iSoft Enters US Integration Market
Social Security Administration Says New Certification Bodies Coming
HIPAA Violations: Nobody Has Ever Been Fined

From UCSFWatch: “Re: UCSF CIO’s e-mail. The GE Centricity Enterprise project is in full stop mode.” The attached and unverified e-mail from CIO Larry Lotenero says this: “The medical center’s Senior Management Group has engaged Kurt Salmon Associates (KSA) to assist us with a review of our IT clinical strategy. We are doing the review because we are dissatisfied with our progress to implement clinical applications to support the care of our patients. KSA will arrange interviews with many of you to capture your insights for the strategy planning. They will be on-site to begin their interviews on August 18. If KSA contacts you, I ask that you be as flexible as possible with your schedule to accommodate this process. We expect to receive a final report before November. For now, all activities associated with developing the GE clinical system should immediately be put on hold. Despite this action, we remain fully focused on our goal to complement our excellent clinical care providers with equally excellent clinical applications as soon as possible.”

From Jeannie with the Light Brown Hair: “Re: Allscripts. What? No mention of the Allscripts class action? Thought we’d hear some anti-lawsuit rhetoric at least.  ” Jeannie, I’m concerned about you. I mentioned the securities lawsuits prominently on 8/5 and again on 8/7, appropriately loaded with anti-lawsuit rhetoric (all the lawsuits since then are just copycat litigation filed by the same old me-too corporate heel-nippers who must love America’s legal system since they make a nice living wasting everybody’s time and money with BS lawsuits just because a company’s stock price drops). My concern: I bet a third of the e-mails I get regularly say, “Wow, you have to check out this story” and send a link to something I’ve mentioned days, weeks, or even months before. So here’s the warning: I write concisely and I don’t follow the lazy “Generalissimo Francisco Franco is still dead tonight” trick of repeating a story endlessly. I figure HIStalk readers are smart enough to get it the first time around. So, the takeaway is this: (a) read carefully, even the short paragraphs; (b) if you miss reading a posting, don’t just skip it since I will probably not repeat any of the same stories out of respect for your time; and (c) I still appreciate having stuff sent my way even if I’ve already mentioned it.

From Weird News Andy: “This is neither weird nor news; I have instinctively known it for years.” Heart attack survivors improve their survival odds by eating chocolate at least twice a week.

WNA also called attention to the above photo, which shows a Lahey Clinic doctor consulting with a patient in a hospital 20 miles away. That led Andy to ponder, “Is the point of service the hospital room or the clinic where the doc is?”

I’ve been citing strong hints for months that iSoft had eyes on the US market, so that has finally turned into news. The big Australian HIT vendor acquires Boston-based integration vendor BridgeForward, which sells the Viaduct integration design studio, the Physician Integrator for connecting EMRs to practice management systems, and integration servers. They paid up to $15 million depending on performance. BridgeForward’s founder was John Moriarty, who founded integration vendor MicroScript before it was swallowed in the bottomless pit that was New Era of Networks. All of the company’s executives were from MicroScript as well.

A former Kaiser executive files a whistleblower lawsuit against the organization, saying it ignored his concerns and instead assigned an HR “grim reaper” to make him quit. He claims that Kaiser refused to track patient deductibles and instead made them bring in receipts; exposed medical information on all of its dementia patients by putting a registry on an unsecured network; and dumped intact patient records into unlocked Dumpsters. This site reports that the complaint says KPIT’s compliance officer responded to his complaint as follows: “That officer told Plaintiff that Kaiser leadership did not care and that there was widespread violations of HIPAA throughout the Kaiser network and throughout the organization. He told Plaintiff that the only way he could get the company’s attention would be to send the information anonymously on a disk to George Halverson, Kaiser Foundation Health Plan’s then CEO, at his home with a note telling him that unless this was corrected by a certain date, the next time he would see the information would be in the New York Times.”

A company I’ve never heard of is bringing 40 jobs “to Henderson”, with no mention anywhere on the site of the Evansville Courier & Press as to what state the company, Henderson, or Evansville are in (I’d guess Indiana except I don’t care enough to waste the energy since the ace journalists can’t be bothered to actually say). The company, Innovative Workforce Technologies (wow, killer name there) doesn’t even have a Web site that comes up on Google. The story says they have an odd lot of apps like interactive patient entertainment, bed management, and some other stuff I can’t decipher from the reporter’s description.

TPD says he likes Google’s Caffeine search engine, the heir apparent to Google search and a Bing-killer, the company hopes. It’s fast for sure (and free of Adsense ads for now). I tried “HIStalk” on both and Caffeine got 91,000 hits vs. 90,000 for plain old Google. I did find one killer Bing feature a couple of weeks back: if you Bing a location and click Maps, you can shoot the location with one click directly to your MSN Direct-powered GPS right over the satellite connection without even plugging the GPS into the USB jack. I’m find that highly useful – any time I’ve looked up an address or location by name, I just click Send and it loads as a Web favorite on my Nuvi 780 the next time I turn it on. That’s just plain brilliant.

maxIT Healthcare of Westfield, IN is a new HIStalk Gold Sponsor. The company’s 300 healthcare-only consultants offer a long list of services, with their long suit being EMR and clinical systems (Cerner, Epic, Meditech, Allscripts, and all the big names). In fact, a recent KLAS report, 2009 Maximizing Your Consulting Investment: A Report on Healthcare IT Consulting Services, survey found that where only four companies had enough engagements for clinical applications consultants to be rated and found that ‘maxIT Healthcare scored the highest, receiving especially high marks for the quality of their consultants’ in Staff Augmentation. Thanks to the folks there for supporting HIStalk.

I don’t have enough interest to want to absorb the details and I suspect you don’t either, but it appears JMJ and its EncounterPRO EMR may or may not be wrapped up in some kind of lawsuit and bankruptcy actions, depending on how you define some confusing holding and parent companies. There’s supposedly a family feud involved (or so this message purports), a 1:250 reverse stock split, a management attempt to authorize 500 million shares of stock, the resignation of the CEO from the board of the holding company, and all kinds of questionable but entertaining gossipy tidbits. Shares are at 6/10 of a penny. If you think your life is hard, imagine being a salesperson for them.

Health plans are responding in inconsistent ways to the drug price drop that will happen in September as a result of the McKesson, First DataBank, and Medispan AWP lawsuits that were settled awhile back. Payors expect a windfall, while PBMs are adjusting prices upward to protect their now-lower margins.

Cardinal Health launches the Pharmacy Health Network, a closed-circuit video channel for retail pharmacies that will will carry what sounds like endless paid advertisements for drug companies aimed at people waiting the inevitable 20 minutes for their prescriptions.

Researchers at Northwestern University create a 120-question pain scale software application. Sounds good, except if I was in pain I sure wouldn’t want to sit there and answer 120 questions about it instead of just pointing to a smiley/frowny face or grimacing theatrically to make sure the narcotic analgesics keep coming.

Here’s another argument for placing exam room computer monitors so docs don’t have to turn their backs on patients. A family medicine doctor turned away from a drug-seeking patient to enter information on the computer. The patient attacked him, biting his finger off.

A consulting firm says half of the $2.2 trillion the US spends on healthcare is wasted.

Siemens posts some ARRA-related online tools (I can’t imagine they’ll be a player, but they have to try), but what caught my eye is the “all your base are belong to us” odd grammar and phrasing, like someone with English as a second or maybe a third language labored to sound like a native English speaker.

