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September 17, 2009 News 41 Comments

From Doofus: “Re: Allscripts. Word on the street that Allscripts is sending a letter to Misys EMR clients stating that they will not make MISYS EMR compliant with ARRA guidelines and that these clients will need to move to the Allscripts family of products. Fees are in the area of $2,500 per provider and a fee per practice. Training and data conversion are not included but are discounted.” A contact there says word on the street is wrong. Since meaningful use hasn’t been defined, Allscripts hasn’t made any statement about the likelihood of MEMR being compliant or what they’ll do (or offer) if it isn’t. Maybe there was some confusion over an ongoing offer to those MEMR customers who would like to upgrade to one of the company’s better products at their convenience.

From Pat Patterson: “Re: HIStalk Practice. The last e-mail blast link takes you to the eClinicalWorks home page. PS – Tell Inga she is my ‘secret girlfriend’. I just love women who can talk tech and shoes all in one column!” Inga was scurrying to the airport and pasted the wrong link into the e-mail, leading Pat to joke that we must have sold the mailing list to eCW. She can definitely talk the girl stuff, to which I agree there’s nothing more attractive than a really smart woman who’s still fun. My secret girlfriend is Tina Fey since I’ve become a big 30 Rock fan. Love the glasses.

From The PACS Designer: “Re: InformationWeek Top 250. The latest rankings from InformationWeek’s Top 250 Innovators has been released with the following healthcare providers being amongst the top 25:  #2 Cincinnati Children’s Hospital M. C., Marianne F. James, Sr. VP & CIO; #9 University of Pittsburgh M.C. (UPMC), Daniel S. Drawbaugh, Sr. VP & CIO; #18 Beth Israel Deaconess M.C., John D. Halamka,CIO; #21 Sentara Healthcare, Bertram S. Reese, Sr. VP & CIO; #22 Christus Health, George Conklin, Sr. VP & CIO;  #23 University of Arkansas for Medical Sciences, Kari Cassel, CIO. TPD salutes these institutions for being tops in IT innovation!”

From Dr. Curious: “Re: Eclipsys. After reading the post about Eclipsys letting their consultants go and giving their implementation work to consulting partner, a huge red flag went off. In this year, they have replaced their CEO, CFO, and dismantled their professional services division. It makes me wonder if there is more to this than meets the eye. For example, could it be that they are preparing for a buyout, or are they struggling through financial difficulties? Everything I have seen and heard about Eclipsys points to a near-term end for them. What are your thoughts?” I suppose it was time to replace the CEO and CFO. Outsourcing the professional services organization is puzzling since theirs was pretty good, but it never seemed to make the money they expected it to, possibly because they don’t sell Sunrise all that often and that probably caused bench time (how else can you lose money billing out $50 an hour employees as $250 an hour consultants?) You may not have noticed that share price has made a steep climb up in the last six months, going from $8 to $20, which is highly positive given the company’s erratic financials in years past. Despite some impressive successes in clinical systems, they’re always going to be banging heads (usually unsuccessfully) with the Epic juggernaut since they have the same sweet spot, but Epic’s got everything else and not just the core doctor-nurse-pharmacist stuff. Positives: the former Premise, EPSi, and MediNotes, all good (but not cheap) acquisitions. Andy Eckert knew zip about healthcare, so I’d consider that a minus, as was the long roster of lackluster and revolving door VPs that served time there. OK, so now that I’ve brain-dumped, here’s what I think: excellent products, hopefully improved management, but sorely in need of a strategy that keeps them out of Epic’s way while earning the confidence of stock analysts. They need a Neal Patterson.

The rumored Eclipsys contractors, by the way, are Vitalize, ACS, and MaxIT. All fine companies, but as one reader said, it all rides on how Eclipsys manages them.

From Anomymously Happy to be Done with Epic: “Re: Epic. I find it really hard to believe that an office is such a perk, given that the employees actually working hard for Epic don’t spend more than three days a month in the office! And as you nicely put it, people become ‘untouchable’ when they leave Epic. They don’t truly try to LEGALLY enforce the non-compete, because they can’t! I was a team lead at Epic and you are ‘encouraged’ to set mutual end dates with your team members rather than fire them. These people are too naive to know that if they do set a mutual end date that they won’t be eligible for unemployment, etc. Mr. HIStalk, please don’t ‘Like their model as a capitalist!’ I feel really bad for new young people who think that Epic is a place to start their career!” I’ll have to disagree a little. Lots of those folks aren’t all that employable, so it’s a darned good job in comparison to their likely alternatives (and pays a lot more than Meditech without the Boston expense besides). The former employees who complain about the company are self-selecting, i.e. they left, so naturally they aren’t going to brag. The ultimate measure is employee turnover, a stat I don’t have.

