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!

Healthcare Solutions
By Dan Field, MD

1. Tort reform. Cap every state as has been done in California and Texas.
2. Medical justice panels. A jury by our peers. Medically trained arbitration panels to hear cases.
3. Eliminate doctors’ malpractice costs for patients who demand free care. If the government insists that ED docs see every patient (through EMTALA), they are de facto government employees for those patients and should receive government indemnification.
4. Limit advertising again. It was a bad move when they opened it up.
5. Research, publicize and reward best practices. The worst hospital at Kaiser today has a better record of sepsis prevention than the best Kaiser hospital two years ago. Some have had ZERO sepsis in two years. Sepsis costs $40,000 to $100,000 per patient and frequently adds to the nation’s iatrogenic death load. Replicate this through the major diseases and some of the $500 billion of savings we need to achieve becomes realizable.
6. Divest physicians of the benefit of profiting from ordering tests. A study shows a doctor who owns a scanner is seven times more likely to refer a patient for a scan.
7. Generics drugs for everybody, name brands for those who want to pay out of pocket (or from the HSAs).
8. Revamp medical reimbursement
9. Create a two-tiered medical system where everyone has catastrophic coverage and HSAs. Allow the rich and others to opt out for value-added service. This might be just enough incentive to keep some innovation moving forward. I seriously doubt most medication advances are necessary — seems to me they just add a molecule so they can extend the patent without any new, real benefit. First tier accepts all, including, pre-existing illness, with no rescission. Everyone pays same rate for basic tier, everyone gets a tax credit. Not sure how to deal with those that don’t work. Incentivize healthy behaviors — non-smokers with low cholesterol and great genetics are an attractive subgroup. Second tier insurance companies will compete for these stars with lower premiums. Veal calves with remotes and cancer sticks will be avoided like the plague and end up in the first tier or paying more.
10. Accept that disparities will continue but that they will be better and more morally acceptable disparities than before.
11. Allow true portability.
12. Give needles to addicts, along with access to treatment.
13. Strongly consider legalizing and decriminalizing drugs.
14. Realize that screening doesn’t save money for society.
15. People should have a right to unlimited end of life care … as long as they can pay for it.
16. All government officials must utilize the system they insist we follow, especially “the public option”.

Dan Field is a physician with The Permanente Medical Group.

CPOE – One Size Fits All?
By Mark Moffitt

The goal behind Computerized Physician Order Entry (CPOE) is worthy — replace handwritten physician orders using information technology to minimize translation errors and provide conflict checking at the point of entry. There’s only one problem: many physicians are not satisfied with CPOE. The reason I hear often by non-physicians is this: “Older physicians reject technology. The newer generation of physicians is more accepting.”

I admit I have voiced this sentiment in the past. But after working with physicians and having seen them embrace technology that makes them more productive, I’ve changed my view. My view now is that physicians accept technology if it helps them be more productive and they reject technology that makes them less productive — regardless of age. However, I have observed that physicians over 50 are less tolerant and more vocal than physicians under 40 when their workflow is slowed. Maybe because they have more work to do in less amount of time?

Most all in the industry know the issue. CPOE shifts work done by low-cost clerical staff on a hospital payroll to the highest-paid people working in a hospital. Compounding the problem, physicians are not always employed by a hospital. So the work is shifted from a hospital payroll to an individual physician. And time spent in front of a computer is time not spent with patients. And seeing patients equals making money.

Let me qualify my statements above with this: This discussion is restricted to CPOE in an acute care setting and does not apply to all physicians. Some physicians love the current model for CPOE. It works for them. It makes them more productive.

National adoption of CPOE is low. The 2008 KLAS CPOE Digest reports that less than 10 percent of hospitals are “doing some level of CPOE.” In only six percent of hospitals nationwide, physicians enter more than 50 percent of orders directly using the system.

CPOE adoption is affected by many factors. One factor is availability of CPOE. Another factor is ease of entering orders. Another is physician workflow.

Physician workflow is influenced by factors including specialty, size of hospital, employment model, practice size, etc. There is no one model for how physicians do their work. There are many models.

It’s possible that CPOE, once widely available, will be embraced by physicians and the nationwide adoption rate will rise quickly to near 100%. The other possibility is that the current CPOE model does not work for all physicians and CPOE adoption rate climbs slow and stalls at some level, say 50%. What outcome do you think most likely?

Given the money involved, I wonder why more research isn’t being done to find other models that provide the benefits of CPOE that doesn’t require a physician to sit at a computer and enter orders? Why, when many physicians have expressed dissatisfaction with the current model? Why, when the industry is spending BILLIONS, partially underwritten by the federal government, to implement CPOE and other technology in healthcare?

For what it’s worth I’m doing my part by researching a new model for CPOE. I call it CPOE without the “POE.” Not a replacement for CPOE, but an alternative to physicians entering orders on a keyboard. Same benefits, only a different model. I’ll write about this topic in a future article.