The Social Security Administration will pay $500 million to settle a class action lawsuit claiming that it illegally withheld benefits. The agency’s computer matched beneficiary names to arrest warrant databases in an attempt to cut off payments to criminals on the run, but instead shut off benefits to people with false allegations and old warrants. I bet there was a fat cat contractor company doing the programming.

CMS, until recently the HIPAA security rule enforcer for over four years, didn’t levy a penny in fines to violators. Likewise, new enforcer Civil Rights Office, which received 44,000 privacy complaints over six years, didn’t issue even one fine. Joe Conn did what journalists are supposed to do (but rarely do in HIT-land) when covering an otherwise mundane story – he dug for the facts that nobody else even thought to ask about.

While I’m kudoing journalists, I’ll laud nextgov, which I’ve found to be an excellent resource. This article about the Social Security Administration’s $24 million contract to automate its disability program, but only for certified products, has some fascinating facts buried in it. An SSA spokesperson said that while CCHIT is the only certifying agency now, “other programs are planned for the near future”. US CTO Aneesh Chopra was reported as acknowledging that CCHIT’s specs have a worthy competitor in the Continuity of Care Record and finds the discussion important. GE was somehow involved in commenting on certification, and being a multi-national conglomerate that hasn’t innovated anything interesting that I can recall in HIT and that sells CCHIT-certified products, took the obvious position: “Officials at GE, which manufactures CCHIT-compliant technologies, said not only are certification criteria not a barrier to innovation, they actually enable it by focusing product development on value-added areas, while facilitating the exchange of data among different health organizations and products.”

A US district judge issues a permanent injunction prohibiting Microsoft from selling copies of Word after a ruling found that it violates the XML patent of a Canadian company. If the injunction is upheld when appealed in the next 60 days, Microsoft won’t be able to sell Word 2003 or 2007.

E-mail me

HERtalk by Inga

From Michelle Duggar: “Re: Tweeting during childbirth. Obviously this lady had issues.” Michelle Duggar sent this story about the wife of Twitter CEO Evan Williams. Ms. Williams tweeted her 14-hour childbirth experience to 15,000 followers, starting from the time her water broke. Narcissistic? Twitter hype? Or perhaps just more effective than Lamaze breathing?

KLAS confirms what vendors have been saying for months: sales of acute care EHRs have been slow. KLAS, which has been collecting similar sales data for the last seven years, reports that 2008 sales were the lowest they’ve ever recorded. However, Epic grew its market share, selling 40% of the new systems sold to 200+ bed hospitals. McKesson and Siemens also saw market gains, though Cerner saw no new net growth for the first time.

CSC is named a preferred vendor for the Georgia Hospital Association. CSC hopes to help Georgia hospitals comply with ARRA’s yet-to-be-finalized Meaningful Use provisions for EHR.

maxIT Healthcare announces that its client, Gila Regional Medical Center (NM), has achieved Stage 6 designation on the HIMSS Analytics EMR Adoption Model. Phoenix Health Systems also assisted Gila Regional advance its Meditech utilization.

Ochsner Health Systems will take advantage of a three-year grant from the CDC to create a telemedicine stroke network. Ochsner will connect physicians at five of its community hospitals to on-call neurologists using REACH’s telestroke and telehealth service.

AHRQ plans to extend $48 million in grant opportunities for developing national patient registries that can be used for comparative effectiveness research. This amount is in addition to the $300 million funded by the economic stimulus to fund similar research. Look for more details this fall.

Meridian Health (NJ) selects Language Access Network to provide real-time video language interpretation services.

Virtua, an IDN in New Jersey, picks the Picis CareSuite perioperative and anesthesia solution for its nine facilities. The Picis software will connect to Virtua’s Siemens applications.

Healthcare Managements Systems secures an order with Madison County Memorial Hospital (IA) to supply an integrated clinical and financial solution for Madison’s 25-bed hospital and two rural health clinics.

MGMA members say their top concerns and struggles are dealing with operating costs rising faster than revenue, maintaining physician compensation despite reimbursement declines, and selecting and implementing an EHR. Interestingly, medical practice managers ranked these same three issues at the top of last year’s survey. Other big concerns centered around patient collections, uncertain Medicare reimbursement rates, recruiting physicians, and negotiating payer contracts.

Telehealth Services signs up two new customers for its TIGR on-demand patient education system. Both Peace River Regional medical Center (FL) and SSM St. Clare Health Center (MO) will install Philips LCD televisions and the TIGR interactive patient education and entertainment systems.

Presbyterian Intercommunity Hospital (CA) reports a 99% CPOE adoption rate since going live on Eclipsys Acute Care last year. The director of pharmacy also notes a 60% decrease in medication delivery times, down from 60 minutes to 24. The hospital recently activated Eclipsys’ Sunrise Pharmacy solution.

At least 10 HIStalk sponsors made the 2009 Inc. 5000 list, which recognizes the country’s fastest growing private companies in terms of revenue. One of the highest ranking HIT companies was eClinicalWorks, which has grown revenues 460% between 2005 and 2008. SRSsoft has grown 330% over the same time period. In case you were wondering, the overachieving Northern Capital Insurance topped the list with a 19,812% growth rate.

Global Med Technologies saw a 79% jump in its Q2 net income. Net income was $272,00 and quarterly revenues increased 66% to $8.1 million. Global Med provides blood and laboratory systems and services.

Perhaps a lawyer can explain how one can even file a lawsuit this vague. A man files suit against an unknown person for an alleged and unnamed medical condition. The unnamed medical condition created unspecified disabling injuries, so the man is asking for Mr. Unknown for $75,000 in damages.

E-mail Inga.

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Ross Koppel, PhD is on the faculty of the Sociology Department, the School of Medicine, and the Graduate School of Medicine of the University of Pennsylvania.

 

You’re a sociologist. What would you say is the major sociology at work among vendors, doctors, and CIOs?

A bit of context may help understand my research on the sociology of HIT. My first love was sociology of work. The use of technology in the workplace came next. About 10 years ago, I was working with some physicians to try to understand medication errors by young docs due to workplace issues like fatigue, inconsistent supervision, and dealing with life and death issues for the first time in their lives. And, remember, hospitals are workplaces.

With colleagues at the Penn Med school, we got a grant to study stressors in the hospital workplace. In response to my questions, the residents always insisted on showing me the remarkably lousy CPOE system. It was generating errors — some horrible, most easily fixed, but not fixed.

If you think about it, my looking at these issues is not all that odd. I’d been studying work, workplaces, technology, and sociology of medicine for 34 years. Also, the 2005 JAMA article combined sociological skills in ways that not many others had at their disposal: focus groups, expert interviews, shadowing docs and nurses, an extensive survey of 90% of the residents, intensive interviews, and observations on the floor. I’ve been teaching research methods at Penn for 17 years. I should have learned something.

Now, to your question directly. The physicians want to get their work done, ideally with greater safety and in less time. The vendors want to sell their wares and capture market share. The hospital CMIOs don’t want the software to crash catastrophically on their watch. None of them want to hurt patients, but the combination of forces is often counter-productive. 

Vendors seek market penetration ASAP because user implementation costs prevent reconsideration of other options once a hospital or even medical practice is committed. But vendor product cycles do not allow the ongoing feedback and adjustments that allow rapid improvements. The vendors are eager to roll out new iterations while the industry structure does not encourage patient safety or the actual needs of hospitals and clinicians. 