From Dan: “Re: your doctor’s EMR. You are an experienced observer and your comments are welcome, but we could all use the context of the make to put it all into some perspective.” I hinted around to my doc, but he never came out and said whose product it was and, surprisingly, I didn’t see its name on the screen. I was thinking GE, but that might have been another doc that I’m recalling. He mentioned McKesson, but he was tying into some hospital information, too, so I don’t know which system he was talking about. I don’t know that there was anything all that special about the EMR anyway, but I was impressed with how he integrated it into his practice.

From RIS Reporter: “Re: Kindred. The Radiology Information System unexpectedly went down at more than half of all Kindred LTAC hospitals in the US. Current radiographs were unavailable for interpretation or view for hours. That would not be so bad, except that Kindred harbors hundreds of train wreck patients.” Unverified.

spyagent

An Ohio hospital employee opens a personal e-mail from a former boyfriend using Yahoo Mail on a hospital PC, surely violating a number of IT security policies. The e-mail had been intentionally infected with a $115 commercially available program that sends all keystrokes and a regular series of screen images to a designated party (the former boyfriend in this case). He not only got 1,000 screen captures loaded with patient and employee information, he also was the recipient of up to five years in jail and a bill for the hospital’s trouble in the amount of $33,000. A quoted security expert was mildly sympathetic to the hospital, but questioned how they allowed it to happen.

Weird News Andy finds this odd but not humorous story: a patient dies six days after she is somehow set on fire during surgery in an Illinois hospital.

ahn_thumb[2]

Alliance Health Network, which runs disease-specific patient social networks used by vendors of related products and services to try to sell them stuff, raises $3.3 million in Series C funding, raising its total to $6.6 million.

University of Missouri big wheels meet behind closed doors with “several unidentified men”, leading to speculation by 100 IT employees that their jobs are about to be outsourced to Cerner. One was quoted as saying, “The workplace is miserable. We come in every day not knowing if we’re going to have a job in five months,” which means nothing much would change if CERN takes over. The suits got careless, apparently, with the CIO letting slip the never-heard term Tiger Partnership in referring to the Cerner relationship and another executive denying a newspaper’s open records requests with the excuse that pending contract discussions are exempt, then saying “we’re done here” when he realized that he had just let the cat out of the bag by acknowledging that the Cerner correspondence involved a contract.

Edgefield Hospital (SC) signs for Swearingen Software’s RISynergy RIS. I didn’t know Randall was still selling, to be honest. Great product, but the “what if he gets hit by a bus” question always came up when we considered it at places I’ve worked, even though we all liked it. I like their Web site, in which the first menu item to the left of the standard About Us is one called About You, which is fun.

uci

UC Irvine acknowledges that CMS nailed it with an “immediate jeopardy” warning earlier this summer, the result of a California Nurses Association complaint that faulty PCA pumps were overdosing patients. Ironically, the CMS found that the pumps were fine and it was nurse errors that caused the overdoses, one of which happened while the inspectors were on site. I’m guessing the rather radical and pro-union CNA quieted down the mad-dog rhetoric a bit on hearing the nurses were at fault like the hospital said all along.

Revenue cycle management vendor Passport Health Communication hires former Cerner VP Seth Rupp as CTO.

Medicity is offering a Webinar next Friday called On the Leading Edge of Meaningful Use: HIE in the State of Delaware.

Listening: new from Muse, dramatic and theatrical orchestral progressive. They even sound kickin’ live — a little Uriah Heep, a little Queen, a little U2 (by my untrained ear). I’m surprised that they’re #6 on Amazon and they have 63 million MySpace plays. Like it lots, although I wish they were more obscure so I could feel smug about finding them by accident.

Our sponsor friends at Culbert Healthcare Solutions redesigned their Web site with a lot of highlights listed for some of their practice areas (Allscripts, Epic, GE/IDX, revenue cycle, etc.) I have to admit that I didn’t know they did as much as they do – workflow, EHR, RCM, interim management, and systems integration. Business must be good because they’re looking for consultants, I noticed.

National coordinator David Blumenthal tells an AHRQ audience that nobody’s done enough research to really know how to implement EMRs, saying “one thing we haven’t done is apply the scientific method in the practice of healthcare and medicine.” So in other words, if EMRs were drugs, FDA wouldn’t allow them to be sold, especially $19 billion worth of taxpayer expense. I’m feeling really good about HITECH right about now. I’m being facetious, but the problem with studying technology implementation is that, unlike drugs and devices, the technology is just a reliable extender of unreliable human variation. Hospitals are run like mom-and-pop shops when it comes to repeatable processes, with a massive variation between what administration decrees and what the front-liners actually do in the uncarpeted areas of the hospital. It would be unenlightening, as well as unfair, to hold the technology accountable for any change in outcomes (good or bad). This makes probably the thousandth time I’ve said this, but here I go again: if you are really good (personally or organizationally), healthcare IT has the potential make you a little bit better. If you aren’t very good, your level of suckitude will be unchanged or very likely will increase when you throw technology into the mix.

