” products and selling services to vendors. There ought to be a law: nonprofits should not be allowed to affiliate with for-profit organizations (hello, AMA?)

Speaking of for-profit nonprofits, UPMC is the frontrunner to get a taxpayer-and-GE funded $830 million vaccine factory. UPMC’s CEO, who made $4.5 million last year, has already gotten face time with Joe Biden, Kathleen Sebelius, and the free-spending Homeland Security people to make his case.

Like Microsoft’s Bing, Yahoo’s search engine is accused of violating federal and state laws by accepting advertising by illegal drug vendors posing as legitimate online pharmacies. Seems silly to me; they can’t possibly check the good character of everybody who wants to run a text ad. If that’s the expectation, say goodbye to Craigslist, which in the few times I’ve tried to use it, seems to be about 90% shady. In the mean time, I see that the DEA is taking out its own Google ads tied to drug keywords.

I’ve tried to use Facebook lately and it was mildly interesting to connect with people I went to high school with (most of whom I don’t even remember, to be honest), but it’s getting as annoying as Twitter. Reason: people keep wasting time with online crap like FarmVille, pointless online tests, and “Which WKRP Personality are You?” results that clutter up the page. Americans seem uniquely suited to taking potentially useful technology (TV, cell phones, the Internet) and dumbing it down to the lowest possible level of triteness. Most of the Twitter followers I’ve gotten lately are porn sites and companies urged by their marketing people to attempt hipness. I thought lame blogs (is that redundant?) were as low as we could go, but Twitter makes the typical cheese sandwich blog look like War and Peace.

I’m not a big David Brailer fan (I can’t put my finger on it, but he just seems kind of arrogant), but he’s good for sound bites that I agree with: “I’m still shocked that there is a business argument for electronic medical records because it kills the very thing that makes hospitals money. The way we pay for health care penalizes efficiency.” OK, I’m warming up to him.

Parkland Hospital starts eliminating 200 jobs, giving its EMR a bad name by crediting it for the cutbacks, “As we have rolled out more components of electronic medical records, more of those [clerical] functions have been replaced.”

The HIT Standards Committee recommends using either ICD-9 or SNOMED to meet 2011 EMR standards, but wants to incent providers to move to SNOMED by 2015.

An Epocrates survey of medical students has some interesting findings from tomorrow’s doctors. They like mobile devices, with 45% of them using an iPhone or Touch and 60% of the non-users saying they’ll buy one of those Apple products within a year. They give medical schools an A- (up from a B) exposing them to technology, with 84% saying they’ve had EMR exposure and 90% saying use of an EMR will influence their practice choice. Over 70% of them said the US healthcare system sucks and 90% say drug salespeople are scumbag liars (I’m paraphrasing, but accurately).

A former network administrator for a hospital in Australia pleads guilty to voyeurism, choosing the geek’s method of planting a video camera in hospital restroom.

We had a big go-live at my hospital recently, giving me a chance to ruminate (no pun intended) on the most important assignment: what’s on the war room food menu? My tips: (a) if you bring bagels, skip the stinky “everything” ones loaded with garlic since the room and the breath of the participants reek of it for hours; (b) don’t cheap out and make people buy their own drinks from the nearest soda machine and also buy about 10 to 1 diet since it always runs out fast; (c) nobody likes pasta salad because it’s oily and full of olives, so get potato salad or, even better, kettle chips; (d) pizza is the cheap and easy option because they deliver, but you don’t want a roomful of IT people stuffed with greasy cheese, pepperoni, and hot peppers to be stuck in an airless room for hours; and (e) you can never have too many kinds of cookies and candy, at least until the analysts freak out on a sugar high and then crash just as you need their full attention to fix some IT disaster. It’s an IT low point to be covering the night shift and subsisting on hardening bagels and weird sandwiches (vegetarian, bloody rare roast beef) that everybody has passed on throughout the day. Other war room disasters: setting up in an office building where the air conditioning shuts off automatically for the weekend, forgetting to bring a hub so everybody can plug their laptops in, and quickly running out of toilet tissue in the nearest restroom that usually goes unused over the weekend.