Also, hospitals want to show how wise are their investments, so few benefit from discussing errors. And many contracts prohibit open discussion of problems. Added to this is the reality HIT only works when it is embedded in complex organizations with other HIT systems. And that’s darn near impossible to test a priori. So even if the software had viable user interfaces and transparent coding, we could never be sure it is safe and functional until we can examine it in situ, which is both difficult and expensive.

Last, we must remember that most of these systems are built on back office programs from the 1980s with interfaces that are state of the art from the 1990s. There are structural issues that are difficult to surmount.

You got a lot of reactions to the 2005 article you wrote about CPOE. Which of them made you really mad?

The ones that misquoted or never read. The University of Pennsylvania wrote a reasonable press release. JAMA wrote more of an incendiary press release. A lot of people never actually read the article, so the things that pissed me off the most were those that were saying, “He only did the three focus groups,” when in fact I had a 90% sample of all of the residents and I had complete logs of every order put in.

There were all kinds of mythologies that were developed that bore no relationship to what I did. That was irritating as hell. I think there were some fair criticisms that the system that I studied was, in fact, an old one, and in fact I have a new study based on a brand new system that’s not been yet published. 

It was the misquoting and the misrepresentation that most pissed me off. I mean, I’m an academic. I’m used to people commenting on my studies. I’m not used to vendors creating a whole mythology from what I said when I never said it.

Was it surprising that HIMSS jumped out and wrote a disclaiming memo of their own when they were not even really directly involved?

Well, HIMSS is a sales agent of the industry, so no, it’s not surprising at all.

The vendors would say, at least based on some of your writings, that you will always find the anti-IT angle to every issue. Is that fair?

No. They should read some of my other writings. I have an article published in JAMIA that speaks very much in favor of CPOE as a patient safety device and develops a whole algorithm to use that. A lot of the work that I did with Michael Harrison — there are two publications there — talk about unintended consequences that focus mainly on the role of hospitals and healthcare organizations in creating errors. In the most recent JAMA article, half of the article, or certainly 40%, is devoted to protecting vendors from unfair attacks by incompetent or misguided or maltrained or otherwise inadvertent errors introduced by hospitals and other healthcare organizations.

I view myself as deeply in favor of HIT. The problem is, some of the HIT vendors and some supporters have some sort of a siege mentality. They see my critiquing some of the problems of the HIT as an attack on the HIT. But that’s like saying that the guys who wanted American car makers to build more fuel-efficient cars are trying to destroy the industry, when in fact, they were trying to save it, maybe not just to save the industry but also for more noble social purposes.

But I see the vendors who misread or mischaracterize my work as being incredibly myopic on their part. I am a lover of HIT. I think it’s going to eventually produce some of the stuff that we all want it to. I think prematurely putting out HIT that’s primitive, that the user interfaces are barbaric, doesn’t do themselves any good.

Ever since that 2005 article — actually, I presented examples of it earlier — I’ve received about 10 or 20 e-mails a day from physicians who say, “Stop me before I kill again” and they send me illegal screenshots and the like. I have a whole battery of material that would scare the hell out of HIT vendors that I’ve never ever, ever, ever shown to anyone … which they know about, because it gets reported to them, but physicians and others are not allowed to discuss it among themselves because of the non-disclosure clause.

So what responsibility does the hospital and the CIO have? They bought the stuff and they’re the ones who signed on to use it.

What a great question. Yes; first of all, they are responsible for some of the errors. If they insist on a blue background because it’s a hospital color or something, and the warning notices come in blue, then how can the vendor know that a priori? They can’t know that in advance. They should be doing more due diligence.

But let’s talk about this. I talked to a CMIO the other day in the New York City area and they wanted to see examples of XYZ vendor software. They were given a hospital in Texas and a hospital somewhere else to go to, and the guys — you know, it’s not like the CMIOs don’t know who they are in a city, and we’re talking major hospitals — they said, “What about X, or Y, or Z two subway stops away, or M fifteen minutes away, or whatever?” And the vendor said, “No, we don’t want you to go there.”

So they shipped them off to their – you know what a Potemkin village is? [note – they were fake village facades constructed to fool Russian Empress Catherine II in 1787] Potemkin hospital 2,000 miles away, and even then, when they asked to see something, they started to say, “No, no, no, you can’t see that screen!” and they covered it with a sheet, claiming HIPAA protective law, which, by the way, is psychotic — I mean, one of the people in the team was a lawyer for the hospital who said, “No, all he has to do is sign a release. We all have HIPAA certification. Three of us are CMIO types or CIO types with medical training.”

I think vendors go out of their way to sell — I’m trying to avoid the word vaporware — I think vendors go out of the way to put a best foot forward in ways that really are more of a marketing effort than an information effort.

But it works, the free market. People are buying their stuff. They’re delivering their promise to the free market to provide what the customers want.

No, it’s different. If you buy a bad toaster and you realize you screwed up, you’ll eventually throw away the toaster. If you’ve spent a hundred million bucks on a whole system-wide software, and then 600 million installing the thing and training all of your staff — you know, hospitals cannot say to people in — pick a neighborhood: northwestern Wisconsin — “Nobody’s allowed to get sick for the next six months while we bring this thing up live.” You can’t do that.

The training and cross-cover for hospitals is an awesome responsibility. I’m not making those numbers up, right? And you know that. The installation, implementation, and then you’ve got to get it working with other systems already in place. That’s a non-trivial task. You just can’t say, “We screwed up; we got Sunrise but we should have gotten Epic,” or “We got Epic and we should have gotten Sunrise.” You’re married. It’s worse than really expensive divorce.

So do CMIOs and CIOs have a responsibility? Yes. But there are all kinds of pressures on them, including the most recent ARRA thing, to buy this stuff. I think the pressure should be removed until they can have software that’s really worthy of the promise that we’re getting.

That does not mean that I don’t think they should buy software. I think that what it does is wonderful. I would much rather be in a hospital with an EMR and a CPOE and an eMAR than one that’s based on paper, but from the reports that I get and my own research, I can tell you some of those interfaces are nightmarishly bad. I mean, if it takes four screens and seven scrolls to find both systolic and diastolic on the same patient, we have to open trap doors to find the lab report you’re seeking that should be right there. This is primitive. You’re in this business. You know the reality of some of those bad interfaces.

But the worst reality is that none are clearly so much better that the ones that aren’t suffer from it.

From what I’ve seen of eClinical Works, it’s significantly better, but that’s just an impression.

Yes, it’s probably more dramatic on the physician practice side. I’m more of a hospital guy, but …

Most of my research is hospital. Although hospitals are moving into — I don’t know what to call it, “eClinical Works Turbocharged” or something — but yeah, you’re right. But on the other hand, they have different faults. One has a reasonable lab reporting system, the other has a reasonable medication list display or whatever. But yeah, there’s an awful lot of mediocre software out there.

Why would the industry take critiques about it as an attack when I desperately love this stuff? I want to see it better so that they can make even more sales with it. This is like selling a really mediocre, unsafe car and insisting that if you point out that it’s unsafe, that somehow you’re doing the car industry a failure. It’s ridiculous.

Nobody seems to correlate the fact that the utilization isn’t very good among doctors and nurses, which may be directly related to poor usability in software design.

No, they blame doctors for being troglodytic, for being technophobes, none of which is true. Doctors may have an unfortunate taste in golf attire, but they’re not morons and they really want to do what’s right.