Rwanda will implement the Jeeva system in all hospitals next year. A little Googling turned up its vendor, India-based Karishma, which focuses mostly on East Africa, Southeast Asia, and the Middle East, but which lists the USA as its #4 market, with partners IBM, Intel, and Oracle and a US office in Virginia. They offer every kind of system that a hospital would need from what I can tell. The clinical decision support system sounds really cool. This might be a company to watch.

Henry Ford Health System chooses Apollo PACS.

A stock analyst says newly public Emdeon is a “melting platform” whose clearinghouse business is threatened by new competitors (athenahealth) and HIEs, speculating that providers will bypass clearinghouses and simply submit claims directly to payors. You don’t often see a new issue getting a “sell” rating.

I’m behind again, so be patient if you’ve e-mailed. We’ve got some good stuff coming, but it takes more time than you might think. I love every minute, but there just aren’t enough of them available.

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Seventeen Bangkok hospitals will use a single EMR, with one benefit being the ability to attract medical tourists. IBM is involved.

You have to like the name of this long-term care physician system: PAR 3 EMR.

Sharp HealthCare is the subject of a press release by ColdFusion Web framework / content management vendor PaperThin, which says the health system redeveloped all its Intranet and Internet pages using its CommonSpot CMS.

North Carolina wants $40 million of federal money to build an HIE, $20-30 million to hire 40 employees for nine regional extension centers, and $28 million for a broadband network for medical images.

National Library of Medicine launches the Newborn Screening Coding and Terminology Guide, intended to help states move forward with common standards for including newborn screening information in EMRs.

Children’s National Medical Center (DC) gets a $150 million donation from the government of Abu Dhabi to create the Sheikh Zayed Institute for Pediatric Surgical Innovation.

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HERtalk by Inga

epic wild west

 

 

 

 

 

 

 

 

 

From: Miss Manager “Re: Epic prepares for a Wild, Wild UGM. Please share fashion tips for western wear, thank you!” Miss Manager sent over this link to the Verona paper detailing Epic’s user group meeting next week, which features a Wild, Wild West theme. First, I am so glad Miss Manager inquired about fashion, since I know far more about that than I do the Epic software. Obviously, boots are a must. I have some adorable Steve Maddens with spurs, so I am bummed I wasn’t invited to attend. Other than that, you can never go wrong with lots of rhinestones and studs. For those of you more focused on HIT than fashion, here are some interesting details to note. Epic is foregoing a traditional keynote speaker, choosing to “not go overboard” in light of the poor economy. The company is offering “recession pricing” of $300 per person, versus the last year’s $600 fee. Expected attendance is 3,000 plus the company’s 3,400 staff. Needless to say, the area’s 2,500 hotel rooms are going fast, and the Super 8 and Holiday Inn Express are already booked.

3M Health Information Systems releases a new application to covert ICD-9 based applications to IC-10.

JPS Health Network (TX) selects Order Optimizer as its evidence-based order set and clinical decision support platform.

I’d love to know who wrote this. Maybe it was Mr. H himself.

oschner

Ochsner Health Systems (LA) goes live on DocuSys Anesthesia Information Management and Anesthesia Drug Management at its 41 anesthetizing locations.

Lots of apologies in the media these days: Joe Wilson, Kanye West, Serena Williams. Now Cleveland Clinic’s CEO also says he’s sorry if his recent comments on obesity caused any offense. Could Mr. H also be trying to make amends with the disabled after he recently accused the elderly of wasting government money on free scooters?

CliniComp names Stephen Armstrong VP of marketing. Armstrong is former VP of marketing and founding executive of Patient Care Technology Systems.

EHRtv.com posts 40 videos from the Allscripts Client Experience, including Glen Tullman’s keynote address and several client interviews.

Healthcare analytics company MedAssurant acquires fellow analytics vendor Catalyst Technologies. The merger creates the country’s largest company providing administrative and hybrid medical record data review and analysis.

methodist dallas

Methodist Health System (TX) agrees to implement Webmedx’s Transcription Outsourcing Service and Enterprise software solution. The system will interface with Methodist’s EHR.

I understand that pharmacies would prefer you hang up the cell phone and talk to the pharmacist when picking up your meds. However, I think this Illinois CVS pharmacy is stretching the truth a bit with its posted signs claiming they’re unable to help customers on cell phones “due to HIPAA regulations.”

The Minnesota HIE is named a finalist for a Minnesota High Tech Association 2009 Tekne Award. The HIE is up for the Innovative Collaboration of the Year award.

The Premier healthcare alliance becomes the first group-purchasing organization to contract with AirStrip Technologies. The AirstripOB product provides providers real-time remote access to such data as maternal contractions and fetal heart rates.

Streamline Health announces its Q2 numbers: $18K loss, compared to a $429K loss last year; quarterly revenue fell 16% to $4.1 million, compared to $4.9 million in 2008.