Cleveland Clinic’s “Chief Emerging Business Officer” says they’ll develop a new revenue stream by selling eICU services and possibly home health telemedicine. As another of those nonprofits that seem anxious to make money, they had a $246 million profit on their latest federal forms, run a bunch of for-profit subsidiaries, and paid several multi-million dollar salaries.

ONCHIT (I know they keep trying to call themselves ONC because they don’t like the sounded-out version of the acronym they chose, but I don’t care) will modify its Connect software to allow states to share their Medicaid information over the Nationwide Health Information Network.

Sloppy physician handwriting is blamed in a Florida hospital lawsuit in which a pregnant inpatient was mistakenly given the abortion-inducing drug alprostadil instead of the labor-slowing drug that was intended, causing her to deliver her two-months-premature baby in her bedpan.

HIMSS tries to drum up member support for having people run around Washington to bug the aides of politicians about using taxpayer money for healthcare IT (haven’t they done enough?). Its Policy Summit kicks off with a “PREP Rally” with a reception “to discuss your future Hill strategy”, which I’m pretty sure the average dues-paying HIMSS member doesn’t have. I notice the HIMSS recap of recent news carefully omits those involving CCHIT’s ongoing marginalization.

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Obama people bring healthcare PR show to Chicago bearing taxpayer gifts
Research article: eICUs may or may not work, but we didn’t really have time to check that out
Medsphere gets a sale

From I.T. Guy: “Re: Cape Cod Hospital. Apparently they made the decision to pull the plug on Meditech after a long relationship and install McKesson.” Unverified.

From Jules Verne: “Re: Check out these earnings.” Ancillary systems vendor Aspyra (warning: their site has loud and gratuitous Yanni-type music to accompany an otherwise stark site) files a horrendous 10-Q: a loss of $1.6 million on revenue of $2.1 million. The company says it will have losses and negative cash flows for the foreseeable future, meaning it needs financing or to sell shares (not likely: 12 million shares are already out and trading at 19 cents, 66% off the year-ago price, valuing the whole shebang at just over $2 million). I might have to ask our new financial expert Ben Rooks to lay out what options the company has (beyond the obvious – sending everyone home).

From Dr. T: “Re: hospital in Taiwan using the PBX-to-Skype gateway. I had been to this hospital and seen this working. It is very effective and the carts are battery operated with standing space for the nurse to actually ride it. The cart accommodates a fixed touch screen along with MAR drugs.” I’m getting a brainstorm … nurse golf carts with a built-in Pyxis machine, a Skype headset, and maybe a drink holder and MP3 player. They can be like those golf course ladies who sell snacks to the people pretending to exercise by riding around on carts of their own and swinging a club occasionally between beers. Patients pop their “give me drugs” bedside button, the nurse gets a Skype message, the eMAR pops open the onboard Pyxis and pops out the med, and the nurse careens off to dispatch it to the patient. Actually, the Taiwan hospital does have a pretty good idea, although Segways would be cooler.

From Sylvester Stallione: “Re: boards. Are you an advisor or board member of any companies that you haven’t disclosed? I don’t see it mentioned on your About page.” I’m not. Nobody really is interested in me as me, only as Mr. HIStalk, and that’s not happening. Sometimes companies ask for advice, but in the rare cases where I have the time and interest to do it, it’s free (and of corresponding value).