I’ve been through the training sessions. I’ve watched the software. I’ve watched allergy indications almost impossible to update. I’ve watched patient information disappear or appear, require seven clicks and twelve scrolls to see two pieces of information that should be contiguous. A 12-year-old programmer would say, “So you want these together, right?”

So why are people still buying? Why doesn’t that move some vendor to say, “Well, I’ll be the usability king and I’ll make a ton of money”?

That’s a great question, and there are a couple of reasons. One, remember back when we were young, they used to say something like “God could create the world in six days and then rest,” and then “Why can’t we have a software program?” And the line was, “God didn’t have to deal with an installed base.”

Some of that is that the software is incredibly complex. When they fiddle with one thing, it screws up the finance department linkage or something like that. Some of it is that they prefer the mythology of blaming doctors for being idiots. Some of it is that when they hire doctors to work with them, the doctors go native.

You know that reference to anthropology? You send out an anthropologist to study some tribe somewhere and he’s supposed to write a perfectly accurate and scientific ethnography of this tribe. Finally you go search for him because you haven’t gotten any reports, and there he is with a bone through his nose and war paint and strutting around. You say, “Doctor Whatever, you’ve gone native! You were supposed to write … ”

When I work with doctors who have been working on these things and I say, “I know we’re deeply concerned about the inability of the physician to see the current medication on one screen,” they go, “Yeah, but look, we’re dealing with pixel X, and with bandwidth problems, and with…” And I’m going, “Wait a second, you did not go to medical school to give me lectures about bandwidth and utilization rates and the time…” There’s got to be a way in which somebody is protecting patient safety and clinician safety. That goes by the wayside all too frequently.

There’s another issue. Given what we’ve said before about trying to capture the market, because once they’ve got you, they’ve got you, right? They are rushing versions to market. They want to grab market share, and grabbing market share often gets in the way of making the product what we really want and know we can achieve. So it’s sort of a structural problem within the industry.

You’ve written about vendors who know about software defects and yet prohibit, in one way or another, customers from saying anything about it to other customers.

The non-disclosure clause. It’s a massive problem because it perpetuates exactly the kind of thing that you were asking about. It perpetuates the slow responsiveness.

So the vendor gets 2,000 complaints. Let’s say — I’m making this number up — 500 are ridiculous, it’s just the guy didn’t know how to plug something in. But of the remaining 1,500, the vendor then picks and chooses on the basis of what has to be immediately fixed to avoid being shown lethal versus what can come in the next upgrade, and what can come in the upgrade again, and then the upgrade later, and how many complaints did they get about this.

And so the vendor picks and chooses on the basis of a market model and a marketing strategy, not on the basis of what is greatest for the greatest number of patients and clinicians. Now, if that were transparent and we could see that there are, of the 1,500 complaints, there have been 10,000 dealing with — those are categories of complaints — I don’t know, the impossibility of entering allergies, or when you enter an allergy, it wipes out the previous allergy. So if the first allergy was anaphylactic shock and the second was a mild rash to latex, anaphylaxis dies, disappears, and you get the mild rash to latex coming up.

If you saw there were 10,000 complaints about that bug, there would be no way in hell a vendor could ignore that for the next iteration. But with the vendor having complete control over the listing, and clinicians being unable to see it and to talk with each other about this except sub rosa, not being able to send screenshots, it just perpetuates the economic self-serving model which does not serve patient safety or clinicians.

Now, why do clinicians accept this? It’s because they didn’t go to law school. And by the way, I’m speaking very soon to a group of healthcare lawyers and the like. The CMIOs come to me and say, “Look at this, we bought this and now we can’t address this,” and the lawyers for the hospitals say, “Schmuck. People come to me with a $5,000 contract to make sure it’s passing muster. You signed a $100-million contract, and now you come to me now that you’re stuck.”

But if we were talking about any other industry that didn’t involve patients, what vendors do would just be considered admirable business — they do what it takes to make a profit and keep shareholders happy. Is it inherently impossible to have a for-profit, publicly traded vendor model and expect them to really care beyond what is in their obligation to deliver? How do you make their interests align with those of their customers?

Exellent question. I think you can make their interests align because, ultimately, they have to be concerned about patient safety, because some of this stuff is going to come out. 

In the most recent JAMA article, March 25th, we did a lot of research. We found that the vendors, when they settle with the hospital and with clinicians and with patients, that’s settled with a closed case, right? And nobody’s allowed to disclose the terms of settlement. It’s not in the hospital’s interest, because the hospital doesn’t want to say, “We screwed up, Mrs. Jones, even though it wasn’t our fault, it was XYZ software’s.” The doctor doesn’t want to say, “I screwed up the patient, but it wasn’t my fault; it was XYZ software’s.” And the patient or the patient’s widow is told that if they want the $1.2 million, they have to stay quiet. So nobody exposes that.

So we know that there are a lot of subverts. If there was openness about the problems because of the patient safety issue, then that avenue of hiding stuff would not be available.

In terms of your attack on capitalism, no, I don’t agree. I think that it is possible to be vigilant about patient safety to produce the best imaginable software and nevertheless to produce profit. I think that the fact that there are well-made, very safe cars on the road is proof that there can be pressures equated to safety, and nevertheless profitability. This is the wrong time of the economic cycle to make this argument, but nevertheless, I still defend capitalism that way.

I think what the vendors have been so frightened of in the 13 years since they held that meeting where everyone — except the AMA, for some reason — agreed that they must do everything in their power to avoid federal regulation. I think that they have put themselves in the position where increasingly, regulation is a possibility.

And by the way, in my article, I argued that there were about 12 steps that they could do before regulation and I laid them out. There could be professional oversight — in other words, the physicians in the hospital associations would say, “We will not accept contracts with non-disclosure, period,” it would end the problem. The lawyers’ association for the hospital could simply say that. The IT industry itself could say that. “We, from this day forward, will not include that.” AMIA could say that.

That said, let’s see what happened two days ago, or four days ago, in JAMA. There was a letter — including my letter, then a rebuttal — that said, “Guess what? The Joint Commission rules state specifically that a hospital and its clinicians are prohibited from not talking about patient safety-related errors in the HIT.” So every single hospital in America, theoretically, that’s involved with HIT would be in non-compliance, would lose accreditation if they follow the rules of the current HIT vendor contract. 

Has anyone contacted the Joint Commission or has the Joint Commission read the letter in JAMA? And the answer is yes. Not me — I didn’t contact them. But it turns out that the Joint Commission reads JAMA, and I have been contacted by them, and they said, wow!

So the Joint Commission may simply say, “There can be no non-disclosure anymore if you want to stay accredited.”

Last question. If you were healthcare IT king for a day, what would you do?

I would say to the vendors, “The solution to your marketing problem is to create really good software, not to abuse people who study it and find problems, not to place the blame on ‘moron doctors’ or ‘idiot CIOs’, but to make really good software.”

And good software includes superb usability. I would say that there are excellent models out there of good usability. For God’s sake, look at Google, look at Google Maps, look at some of the people who are doing really innovative work out there. I would not shunt them away, but rather I would choose them as models.

I would develop a system of openness wherein we could really compare and test, not these Potemkin hospitals where you send potential purchasers, and really seek to improve on a real basis what is best. I mean, do the manufacturers of Epic really think that nobody from Sunrise ever sees their software or the like? There should be a real, open — call it a bake-off, wherein people can see what’s happening, and they’re not selling vaporware.