St. Vincent Health (IN) expands it use of MedAssets’ RCM products to improve contract management, charge capture ad recovery, and claims management.

Adventist Health System signs up to implement Dolvey Systems’ computer-assisted coding solution. Fusion CAC will be installed in Adventist’s 33 hospitals to enhance both the inpatient and outpatient coding process.

Sentara Healthcare moves a fifth hospital to Epic’s EHR with its recent go-live at  Sentara Williamsburg (VA.) Sentara is investing over $230 million in the project for its seven acute care facilities and 380 clinics.

Novant Health plans to roll out MEDai’s PinPoint Review predictive modeling solution across its nine hospitals. Novant will use the tool to identify and manage its inpatient populations while patients are still in the hospital.

Here’s some promising news: at last week’s HITSP board meeting, committee chairman Dr. John Halamka predicted the cost of developing health data exchanges are likely to fall as providers begin adopting standards. Halamka is betting that interfaces that today might cost $20,000 to $30,000 might in time fall to $5,000 to $10,000.

inga

E-mail Inga.

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Currently there are "41 comments" on this Article:

  1. Regarding Missouri and Cerner. I am sure it is merely a coincidence that Gary Forsee has family members that work for Cerner. Politics at its best, capitalism at its worst there. Check it out.

  2. Dr. Curious: “Re: Eclipsys…” Think Mr. HISTalk hit the nail on the head…again. During the last few months, the leadership turnover seems to be “just what the doctor ordered.” CEO Pead has an excellent track record in the industry and has the intestinal fortitude to make the tough staffing decisions separating the wheat from the chaff. Pead is a charismatic leader who has the capacity to lead the company forward. Customers love his keen business acumen, insight into customer pains and his dedication to making Eclipsys a product driven company. Wouldn’t surprise me to see a few more staffing changes as Pead assembles his dream team. In his favor, the Eclipsys tagline and proof points as, “The Outcomes Company” aligns beautifully with ARRA intentions – improved measurable outcomes, quality care and interoperability through their HIE. And I hear Pead doesn’t like pizza.

  3. In Response to Doofus’ post. . .

    Misys EMR Product Strategy Update

    Misys EMR Client Base

    Our Misys EMR customers represent the largest EHR base within our organization.
    We have about 1,800 clients currently using Misys EMR; therefore a critical goal for
    Allscripts is to maintain and enhance the satisfaction of this user-base.
    Misys EMR Product Strategy

    When Allscripts and Misys merged last October, a strategic goal was to provide Misys
    clients an expanded EHR portfolio to help meet their long-term needs.
    We are committed to a Stimulus path for Misys EMR clients. At this point, the Stimulus
    “certification” criteria and the definition of “meaningful use” have not yet been fully defined,
    and will not be until year end.
    As the criteria are not yet set, there is the possibility that Misys EMR may qualify for
    the 2011 timeframe. We won’t know for certain until the rules are finalized, however,
    based on the current draft of meaningful use, Allscripts does see some functionality gaps.
    In the future, we do know that the requirements will become progressively more difficult
    for stimulus years 2013 and 2015.
    If the Stimulus opportunity is a driver for your business, then Misys EMR may not
    meet the expanded requirements over the Stimulus period.
    Misys EMR Bottom Line

    We are not retiring Misys EMR; we will continue to support, maintain and enhance it.
    We are committed to a Stimulus path for Misys EMR clients and are working diligently toward that goal but require more time until meaningful use is fully defined and the rules are finalized.
    We have been evaluating potential pathways for Misys EMR clients to take advantage of this opportunity. Customers can either:
    Remain on Misys EMR. Allscripts will provide quarterly service packs to address maintenance needs, but we do not plan to deliver any significant new features or functionality. Depending on how the 2011 stimulus rules are defined, we cannot guarantee that Misys EMR will meet the Stimulus criteria.
    Upgrade to Allscripts Professional EHR. The comparable product to Misys EMR is Allscripts Professional EHR. In most situations, Professional EHR represents an enhancement in functionality, stability and clinical user experience.
    If you choose to plan an upgrade now, Allscripts will:
    Protect your current software investment
    You will not have to buy another EHR as Allscripts will provide a License-for-license exchange and like-for-like interface swaps at no charge to the Professional EHR.
    Leverage your existing infrastructure
    Allscripts is investing significant time effort and capital and is working diligently to reduce additional infrastructure needs. However, if additional hardware or third-party software is necessary, it will be offered at substantial discount.
    Minimize the disruption to your business
    Allscripts is developing an Upgrade Enablement Center to create a seamless upgrade experience while providing your staff with the most effective and efficient training at the minimum financial and operational disruption.
    The best and most efficient method to get ready for the stimulus is to leverage your existing Practice Management system. Therefore, we are not recommending or including upgrades to Professional PM from Vision or Tiger in the Misys EMR upgrade program (see FAQs for more information on the Tiger and Vision roadmap).