Vice President Joe Biden, HHS Secretary Kathleen Sebelius, and ONCHIT head David Blumenthal visit Mount Sinai Hospital in Chicago to talk up the administration’s healthcare reform programs and to announce $1.2 billion in ARRA grants for Health Information Technology Regional Extension Centers and state-level information sharing projects. The public wasn’t invited and the dignitaries wouldn’t take questions from reporters. Maybe I’m cynical (OK, I’m cynical for sure), but it mostly seemed like a PR visit to put some positive spin on the administration’s floundering healthcare reform program, sending the politicians with some Uncle Sam financial lollipops to hand out. The best quote came from an ED nurse at the financially dying hospital, which recently had less than two days’ cash in the bank: “We’re spit at. We’re swung at. We’re kicked. We have urinals thrown at us. We have bedpans thrown at us." That’s always the bad side of some of us paying for the care of others like we do for welfare and other entitlement programs: sometimes the recipients are nasty ingrates that make us wish we’d spent the money on someone who appreciates it.

Hospitals using electronic ICU systems like those sold by VISICU/Philips think they are improving safety and outcomes, but a 100-hospital study of those facilities shows no improvement, according to a Robert Wood Johnson Foundation study. But here’s the kicker: it appears that the methodology used was to just do a bunch of interviews about why hospitals bought the technology and ask their opinions about the benefits received. I didn’t see anything in the article suggesting that the authors actually looked at outcomes data of any sort. So, the conclusion isn not that eICUs don’t work, it’s that hospitals that use them think they do; therefore, they don’t see the need to do outcomes studies of their own (notice also that the article appears in Health Affairs, which is a health policy journal, not a clinical journal). Here are the takeaways: (a) nobody knows if widespread adoption of eICUs would save money, improve outcomes, or increase intensivist coverage (even after reading this article, which you might think would try to answer that question); (b) hospitals use eICUs to improve outcomes and utilization of specialists; (c) eICUs would work better if they were more interoperable with other clinical systems (gee, I wonder why clinical systems vendors aren’t more cooperative about interfacing to the product of a competitor like Philips?); (d) hospitals that don’t use them don’t believe they are worth the effort and cost (duh, and why even bother surveying those who don’t have them?); (e) here’s the money shot: “All ten respondents from eICU hospitals were enthusiastic about the technology’s impact on ICU performance, particularly on quality and safety. They all emphasized the benefits of redundant processes in the care of critically ill patients, whose clinical conditions can worsen rapidly.” So why in the world would the opinions of the non-adopters be relevant in any way? If you were considering buying a particular car, which would influence your decision: (a) asking 100 owners of that model if they like it and having every one of them say yes, or (b) asking 100 people who don’t even own a car at all why they haven’t bought one? The article doesn’t even answer the question that serves as its title: “Does telemonitoring of patients – the eICU – improve intensive care?” It seems like a pitch to have further eICU studies funded by government grants. The organizations with which the authors are affiliated get most of their income from grants. I suspect correlation, if not causality.

Informatics Corporation of America will add XML-based quality reporting capabilities from Mark Logic to its clinical portal.

NextGen gets several community health centers as new customers. ARRA will help a lot of them pay for new IT systems, so it’s a market that could be pretty hot.

HP, which bought EDS for almost $14 billion less than a year ago, is whacking the top-heavy salaries of the former EDS employees to be in line with what other HPers make, which is also a lot less since they cut salaries on the HP side in February. Some employees will take a hit of more than 30%.

Adena Health System (OH) extends its contract with MEDSEEK to automate physician referrals and to let patients view estimated out-of-pocket expenses before tests or procedures are performed.

The just-finished and sold out e-MDs user conference in Austin provided CME credits to physician attendees, which was apparently well received.