I went to one hospital the other day where they gave the top vendors a scenario then said, “I want you to do this, and then you get interrupted, and then you have to have a lab report to comment on, and then you’re going to wait for another drug information, and you have to do this live.” They did a real test. Most of the vendors either refused or failed. One vendor who I don’t particularly love passed.

Why did it have to be this one hospital CMIO type to call this test? This should be standard. There shouldn’t be hiding about this stuff. Patients’ lives are on the line and physicians’ reputations are on the line. Hospital bottom lines are on the line. Nobody benefits from having mediocre software, except maybe the salespeople of mediocre software. We can do so much better.

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McKesson Will Distribute CytoCare Chemotherapy Compounding System
Nuance Trims Losses, Beats Expectations
England’s Conservative Party Pushes Non-Centralized Electronic Medical Records

From Baron de Cobray: “Re: blaming vendors. Hospital administrators seem to be using clinical systems as an excuse for poor outcomes instead of their own poor management and operational workflows. I have seen hospitals bleed money because they refuse to fix workflow while demanding to replace a current IT system. The attitude that a system should fix these problems is absurd. Why do people believe they no longer have to think?” Ever since systems were first sold. In my experience:

• Hospitals like the idea of solving a problem by buying something — a piece of equipment, the services of a consultant, or a software application. It seems so much more decisive than the unglamorous chore of fixing poor organizational habits or culture.
• Hospital project management is usually iffy and IT portfolio management and governance even worse. IT should not own or run any IT project except infrastructure, yet you see IT departments claim they are going to lead clinical transformation. Not likely.
• Once the switch is flipped, everybody walks away instead of starting the long-term work of wringing value out of the technology.
• Hospital buy applications to avoid confronting employees for subpar job performance and managers for poor job definition. Hospitals almost never fire salaried employees, so nobody feels much pressure to change.
• Every area within a hospital thinks they are too different to allow conformance (especially pediatrics and surgery). Every hospital with an IDN (especially the flagship one) is convinced that nobody has a better idea.
• All that said, it’s easier to blame your vendor and then dump them than to look in the mirror to see who’s really responsible. I rag on vendors because I know they could do better, but when you paint an ugly picture, it’s ludicrous to blame the paintbrush you willingly chose. Every vendor’s product is wildly successful in at least one site, so that pretty much validates that it works when implemented and used correctly.

From The PACS Designer: “Re: file backups. TPD wants to inform HIStalkers of a backup system that can provide automatic continuous backup of your files through a USB attachment. The product is called OneTouch 4 Plus and is manufactured by Seagate/Maxtor. The OneTouch comes in several capacities. TPD installed a one-terabyte system for a family member and was impressed by how easy it was to copy all aspects of the system to a USB backup system. The one-terabyte system can be bought for about $125.00 from various sources.” I got the same device in a 500 gig USB hard drive configuration a couple of months ago, with the OneTouch software doing daily backups and prompting for regular full-system backups. What impressed me the most (other than the price, now $70) was that the drive turns itself off when the PC is turned off, apparently reacting to the loss of USB connection, so I don’t have to unplug it or turn it off.

Kaiser Permanente is cutting 1,200 more jobs, or 2% of its workforce, due to economic and enrollment issues. IT took the big hit back in the spring, with Kaiser confirming 850 IT-related jobs eliminated then. It’s also eliminating merit increases and delaying capital spending. A reader reports that one Kaiser region is offering voluntary retirement in hopes of reducing layoffs and, for those affected, offering generous severance benefits.

Health Alliance (OH) promotes Jay Brown to CIO.

Web-based transcription vendor iMedX gets a $13 million equity investment.

The eHealth Ontario news just keeps getting juicier. Former CEO Sarah Kramer got the job only after Ontario Premier Dalton McGuinty overrode the objections of his staff who questioned her lack of experience. Sealing the deal was the hiring of Alan Hudson as eHealth’s chairman of the board, who said he wouldn’t take the job unless Kramer, who worked under him as CIO when he was president of Cancer Care Ontario, was chosen as CEO. Both recently resigned in a scandal over excessive expense reimbursement and no-bid consulting contracts. Critics say eHealth Ontario has spent hundreds of millions of dollars without accomplishing much of anything.

Medsphere’s strategy is interesting, as published (warning: PDF) on the WorldVistA site: they’re targeting hospitals of 100-500 beds, for whom they say competing systems are unaffordable and low in customer satisfaction (I’m not sure that’s true of all competitors, but certainly some). They’re looking to hit the customer bang-for-the-buck plateau of the HIMSS Analytics EMRAM Stage 3, meaning no CPOE, clinical decision support, closed loop meds administration, physician documentation, PACS, and interoperability. Reason: Stage 3 costs only 40% of the tab required to get to Stage 7 and that bed range doesn’t necessarily have the money or the interest to shoot for the EMR moon. All of that sound good, but it’s really not all that insightful since most vendors in those bed ranges aren’t pushing CPOE or physician documentation either. Still, it’s a solid plan. Click the graphic above to see the cost-per-bed of several vendor clients.

Healthways, the disease management and health management company (market cap: $470 million) contracts for health services for its employees from Marathon Health. Employees get an on-site clinic, health coaching, and an EMR/PHR. Just about everyone on the Marathon executive team came from IDX.

McKesson announces an exclusive five-year partnership with Italian oncology IV robotics vendor Health Robotics, whose CytoCare compounding system will be sold along with McKesson’s ROBOT-Rx cart filler and MedCarousel drug picking system. A good move by them. Health Robotics also sells systems for non-hazardous IV compounding and is developing a similar system for TPN compounding in the pharmacy. I mentioned the company in March, also pointing out that former Eclipsyser Gaspar DeViedma is on the company’s management team and board.

England’s Conservative Party, calling NPfIT “shambolic,” wants to dump plans for a single national medical record per patient and instead share records kept individually within each hospital and practice (in other words, they propose to do it more like we’re trying to do here). Their plan to renegotiation contracts with BT and CSC doesn’t make sense to one analyst, who said, “It sounds a nonsensical approach with all the compensation payments that would be due. They could not make the contracts any cheaper – when they were struck years ago they managed to screw the lowest possible price and that led to the suppliers not being able to make any money.”

Weird News Andy checks in with a story from England involving a gang who held down a 14-year-old boy and forced a python to bite him. Paramedics on the scene identified the snake by Googling “snakes” on a cell phone, showing the boy pictures until he recognized it. It was found to be non-venomous, so he’s fine.

HITGhost followed up on my “female bass player” observation, pointing out Jeff Beck’s outstanding, jazzy bassist Tal Wilkenfeld (excellent live video here). She’s 23; Beck is a doesn’t-look-it 65.

Kaiser Health News runs an interesting story on EMR projects in Seattle’s hospitals, pointing out that three of the best hospitals in Washington are in the same neighborhood and use fancy EMRs, none of which can share information with each other. Fine comments from Swedish Medical Center CIO Janice Newell, who says that the Feds should encourage use of existing systems to avoid having the money “go down a rathole.” Even Steve Lieber of HIMSS gets in a rational, non-cheerleading quote that advocates reform along with automation: “As long as you will pay every time I do that test, the incentive is to do that test as many times as I can.” And kudos to David Brailer, whose viewpoint I share in pushing the network, not the devices that connect to it: “Imagine if companies tried to sell cell phones connected to some networks, but not others or that would call only certain area codes. The equivalent is trying to get doctors to switch to electronic medical records when they have, at best, a patchwork network to connect to.” That’s not the kind of story the trade press runs between the Most Wired beauty contests and vendor-written fluff pieces.