    Misys EMR Summary

    Your investment is safe with Allscripts.
    In the next 60-90 days, we will be reaching out to you proactively in targeted groups.
    We will keep you updated with the Misys EMR Upgrade Enablement Center development and the stimulus rules and updates.

  4. Re: National coordinator David Blumenthal tells an AHRQ audience that nobody’s done enough research to really know how to implement EMRs.

    This is true. Our own National Research Council has called for that research in their report “Current Approaches to U.S. Health Care Information Technology are Insufficient.” ( http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572 )

    Mr. HisTalk writes:

    “’m being facetious, but the problem with studying technology
    implementation is that, unlike drugs and devices, the technology is
    just a reliable extender of unreliable human variation.”

    I would agree and add that technology is indeed a reliable extender of unreliable human variation, as in, the unreliable humans who produce the rechnology which them often turns out to be problematic or presents a mission hostile user experience or is downright defective.

    We won’t reform healthcare until the culture that produces IT itself is reformed, and considering the failure rates of IT endeavors across all fields, I don’t say that lightly.

    (See the JAMIA article “”Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop” for some of those rates anda synopsis of the literature – over 70 references. It is at http://www.jamia.org/cgi/content/full/16/3/291 )

  5. And by the way, regarding

    “Blumenthal: nobody’s done enough research to really know how to implement EMRs, saying “one thing we haven’t done [in HIT, I presume he means] is apply the scientific method in the practice of healthcare and medicine.”

    I wrote almost these same words quite a few years ago at http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/ main essay:

    “It is clear, however, that the scientific rigor of medicine itself – rigor that requires critical examination of evidence, both pro and con towards new drugs, treatments, and tools – is lacking in healthcare IT. This must change.”

    Just sayin’…

  6. and considering the failure rates of IT endeavors across all fields

    Indeed, IT failure rates are causing many different fields to toss out their computers and go back to using paper!

    Wait a second…

  7. Am trying to remain calm here while I pick myself up off the floor. Can anyone ‘splain InformationWeek’s criteria for Top 250 list? I could not find it at the IW link given.

  8. >National coordinator David Blumenthal tells an AHRQ audience that nobody’s done enough research to really know how to implement EMRs, saying “one thing we haven’t done is apply the scientific method in the practice of healthcare and medicine.” So in other words, if EMRs were drugs, FDA wouldn’t allow them to be sold, especially $19 billion worth of taxpayer expense.<

    Actually, nobody has done enough research to really know if the EMRs should be implemented.

    Researchers such as Han at UPMC and Koppel at U Penn, among many others, have already provided proof in support.

    On the WSJ Health Blog, a commenter wrote something to the effect of can you imagine having to pay more for malpractice insurance because of EMR use?

    Dr. Blumenthal, do not put the cart before the horse.

  9. Re: Sitting Back and Watching’s comments: This is obviously written by the marketing department at Eclipsys probably with Jay Deedy’s instructions because they do monitor everything that Mr Histalk has to say about them. It’s a fallacy to think that Pead has great vision; what has he done in prior life except take care of himself and friends (CFO, Consultants) with fat cushy salaries and options at $0 (and this is alignment with shareholders?) and then sell a company? Business and lack of vision as usual making knee jerk decisions around product functionality related to problems de jour, staffing decisions and major league sucking up at the corporate offices.

  10. On the WSJ Health Blog, a commenter wrote something to the effect of can you imagine having to pay more for malpractice insurance because of EMR use?

    Did this commenter say WHY you would have to pay more for malpractice insurance because of EMR use?

  11. RE:
    However, I think this Illinois CVS pharmacy is stretching the truth a bit with its posted signs claiming they’re unable to help customers on cell phones “due to HIPAA regulations.”

    Most pharmacies have implemented signs warning patients in line to drop off or pick up prescriptions to stand behind a line that is supposedly out of earshot of the “HIPAA protected” discussion going on at the counter — I should think that some unkown person on the other end of a cell phone should be treated no different.

    Hanging up the phone seems like the only way to “protect” that discussion.

  12. Programmer wrote:

    “Indeed, IT failure rates are causing many different fields to toss out their computers and go back to using paper! Wait a second…”

    What immature bs. Grow up. Seriously.

  13. Interesting article for all to read, “CCHIT’s Latest Gambit”, by Glenn Laffel, September 15, 2009. It is posted in Healthcare It News, which is published in partnership with HIMSS! The article originally appeared on the Health Care Blog:
    http://www.healthcareitnews.com/blog/cchits-latest-gambit
    http://www.thehealthcareblog.com/the_health_care_blog/

    “With its latest announcement, the Certification Commission for Healthcare Information Technology (CCHIT) appears to have entered the fortune telling business.”

    “Conclusions and Recommendations

    EHR vendors should perform their own analyses against the published HIT Policy Committee criteria and follow the HHS Web site for announcements regarding meaningful use criteria and the process by which EHRs will be certified.