Scot Silverstein had a great idea to follow up on my “should I disclose vendor non-disclosure terms”. His thoughts: I shouldn’t have to do that because vendors should, as he says eloquently, “in an atmosphere of transparency and in deference to patients safety and to hospital governance, should gladly and transparently do so if such language exists in their contracts.” Great idea. OK, here’s what I know: Medsphere says it does not put nondisclosure language in its contracts. A reliable Meditech source says they don’t either. So here’s the challenge to Cerner, Epic, Eclipsys, McKesson, and other vendors of clinical systems: tell me that your standard contracts don’t prohibit customers from freely talking about software defects that could have patient safety implications and I’ll proudly announce that on your behalf right here. Or if your contracts do include such language, tell me why. I still feel creepy that when I worked for a vendor long ago, we were instructed to lie to customers who were anxiously reporting patient-endangering bugs, resulting in some wildly over-the-top telephone histrionics by thespianically challenged support reps. A typical overheard conversation: “Oh, you’re kidding – you don’t get a warning when entering that order?” (meanwhile, the rep is giving adjoining cube mates a laughing nod and making an overtly suggestive up-and-down fist movement that indicates a serious lack of concern that somebody’s loved one may be at risk because we as the scumbag vendor didn’t want to admit defects that would get us sued or replaced).

Medsphere gets a sale to 60-bed Beauregard Memorial Hospital (LA).

Weird News Andy found this article, which describes the previously illegal practice of hospitals paying doctors a cut of whatever cost savings their treatments generate. CMS is testing the practice in, as you might expect, graft and corruption rich New Jersey, where the concept of healthcare vig is well established in a less reputable way.

”Experts” in Australia say that too-rapid implementation of e-prescribing could compromise patient safety, citing a government study that found one hospital’s system doubled the rate of medication errors because it defaulted to the maximum dose and auto-refilled.

CMS is shopping for claims auto-denial software that will cut the $10 billion in improper payments it paid in 2007. These are the folks urging adoption of patient-critical computer systems, right?

OhioHealth goes live on a remotely hosted version of the EMPI of Initiate Systems, running on the interoperability platform of Accenx.

Garden City Hospital (MI) contracts with CareTech Solutions to support new AMICAS radiology workflow modules.

The backup generator fails at Fletcher Allen Health Care, taking its Epic system offline.

Capital Health CIO Gene Grochala is intereviewed about its implementation of Keane’s clinical system, which he called “a diamond in the rough … a sleeper” that the hospital’s clinicians scored 93 on a 100-point scale.

Cardinal Health’s Q4 numbers: revenue up 10%, EPS $0.86 vs. $0.96, but meeting expectations. The sexy part of its business will be spun off on August 31 as Carefusion, leaving Cardinal as basically a warehouse and truck delivery operation for drugs.

Sometimes I wonder if doctors pay attention to pre-med economics: this one is proud to do his own network wiring and PC maintenance, thus turning his own valuable time into that of a $30 an hour technician. You can’t accumulate wealth if your time is spent doing low-value chores like computer programming or screwing around with PCs, which is really more of an expensive hobby than a frugal handyman gesture when the only thing you have to sell is your time.

Odd lawsuit: a patient given what appears to be a single dose of the very common sedative Ambien during a hospital sleep study sues the hospital, claiming the drug blinded and paralyzed him. Ambien is not known to cause either problem.

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Vice President Joe Biden, HHS Secretary Kathleen Sebelius, and national coordinator David Blumenthal will meet today with doctors, nurses, and administrators at Chicago’s Mount Sinai Hospital, according to an announcement from the vice president’s office.

Grants of $1.2 billion will be announced, including $598 million to fund 70 Health Information Technology Regional Extension Centers and $564 million for states to develop practices on sharing information with the Nationwide Health Information Network. The grants will be funded under ARRA, with money available in 2010.

The panel discussion will include Peter Ingram, CIO of Sinai Health System, as well as clinicians from Mt. Sinai and Northwestern Memorial Hospital. The discussion is not open to the public. A second event will take place Friday in Ohio.

HHS also says it will e-mail everyone who has signed up for the administration’s healthcare updates with the benefits of using healthcare technology. Jeanne Lambrew, director of HHS’s Office of Health Reform, was quoted as saying “All that paperwork is more than just annoying. It wastes time, prevents quick and accurate diagnoses and makes our health care system less efficient. And it simply doesn’t make sense in today’s digital age.”

The government also released a video of Secretary Sebelius touring “first paperless hospital” 83-bed Lakeside Hospital in Omaha, NE in June.

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