Tidewell Hospice (FL) names David Lafferty as EVP/CIO.

A group of Connecticut providers and insurers plans to launch an HIE next year, hoping to get stimulus money.

Allscripts is named one of North Carolina’s 10 Best Employers for 2009.

Hospital PR people will get hammered for information after a Hearst investigation concludes that 200,000 Americans will die from preventable medical errors and hospital infections this year. The report noted that federal and state governments have done next to nothing since “To Err is Human” came out in 1999, although assuming that government reporting and regulation will improve the admittedly ludicrous situation is a stretch.

An unemployed math instructor who claims his “energy medicine” machine can cure disease has sold 17,000 of them at $20,000 each (that’s $34 million worth) despite a lie-filled resume and a shady network of dealers and practitioners. He got two of the devices into St. John’s Hospital in Springfield, MO and touted that as mainstream acceptance, but it turns out that an RN in that department is also a regional sales manager for the company and her VP boss conducts training on its use. Googling the product’s name (EPFX) yields 26,000 hits.

Mayo Clinic hires an online ad network to place consumer ads on MayoClinic.com. Seems like a really bad idea for Mayo to pimp itself out that way. There are lame excuses at how the ads will help consumers, but it looks to me like Mayo just wanted to cash in like a mini-WebMD.

India will issue an RFP for a 20-hospital Health Management Information System, which sounds like a patient portal for getting information, making payments, and reviewing lab results.

iSoft says that a National Broadband Network in Australia would save $8-10 billion per year in healthcare alone, paving the way for healthcare reform and cost reductions and paying for itself twice over. It could be used for a health records network, patient management, and telemedicine.

The family of a patient who died of what they say is a Stanford University Medical Center medical error claim that, after the mistake, the hospital deleted entries from the patient’s medical record. The Department of Public Health seems to agree, finding that entries were indeed deleted and post-mortem entries were made by a nurse as instructed by her supervisor. Stanford says the deleted information was intended to be temporary, not part of the medical record.

A study conducted by a children’s hospital in Israel finds that the adoption of CPOE in the pediatric intensive care unit reduced error rates a little, but clinical decision support made a big difference. Medication prescribing errors dropped from 5.5% to 0.7%, although one might quibble at the definition of “error” vs. “error likely to not be intercepted and to therefore cause patient harm.”

Odd lawsuit: the widow of New York City’s first H1N1 flu victim says the city didn’t do enough to control the outbreak and didn’t tell her husband that he had come in contact with people who had tested positive for H1N1. She’s filing a $40 million lawsuit.

E-mail me.

HERtalk by Inga

The Social Security Administration plans to spend $24 million to link with healthcare organizations and hospitals. The goal is to seek health data on patients seeking Social Security disability benefits.

Healthvision boasts 13 new customers and two new partner engagements for the second quarter. The company also announced its upcoming user conference October 5-7 in Irving, TX.

INTEGRIS Health (OK) signs a three-year agreement with CareTech Solutions to provide Web services. INTEGRIS will implement the CareWorks CMS content management system to support its 13 hospitals.

James E. Peebles is named the new Chairman of QuadraMed, replacing Robert L. Pevenstein. Pevenstein will continue to serve as chair of the audit committee. Meanwhile, Julian A. L. Allen resigned from the QuadraMed board after a year and a half of service.

Springhill Medical Center and Eclipsys announce that their outsourcing agreement won a 2009 Outsourcing Excellence Award for Best Impact. The award is presented by the Everest Group and Forbes and winners can be nominated for a mere $1,500 fee. In addition to industry recognition, winners have the opportunity to spend a “winners night” on the Forbes Highlander yacht. I like the $1,500 per nomination idea. In fact, I’m now motivated to work on a business plan for Mr. H that includes charging similar fees for next year’s HISsie Awards. I’m hoping to leverage Jonathan Bush’s boat show connections for a cruise down the Chattahoochee River.

Patients needing to visit an HCA hospitals in South Carolina can send the hospital a text message and and their zip code; a reply will come back with the average ER wait time. If that method doesn’t work for you, you can either view the wait times online (www.grandstrandmed.com) or check out one of the digital billboards along the highway.

McKesson Specialty Care Solutions is adding up to 200 full-time positions at its call center in Scottsdale. New jobs are so much nicer to talk about than job layoffs.

Speaking of jobs, healthcare employment grew by 20,000 in July. The total unemployment rate, by the way, is a dismal 9.4%. Healthcare employment has grown from 13.3 million to 13.6 million over the last past year.

Elsevier announces that CHRISTUS Health (TX) will install five of Elsevier’s online clinical decision support solutions.

LRGHealthcare (NH) purchases IntraNexus SAPPHIRE clinical software suite, including IntraNexus’ Web-based EHR.

Diagnostic imaging provider Foundation Radiology Group will use software from Vital Images in its 20-hospital customer base.

Pendulum Healthcare Development Corporation selects DocSite as its preferred PQRI vendor.

Individual and family health savings account balances increased in the first quarter of 2009, which is the first time since Q2 2008. Employer and employee contributions to HSAs nearly doubled quarter-over-quarter. Individual and family account holders age 51+ hold the highest average account values.

Boston Medical Center claims referral volume has grown 10% since adding Carefx’s Referral Management Solution. Since May, the hospital has measured a a net 20% improvement in scheduled referrals and a net 5% reduction in no-shows. Administrators estimate they’ll generate an additional $7 million annually, based on preliminary ROI analysis.

Nuance Communications beats analysts’ expectations for its fiscal third quarter. The company posted a quarterly net loss of $1 million, compared to a loss of $9.9 million during the same time period last year. Total revenue grew 11% over last year, led by a 27% increase in Nuance’s healthcare and dictation revenues.

The folks at SCI Solutions are sponsoring a webinar next week and asked us to extend an invite to readers “following the healthcare reform issues/challenges on Capitol Hill.” After one of last week’s posts, I am positive there are a large number of folks following the situation closely. The webinar is entitled, “Healthcare Reform Update from Capitol Hill: The Latest News from the Senate Finance Committee.”

Virginia Hospital Center is deploying a wireless network across 1.1 million square feet in three separate buildings. The hospital is installing Horizon Converged Wireless solution by InnerWireless  to provide mobile access to a variety of applications, including the soon-to-be installed Siemens Soarian HIS.

A grandmother becomes the first American to receive a wireless pacemaker that allows her doctor to monitor her health over the Internet. The monitor communicates with a server at least once a day. If anything is abnormal, the system immediately calls the doctor.

Canadian researchers announce some important results of a social networking study: the more time people spend on Facebook, the more jealous they get about about the other relationships of their partners. Having been de-friended by someone recently (the nerve, huh?) I found the results very comforting. Clearly I was de-friended because of some jealous, psycho girlfriend and the action had nothing to do with me. Whew!

E-mail Inga.

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Bert Reese is senior vice president and CIO of Sentara Healthcare of Norfolk, VA.

You’ve been at Sentara forever. What’s the secret to CIO longevity?

I think the secret is to make sure that the technology is aligned with the enterprise, both the clinical and business initiatives that the company is addressing. So the closer the IT is aligned to the business and the more you are able to deliver on that, the more successful a CIO would be.

Sentara was mentioned recently for developing its own interface from Epic to Picis LYNX. Tell me a little bit about that project.