    If a vendor insists on having its fortunes told, it should consult with a reader of tea leaves next time the carnival is in town.”

    Didn’t “CJ” call CCHIT a three-ring circus back in Feb 09? Seems like CJ hit the nail on the head! I wonder what HIMSS CEO H. Stephen Lieber thinks now of his CCHIT business enterprise?

  14. __Did this commenter say WHY you would have to pay more for malpractice insurance because of EMR use?

    Dearest Programmer:

    Reports are coming in that there has been an increasing incidence of medical negligence in health care venues in which EMRs and CPOE have been implemented. Pervasive and hard to find mistakes are being made, injuring patients. Medical care and therapies are delayed because of the technology, resulting in worsening of illnesses.

    More will be known. This will preferably happen before the government pays for the pig in the poke it has already pledged to buy.

  15. Reports are coming in that there has been an increasing incidence of medical negligence in health care venues in which EMRs and CPOE have been implemented. Pervasive and hard to find mistakes are being made, injuring patients. Medical care and therapies are delayed because of the technology, resulting in worsening of illnesses.

    Can you provide some links to these reports?

  16. About the only ROI from EMR is that IT spits out an elaborate progress note loaded with useless information that fools the auditors at CMS and other carriers into thinking that a maximally complex E and M encounter had occurred. Otherwise, the time IT wastes cuts 30% from productivity of previously efficient and competent health care professionals. Will the users avoid fraud accusations? Time will tell.

    The readers of such progress notes also waste time and rarely find the information sought. HIT is not ready for prime time.

    A good going over of HIT products by the FDA, as a drug or medical device would have done, is indicated.

    For this to start now would be in the interests of all parties.

  17. “Can you provide some links to these reports?”

    Just off the top of my head:

    From the Joint Commission at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm :

    The United States Pharmacopeia MEDMARX database includes 176,409 medication error records for 2006, of which 1.25 percent resulted in harm. Of those medication error records, 43,372, or approximately 25 percent, involved some aspect of computer technology as at least one cause of the error. Most of the harmful technology-related errors involved mislabeled barcodes on medications (5 percent), information management systems (2 percent), and unclear or confusing computer screen displays (1.5 percent)

    Also see “Bad Informatics Can Kill” from the European Federation for Medical Informatics (EFMI) at http://iig.umit.at/efmi/badinformatics.htm

    Also see this from the National Research Council of the National Academies (the highest scientific authority in the US) for reasons these problems may occur:

    http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572

    WASHINGTON — Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders’ vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.

    … Although the institutions showed a strong commitment to delivering quality health care, the IT systems seen by the committee fall short of what will be needed to realize IOM’s vision. The report describes difficulties with data sharing and integration, deployment of new IT capabilities, and large-scale data management. Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.

    IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans’ Medical Centers, JAMA Mar. 4, 2009, p. 919-920.
    http://jama.ama-assn.org/cgi/content/extract/301/9/919

    Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System, Han et al., Pediatrics Vol. 116 No. 6 December 2005, pp. 1506-1512
    http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1506

    Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes and Threats to Patient Safety, Koppel, Wetterneck, Telles & Karsh, JAMIA 2008;15:408-423
    http://www.jamia.org/cgi/content/short/15/4/408

    The Computer Will See You Now, New York Times, Armstrong-Coben, March 5, 2009,
    http://www.nytimes.com/2009/03/06/opinion/06coben.html

    High Rates of Adverse Drug Events in a Highly Computerized Hospital, Nebeker at al., Arch Intern Med. 2005;165:1111-1116.
    http://archinte.ama-assn.org/cgi/reprint/165/10/1111.pdf

    Many more are emerging.

  18. <>

    Was there a threat of retaliation that was responsible for the nurses having to go to their association? Were the Irvine administators deaf to the complaints? Were the nurses scared?

    Witness the game of blame the user when the pumps were undoubtedly user unfriendly. That said, in conjunction with meager training, adverse events are expected. Such sentinel events may not be avoidable in the best of situations.

    Such events have occurred with electronic ordering of care and therapy due to user unfriendly equipment and similarly meager training. This may be the genesis of the negligence referenced by one of the earlier commenters.

  19. Confirming that RIS software failed at Kindred hospitals causing delays in treatment of patients on ventillators w respiratory failure. The standard line: no patients were injured.

  20. That’s not the claim at all.

    Then you have to be more careful how you word your posts. Becasue “considering the failure rates of IT endeavors across all fields” certainly implies that you believe that IT is failing across all fields.

    I’m curious what insights you think are contained in the JAMIA report you posted. Try to imagine that you are designing a routine that physicans will user to enter patient assessments. How does that JAMIA article help you?