Mark Moffitt is CIO at Good Shepherd Medical Center in Longview, TX.

Those Who Believe in The Network Will Go Far
By Carl Byers

 As one of Mr. H’s and Inga’s biggest fans, I am lucky to have had the chance to meet them in my travels as CFO of athenahealth. It is therefore an honor to submit this post.

I soon will be far from the world of HCIT. As announced in June, in early 2010 I will step down from the job I have treasured for more than twelve years to live abroad with my family. My wife and I have dreamed of immersing ourselves in another culture before our kids (ages 11, 7 and 3) are too cool to hang out with Mom and Dad. We will be in Chile for 18 months, and we look forward to returning with new energy and a fresh perspective on the world and on our role in it.

As a finance guy, I am not a technology innovator or a clinical subject matter expert, so I can’t address the future of technology or patient care. What I can address is a question that I am often asked gingerly and respectfully: “How is athena able to achieve such a high value?” Last week, on a panel discussion in Boston, an audience member’s way of asking was far less discreet: “Everyone thinks you are overvalued. Why is that?”

There are all sorts of fancy answers from capital markets people to explain prices based on total addressable market, long term margin profiles, and Price-to-Growth ratios (in fact, a fellow panelist from Goldman Sachs gave this type of answer to the questioner). I won’t attempt to do that sort of analysis justice here. And, I certainly can’t tell you why stock prices jump around as much as they do, but I do have a clear point of view on athena.

Simply put, I think our company trades where it does because of the scope of our vision and the confidence people have in us actually accomplishing it. It was Warren Buffett who said that, in the short run, the market is a “voting machine” and in the long run it is a “weighing machine.” I have no idea what the votes will say from day to day or even year to year, but I know that the weight of our business will be extremely hefty over time.

How can I be so sure? The reason athena has done well as a public company is the same reason athena has done well in the marketplace — because we offer a better way to solve our industry’s most complex problems and the market is responding. athena is one of very few companies in our sector that is not hopelessly stuck in a software mentality, and the market understands that the days of software as we know it are limited.

From complex reimbursement processes, to clinical coordination, to patient communications, to research, the future of health care (just like the future of the rest of the world!), is not software; it is “The Network.” In 1992, I worked on the Clinton campaign staff in Little Rock. If James Carville were in HCIT, he’d put an even sharper point on it — “It’s the Network, stupid!”

The market understands this because outside of HCIT, The Network has already taken over. This shouldn’t be news. How long has it been since salesforce.com put that big “no smoking” sign on the word “SOFTWARE”?  For how many years has Sun Microsystems declared, “The Network is the Computer”? My boss and friend Jonathan Bush said it even more clearly a couple of years ago: “Software is dead… Dead. Dead. Dead.”

And yet everyone — from pundits in Washington to some of our industry’s best technologists — remains fixated on terms like “versioning,” “implementation,” and “interoperability.” Not only is client-server software fundamentally unable to succeed in this new reality (whether installed locally or hosted from a giant data center), it drives business models with much lower visibility, much weaker alignment of incentives with practitioners, much lower sustainable margins, and much lower lifetime value of a customer than does a software-enabled-service like athenahealth.

What the software mentality misses is that at its core, the problem with health care is one of supply chain coordination. Isolated practitioners typically know next to nothing about what care has occurred in a patient’s life outside of his or her own four walls. Creating software that asks practitioners to type into templates in isolated local databases will not accomplish much of anything given the broader coordination challenge. This is why EMR adoption is so incredibly low today. Only through the emergence of copious networks of information and related process-oriented services will the silos break down and will the coordination (and quality) actually improve.

In every industry (including health care), the only way such networks come about is when there are financial incentives to exchange information. PBMs, pharmacies, and manufacturers of pharmaceuticals seem to have figured out how to build networks, and they didn’t need federal interoperability standards to do it! All they needed was a strong financial incentive to get aligned and remove wasted effort from the supply chain so patients could get their meds without huge inventory write-downs or large commissions for middlemen.

Similarly, athena is focused on building real networks so that the supply chains that extend into and out of the physician office can improve — not just for the coordination of payment information with payers, but also for the coordination of physician order information with labs and pharmacies. athena is also building a network for coordinating schedule, payment, and results communications with patients and referring providers. And to do this, we don’t need to wait for federal transaction and software standards — we just need an opportunity to earn financial rent for having made it happen (and in the process having made physicians, their trading partners, and the industry better). Networks cannot be only about information, they have to relate to real work — and it is through accomplishing the work that revenue, profits, and value flow.

So, as I start a new personal chapter in the New Year, my answer to that persistent question and my message to our industry is this: those who believe in software alone will fall away; those who believe in The Network will go far. Companies that embrace this distinction and produce tangible improvements in the delivery of care as a result will help to bring about the health care vision we all seek.

Thank you for the opportunity to comment here on this very unique network of your own.

Carl Byers is senior vice president and chief financial officer of athenahealth of Watertown, MA.