We were a Picis LYNX customer before we did Epic. The problem that we were trying to solve with LYNX was our inability to code properly in the ED, and therefore, our billings were inaccurate.

What the Picis LYNX software did for us, prior to Epic, was give us the ability to properly code the patient during the visit. We saw that in the old world, prior to LYNX, that we were under-coding, which actually meant that we were understating our revenue potentials from the ED, and from a clinical perspective, not really indicating the proper problem that the patient was being treated for. With the LYNX software, since it’s a logical part of work in ED, it was more convenient for the nurses to code as part of the care process, so it’s worked out very well for us.

We went to Epic, and we wanted to preserve the capability of LYNX, so we developed an interface between LYNX and Epic to allow us to move information from Epic down to LYNX so that they could continue to use the coding software in a convenient way. One of the issues that you have is that nurses and caregivers don’t see coding as value-added to the care process; it’s more an administrative function. So when you want them to do something like that, if you can make it a byproduct of how you treat the patient. Then it’s a lot more convenient and they’ll do it. That’s what we did. It’s pretty straightforward; that’s the real secret sauce is in the Picis LYNX software.

Your EMR project is said to have cost $237 million. How will you measure its benefits?

That’s a great question. So it’s $270 million over ten years. The first thing was we set an expectation that a project of this magnitude goes out over an extended period of time and that you have to set the expectations of the company that they will be spending this kind of money for awhile.

The second piece of it is that when we started the project, we identified 18 major clinical processes that drive about a $35 million-a-year annual return of investment. We have identified those, we have four of our eight hospitals up, and we have seen benefits this year – `09 – at around $16.7 million.

So we know from a dollars-and-cents perspective that electronic medical records do create economic value. If you take that $35 million over the $270 million investment, that’s like an internal rate of return of about 12.3%. That’s a good return of your investment.

The other part of it relates to clinical quality indicators. If you follow the clinical quality indicators and see some level of improvement in clinical quality activity — that is, you see the patients are being better cared for under electronic medical record — then there is that benefit as well.

We have seen great clinical quality. I’ll give you an example of one. In the old world, it would take 137 minutes for the doctor to enter a medication in the hospital before it was administered to the patient. Now, it’s less than five. And there’s tons of stuff on turnaround time and length of stay and things like that.

The key to this — in looking at the return of investment, you look for where there is hunting and gathering of information, i.e., you’re looking for the old paper chart and/or whether there will be hand-offs between one care partner to another care partner. That is where the opportunities are for both economic and clinical quality savings. 

What are your overall impressions of the Epic system and its implementation?

First of all, in the way of background, I’ve got experience with Cerner, Eclipsys, Epic and GE’s IDX/Centricity, so I’ve seen a lot of them. I will tell you coming out of the chute that you can have the best software in the world, but if you do a sloppy install where you support it in an inappropriate way, you’re going to have a failure.

Part of the secret sauce is in the quality of the software. I would say the other part of the secret sauce is in the quality of the local IT staff. Then, the culture of the company who’s adopting the technology.

In the case of Epic, Epic is a superb piece of software. It’s not buggy. It comes very, very clean. They’re a very collaborative company. That makes it easier. It’s less mysterious on the IT side about what it is you’re going to get and what you’re trying to do with the software when you get it fixed, or an upgrade or something like that.

But I will tell you that the responsibility, ultimately, is at the hospital or health system level. They need to make sure they made the right investment in order to have a varsity team to be able to support an application, either in the Cerner, Eclipsys, or an Epic type of venue.

Did you use outsourcing for the implementation?

I used it in an unusual way. In the old world, I was converting from a TDS 7000 to Epic and I had a choice: I could either bring in new staff, or outsource staff to help me with Epic, or I could take my Eclipsys support and give it to an outsourcer — it will move my old staff to learn Epic. 

I elected to do the latter. We hired Perot Systems to commit and run our Eclipsys environment for us while we took our old medical systems team, retooled them on the Epic toolset, and had them support the implementations. Perot is still with us today because we have a couple more hospitals to do on the Eclipsys side, and so they’ve been with me for about five years or so. They do a great job.

How have your IT strategies changed, or have they changed, with the economic climate?

First of all, I want to make a comment. What we’re doing is not about electronic medical records. In our view, in our culture, an electronic medical record — when you have it implemented, most organizations will become a technology-driven company, and our advice is: skate to where the puck is.

The puck is not being a technology-driven company. The puck is going to be when you are a data-driven company, meaning that in order to use the data, a prerequisite is to have the electronic medical record.

When you have the data, the advantage will go not to the organization that has the EMR. It will go to the organization who can convert data to information, to knowledge, to action the quickest both business-wise and clinically.

I’ll give you an example. In the old paper world, I could tell whether you had been in the hospital, whether you had pneumonia, and whether you had an antibiotic administered; but, I couldn’t tell you when I gave you the antibiotic. I can’t tell you the outcome. The outcome would manifest itself. Does it shorten the length of your stay? Did you have more doctors’ office visits at the end of your hospital episode? Because I couldn’t see across the continuum of care.

Now we know when we study the data that when you present with pneumonia in the doctor’s office or in the ED, and the doctor concludes that it’s serious enough that he wants to have you admitted, to onboard the antibiotic as soon as possible. So if I know you’re in the practice or in the ED, and I’m going to send you to the hospital, I’m going to give the antibiotic immediately, because we know that getting the antibiotic onboard will start the curative process, will shorten the length of stay, and shorten the subsequent doctor office visits that are required.

That improves the care for that patient and reduces the cost. You can’t do that without having the data. You can’t do that without having electronic medical record, so that when you decide to tell the care delivery team if you’ve got a diagnosis of pneumonia, "Give the antibiotic now," because you can communicate it electronically to all sites — you can’t do it without that.

So the electronic medical record in our view is, "Welcome to the starting line." It’s going to revolutionarily change healthcare. As it relates to my current level of investment given the current economics, they’re giving us more money. They believe in what I just stated. They believe it’s all about data and the new information that will be created.

So if I was going to summarize it for you: electronic medical records improve quality and make money and they position you for extraordinary opportunities that you’ve never imagined.

You have to have administration that supports that concept?

Yes, absolutely. I think what the role of IT is in the future is that a lot of times, our customers are a rearview mirror. They’re not a guide to the future. So a customer, perhaps, would have never invented the television set, the microwave, the iPhone. It was technologists who invented those technologies and innovations, right?

And so it is the role of technology in the enterprise or in the health system to create a new reality for the company based on the technologies that are available. That’s a big statement. I don’t wait for my administrative staff to create a new reality. I, because I understand the technology, create a new reality on their behalf.

Back to your first question about how it is that you last so long as a CIO in the organization, it’s because I’ve been able to innovate in front of the company to improve what it is that they wanted to do.

Tell me about your internal work with standardization.

You’re right on point. That is part of the secret sauce. If you’re going to report on data, that means that you have to call the same thing the same thing across the enterprise. So a chest bilateral is a chest bilateral, not a chest x-ray. And, more importantly, you have to have the same lab normal values across the enterprise. One pathologist may say with a CBC, "This is a normal value," and another pathologist may say, "That is a different value from the normal limit."

One of the discussions you have to have early on is — what are you going to call things? What will be the standard of practice within the enterprise? So from the Sentara perspective, we are heavily standardized. We took a page out of the banking business back in the late 80s, early 90s where bank mergers took place and went through a heavy standardization. You’ve seen it with stimulus packages and banking consolidations. We took a page out of how they did their conversions and we decided to go that way.