  21. Just off the top of my head:

    You’re going to have to keep looking. You posted a single report of an increase in errors at a single site. That hardly meets the standard of “pervasive” errors, which are going to increase your malpractice insurance. You need to find reports that show that EMR use is making hospitals MORE dangerous for patients than hospitals using paper.

  22. Programmer,

    You should, for example, know that a slight syntax change or omission changes meaning:

    Root> rm -rf /*

    is a lot different than

    Root> ls -rf /*

    You wrote “The claim that IT is failing across all fields is absurd.”

    I’d written:

    “We won’t reform healthcare until the culture that produces IT itself is reformed, and considering the failure *rates* of IT endeavors across all fields, I don’t say that lightly.”

    You omitted the word “rates” from your rebuttal.

    You also wrote “I’m curious what insights you think are contained in the JAMIA report you posted. Try to imagine that you are designing a routine that physicans will user to enter patient assessments. How does that JAMIA article help you? ”

    I don’t have to imagine, as I was doing exactly that over fifteen years ago. For example, to remediate a stunningly failed project, I architected the conceptual, physical and logical data modeling and supervised the UI and reporting design for an invasive cardiology information system at Christiana Care in 1996-8, still in use according to the invasivists last I was there about a year ago.

    How could I do this? I had both extensive clinical cardiology and CCU experience, as well as computer and HCI expertise.

    As to the article, there are multiple relevant insight to your question, but I consider the most important to be:

    “Education: Participants called for developing informatics curricula for both students and professionals. They pointed to the need for core curriculum in medical informatics that would include project management, implementation, and other topics addressed by the workshop. Another idea was to design curricula around actual projects. Participants suggested more training in executive leadership. They further suggested that AMIA partner with professional organizations, the Centers for Medicare and Medicaid Services (CMS), and other entities pushing for Pay for Performance, to develop and promote curricula on best practices and lessons learned. In addition, AMIA working groups might work with the Education Working Group to help develop curricula especially relevant to implementation issues.”

    To put that advice in perspective, read the account of the aforementioned cardiology project at this link:

    http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story

    Beyond this, you’re on your own. My time is money, and I have paying graduate students to teach,

  23. You omitted the word “rates” from your rebuttal.

    I omitted the word “rates” because you omitted the actual rates. If you don’t post the actual rates the word is meaningless. If you said the rates were extremely low I wouldn’t have responded to you. You clearly think the rates are extremely high (to the point of complete failure), but provide no evidence to support that.

    To put that advice in perspective, read the account of the aforementioned cardiology project at this link:

    This account had very little to do with design issues. Mostly it detailed the political pissing contest between the cardiologists and MIS department at a hospital that installed a data collection system.

    By the way, in the end the system in this example appears to be a success.:

    Postscript:
    This heart center information system in its first two years of operation has allowed this organization to save well over a million dollars in cath lab operating costs, through stronger contracting, efficient equipment stocking and utilization, etc.

    That directly refutes the claim by Suzie RN

  24. Programmer,

    You are illustrating the difference between an unscientific IT person and a scientist.

    In fact, I wrote: “We won’t reform healthcare until the culture that produces IT itself is reformed, and considering the failure rates of IT endeavors across all fields, I don’t say that lightly.(See the JAMIA article “”Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop” for some of those rates anda synopsis of the literature – over 70 . It is at http://www.jamia.org/cgi/content/full/16/3/291 )”

    You apparently did not read that last sentence, nor the article, but instead jumped to your own conclusions. In fact, your statement “you [ss] omitted the acutal rates” is in error. I provided them in abumdance, with references, in linking to the article by the statement “see [the article] for some of those rates and a synopsis of the literature.”

    You wrote “You clearly think the rates are extremely high (to the point of complete failure)”

    Again, it seems you believe well-referenced scientific articles mean little – read the above linked article.

    You wrote “This account had very little to do with design issues. Mostly it detailed the political pissing contest between the cardiologists and MIS department at a hospital that installed a data collection system.”

    It had everything to do with design issues at the levels of (conceptual, logical and physical) data models, workflow and cognitive support, user interaction design and user experience, and other issues, which in the vendor product were extremely flawed to the point of profound unusability. Your type of narrow view, esp. about a critical care area and after reading the account, demonstrates a lack of understanding of what’s tactical and what’s strategic in HIT. Such views caused the initial failure of this project in the first place.

    You wrote “the way, in the end the system in this example appears to be a success.”

    Because a medical informaticist (me) took it completely out of the hands of IS. See an executive’s account of the story at http://www.ischool.drexel.edu/faculty/ssilverstein/scotsilv/invascard.htm

    You wrote “That directly refutes the claim by Suzie RN”

    No, HIT when done well can deliver tangible benefits. The hard part is “doing it well.”

  25. I forgot to add the last sentence to my prior post:

    “When I write that HIT development lacks the scientific approach of medical science itself, I write that from all too many debates with IT personnel such as the above.”