When we affiliate with a new hospital or a doctor’s group, we bring them onto our standards suite with their application. In the case of my eight hospitals, there are no Norfolk General status set screens, there are no Sentara Careplex status screens; there are only Sentara Healthcare status screens. All those hospitals collaborate in what those screen flips look like, which means heavy dialogue, heavy participation, great collaboration, and a lot of fun.

How important are mobile devices for your clinical projects?

Not so much. The biggest extent of mobile devices we have are WOWs, workstations on wheels. Medical staff is not pushed to move them to phones or tablets or anything like that. At the doctor practice level, inside the practices, we experimented with mobile devices and we found, based on the workflow, that the fixed workstation worked best.

Let me describe that for you. If you’re a patient going to one of our doctors and you go into the exam room, you’re normally accompanied by the doctor’s nurse, who then logs on to the system and then enters your problem, enters any of your vital signs, any of your current meds, any changes in your physiology, and brings everything up to date. She then locks the workstation; she bookmarks where she is on your record, and locks it. When the doctor comes in to see you, he logs right on, right where the nurse picked up. So he doesn’t have to reacquire you as a patient, doesn’t have to ask any additional questions. He’s right where she left off, right where his workflow starts.

If he was walking from exam room to exam room with a mobile device, he’d have to log on every time and reacquire the patient. I wade through all the patients I’m going to see that day. And so we found it to be faster if the nurse does her work like she normally would, locks the workstation — he comes in, logs on, and he just picks up right where her summary of the information is and carries on the conversation with the patient. So mobile devices have been interesting for us, but that’s where we are right now.

Anything else that you want to add?

The only other thing I would say around community physicians and electronic medical record — there’s stimulus money out there for doctors that go up on electronic medical record. I would say to the hospitals and the health systems that they have a responsibility to guide that conversation in their communities that they reside on behalf of their community-based physicians. They should become the rallying point, they should become the center of truth, and to help the doctors with the decisions they have to make on the electronic medical record, because they have the capability of doing it.

What I don’t want to have happen is I don’t want a doctor, because he’s anxious about the stimulus money or losing Medicare funding, to make a knee-jerk reaction to a decision. I believe in the theme of better together, and I’d like to have my community doctors as close to us as possible so we can all go there together. And that if we make a mistake, well, we’d all make it together, and hopefully we’d have the power of crowds, maybe we’ll learn from each other.

I would encourage everybody to take on the responsibility of helping to guide the community physicians as to what they should do with the electronic medical record. There is certainly benefit for the hospital, but there’s also certainly a benefit for the patient. If you control the conversation or help guide the conversation, you’ll probably minimize the number of technologies that you have in your community. That means we can start to solve the interoperability problem when you have to hand the data off from a primary care doctor who’s on the XYZ system to a specialist who’s on another system, that the chances of that being done successfully and clinically correct is improved.

So I think the patient benefits, and then ultimately the hospital and the caregivers, because they’re able to have more information in order to care for the patient better. Ultimately, it’s all about the patient.

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Well, it appears that the only readers writing this week are Gregg Alexander (from HIStalk Practice) and me. Technically, we’re readers too, but it would be nice to have some company up here on the good old Internets. Who’d like to contribute? Anyone? Anyone at all?

BrevIT Revisited
By Mr. HIStalk

Ah, the late, lamented BrevIT newsletter I used to write every Saturday, giddy and dog tired after many hours of writing HIStalk throughout most of the same day. BrevIT was sometimes insightful, often educational, and usually funny (the headlines, anyway). I’m really proud of having done it from mid-2007 to mid-2008, but it took a lot of time and, like most e-mail newsletters, most recipients weren’t reading it even though it had a loyal core following.

I miss it, and if I ever figure out how to do this full time, I’ll bring it back in some form. Or, maybe I’ll roll it into HIStalk in some fashion (I’m open to ideas).

Here’s the index of issues in case you want to read some old ones (odds being that you probably never read it when I was e-mailing them out). Below are some of the headlines I liked as I read back over the old issues. You can probably guess the stories.

• Cerner Announces Millennium for Xbox
• Cerner Slashes Payroll, Stock Price By Dis-Association
• Study: Government’s HIT Initiatives About as Ineffective as Government In General
• RHIO Failure News Slow to Reach Maine, Apparently, as HIE Launches
• Wal-Mart Starts PHR Rollout Quickly After Omnimedix Rollback Special
• Dumped in Dubuque: McKesson Horizons 79
• Hydroelectric Power: VA Facilities Close Due to Data Center Flooding
• Non-World Wide Web: Internet Outage Cuts Off Asia, Middle East
• QuadraMed Curries Little Employee Favor by Offshoring
• Revolution Health Brags That It Has More Freeloader Readers Than WebMD
• Microsoft Bobs in Rough Healthcare Applications Seas
• Allscripts, Eclipsys, WebMD Shares Trampled in Investor Stampede
• Wal-Mart Has a Blue Vested Interest in eClinicalWorks
• HIMSS Fills Orlando with Non-Mouse Ear Wearing Tourists
• Cerner’s Legacy: Taking Yet Another Epic Beating
• Is That Your iPhone In Your Pocket Or Are You Just Glad To See Me, Doctor?
• Looking Up Britney’s Dress Was Free, But 13 Play Dearly for Ogling Her EMR
• Ohio Dots the I in its Standards for Practice-Friendly EMR Contracts
• Cerner Looks to Inhaler to Cure Its Heavy Breathing for Earnings Growth
• Allscripts and Misys Consummate Desperate Lust; Shareholders Hose Them Down
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Cash for Clunkers?
By Gregg Alexander

“Cash for Clunkers”? Hot diggity dog! What a great new idea to adapt into the whole new ARRA/HITECH EHR adoption drive!

I mean, think about it…we’re trying to drive users to EHR adoption, right? We’re hoping to encourage “meaningful use” which could sort of be interpreted as improved mileage, yes? We want every new EHR driver using a system which will participate and share safely on the health information sharing multilane highway, no? And, ultimately, we’d like to see all those non-CCHIT-certified, non-government-approved EHR clunkers off the road, eh?

So, if you read or watch any news lately, you know the auto-selling industry has had a landslide success with the government’s “big bucks for your trash trade-in program” formally known as the Car Allowance Rebate System or CARS. (Cute, huh?) Intended to run until November, the billion dollar budget appears to have been blown in only one week. Talk about end user adoption!!!

Such blazing success should not go unimitated. You want an EHR in every provider pot? Let’s take a lesson and forget the whole 44K reimbursement nonsense. Here’s the new deal:

• First, we pick a catchy name like “Every Human Receives Something” or EHRs
• Next, we choose a cute-ish informal moniker, say, “Moolah for Medicine”
• Third, we decide upon a set of high mileage models worthy of reimbursement … of course, CCHIT-certified systems will likely be the de facto choice.
• Finally, we offer cold, hard, trade-in cabbage to all clunkers out there — those notoriously antiquated non-CCHIT systems and, obviously, anyone still driving the prehistoric pen-and-paper monstrosities.

If $4,500 for a running, drivable, used car inspires sufficient adoption of new, high-mileage models to burn through a billion bucks in one week, I’ll betcha an upfront $44K to turn in old, gas-guzzling EHR junkers or paper-based jalopies for sleek, new, energy efficient health record roadsters will tear through 19 billion greenbacks in two, three days, tops.

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

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