  26. No, I think what we have illustrated here is the difference between someone who is actually an IT person (me) and someone who likes to talk about it (you) and link to reports that don’t actually support his claims (you again). The 70% number is completely unsupported. I’ve read the reports claiming high failure rates, and inevitably there is a statement in the report that says, in one way or another, “defining failure is not possible”.

    It had everything to do with design issues at the levels of (conceptual, logical and physical) data models, workflow and cognitive support, user interaction design and user experience, and other issues, which in the vendor product were extremely flawed to the point of profound unusability.

    It had nothing to do with anything. It detailed a pissing contest (from the point of view of the physicians), and nothing more. Absolutely no details about the original system were provided. No details about why it was selected were provided. I can’t even tell if it was intended to be used in a hospital. There was no input from the MIS department. There was no input from the vendor. It looked like a CYA exercise by the physicians.

    But, congrats on saving the day. I hope you didn’t dislocate any vertebrae patting yourself on the back.

    No, HIT when done well can deliver tangible benefits. The hard part is “doing it well.”

    According to Suzie RN, we can’t even conclude that it can deliver tangible results when done well:

    Suzie RN: Actually, nobody has done enough research to really know if the EMRs should be implemented.

  27. This quote from one of your links pretty much covers how things should work:

    Artz’s continued, “Because I’m a physician, I understand what the physician needs, so that when the IS department has a request on how something should work, I can bring that back to the IS department and translate it to the appropriate people on staff. Then I can work with them to make sure that what is being developed will be useful for the physicians.”

    Vendors who don’t consult with their users probably won’t be in business very long.

  28. You are illustrating the difference between an unscientific IT person and a scientist.

    What if I am working on a project with a cardiologist and his/her recommendations clash with my understanding of IT “science”? Should I always assume that the cardiologist always has a better understanding of IT “science” than myself, even though I have over 20 years of programming experience?

  29. Dear Programmer,

    The rigidity of your thought parallels that of the HIT industry leadership, to the detriment of the nuances of medical care of all patients. Do your corporate colleagues from Kansas City know you are exposing the frailties of the HIT industry?

  30. The rigidity of your thought parallels that of the HIT industry leadership, to the detriment of the nuances of medical care of all patients.

    I do admit to being constrained by the rigidity of reality. The reality is that we are constantly updating our software based on the input from our users.

    Do your corporate colleagues from Kansas City know you are exposing the frailties of the HIT industry?

    I have done nothing of the kind. All I’ve done is point out that your claims have no basis in reality.

  31. Programmer, you’ve lost the argument very badly. Physicians reading this site are aghast at your views. You should quit while you’re ahead.

  32. Programmer wrote:

    “No, I think what we have illustrated here is the difference between someone who is actually an IT person (me) and someone who likes to talk about it (you)”

    The crux of the matter. Programmermaintains that “I am just “someone who likes to talk about IT” and he is a “real IT person.”

    The old “Doctors don’t do things with computers” line (from ten years ago, see http://www.ischool.drexel.edu/faculty/ssilverstein/informaticsmd/tactics.htm#dddtwc ).

    I can offer no more commentary on Programmer’s territorial “mine’s bigger than yours” views and callousness about patient welfare and physician time.

  33. anon Says:
    Programmer, you’ve lost the argument very badly. Physicians reading this site are aghast at your views. You should quit while you’re ahead.

    The physicians who are aghast at my view that we should consider their input when designing our products should probably speak for themselves.

    In the meantime, I certainly don’t disagree with everything that S Silverstein has posted at HIStalk.

    S Silverstein Says:
    6Anon writes:

    “Hey Doc Silverstein, you should lay off the coffee before someone sues you for your “potentially distracting” HIStalk posting habit that “could likely lead to adverse outcomes”

    Dear Anon,

    Your comment is stupid.

  34. Your “last word” looks like an attack of the stawmen. I was not aware that “consulting with our users” is considered “the control-seeking culture of IT personnel” in your world.

    In any case, I have no problem with you marketing yourself as a “medical informacist”, or whatever you call yourself. If you can make money at that gig, all the power to you. Just don’t try to pretend that the hospital IT system is going to fail if you’re not hired. That simply is not true.

  35. Silverstein: “We won’t reform healthcare until the culture that produces IT itself is reformed, and considering the failure rates of IT endeavors across all fields…”

    Across all fields? Wow, I never actally knew that. And don’t you just hate all this pesky focus on the need for healthcare reform, and so much negativity about medical errors and such – when they really ought to be looking at the real barriers to good medical practice – those computer guys?

    By the way, if you can describe who exactly is that “culture that produces IT itself”… well, I may just start a campaign to get this national dialogue where it really belongs – on those IT bastards.

  36. Response to the Misys option.

    Why oh why would anyone want to stick to an antiquated, unstable product. Its funny how they mums the number of users *1800, yet fail to mention Allscripts (the original) before the merge, has well tripled the amount.

    Bury it already!







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