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From DemoChic: “Re: NextGen. Pat Cline, President of NextGen, has been promoted to president of Quality Systems. His replacement will be Scott Decker, formerly of Healthvision, but in place at NextGen since 2007.” Rumor reporter Boba Fett said in June 2008 that these changes would happen. The announcement is here (warning: PDF). I was impressed with Scott (but not so much Healthvision) when I interviewed him in 2007. Maybe he said the right thing in the interview in naming Pat Cline as the person he who admired in the industry (he was hired by NextGen as SVP nine months later). It’s a strong team there.

From Cousin Carl: “Re: reader contest. Let’s hear ideas to reduce healthcare costs and improve quality with a minimum benefit of $1 billion in 500 words or less. The simpler and easier to implement, the better.” Sounds like fun. Anyone want in?

From Junior Mints: “Re: Eclipsys. Eclipsys failed to disclose that the 50 million orders entered at Sarasota Memorial actually go back to the days of the TDS 4000 system, which was later upgraded to TDS 7000, which was replaced with Sunrise. The company has never been forthright on this.” I knew the history, but in their defense, they didn’t specifically say Sunrise and it is true that Sarasota’s 50 millionth order was entered in Sunrise even though the first 30 or 40 million went into TDS. It also didn’t specifically say Eclipsys systems since TDS sifted through a variety of corporate hands before winding up as Eclipsys and Eclipsys bought Sunrise from HealthVISION (the Canadian EMR vendor, not Scott Decker’s previous employer). I think it’s a fair announcement that pays de-identified tribute to TDS, arguably the best system before or since when it comes to innovation, pro-clinician design, and patient impact. If a company wants to compete with the decades-old clinical systems that dominate the market, they need to do it the TDS way — put the development teams on the ground in a forward-thinking hospital to work with clinicians and target a specific customer demographic instead of a one-size-fits-all approach (TDS was aimed at big community hospitals and some academic medical centers with big iron hardware and internal technical expertise).

I hope your Thanksgiving was happy. Now begins the official season of not getting much work done in hospitals, so here’s to a month of fewer meetings, fewer project startups, and days with fewer annoying co-workers around.

Thanks to Steve Meyer for pictures from the recent SMS reunion. That’s Harvey Wilson and Jim Macaleer in the first picture. The second has Steve, Harvey, Vince Ciotti, and Jim Carter. If you work in the healthcare IT industry, you might give pioneers like these some mental thanks for creating it several decades ago. Steve was telling me how long some of them have been retired, so they must have made some nice money back in the day (or maybe hung onto their SMED shares until Siemens came knocking). I also said I hoped they raised a glass to those who aren’t with us any more, to which he replied that they did, using a phrase that I’m sure I’ll co-opt as my own: “Any day I’m still on the green side of the grass is a good one.”

Give Mediware credit for ambition, albeit unfocused. It acquires Healthcare Automation Inc. (home care software) and Advantage Reimbursement (home infusion reimbursement) from their single owner group for up to $8 million in cash. The company cites the 20% annual growth in home care, but the markets they’re already in (blood banking, medication management, BI) should be growing pretty well, too.

The Johns Hopkins Hospital is recruiting a chief nursing information officer, co-reporting to the CIO and nursing VP.

I mentioned the radiology practice that had two doors and different levels of service for insurance vs. cash-paying patients. I didn’t mention my opinion: I think it’s great. Patients get precisely the same medical care using the same personnel and equipment. Those willing to pay extra for shorter waits, a nicer waiting room, and a more personal experience have that option, no different than those folks willing to pony up for first class airline tickets even though everybody still lands together. Why not let providers make their profit from cash-paying nicety-seekers and let those profits subsidize the medical care of those who can’t or won’t pay the difference?

Christian Scientists are pressuring Congress to include a provision in healthcare reform legislation that would require insurance companies to pay church members who pray for patients from home.

The local paper has fixed their headline’s spelling error (is a rouge employee one of those mall cosmetics people?), but the story stands: two pathologists say Wentworth-Douglass Hospital (NH) is ending their contract of 28 years because they that discovered a rogue hospital employee got into the IMPAC PowerPath anatomic pathology system and inappropriately changed the names of doctors on the reports. The employee was fired and the doctors say they were, too. I’m going to hazard a guess that other unmentioned issues are in play.

The folks at Mikogo saw my post about the questionable marketing company award given to LogMeIn and pitched their own product as a free alternative. It looks cool: screen sharing over the Web, remote keyboard/mouse control, file transfer, a whiteboard, and session recording and playback. It’s good for Web conferencing, online demos or meetings, or remote support. They even have a native Mac client and free voice conferencing. Best of all, it’s free for both commercial and non-commercial use for up to 10 session participants with unlimited use (there’s no catch other than they offer a paid version for running larger meetings). I love this stuff and have tried several apps, so if this one works as advertised, a bunch of HIT people might find it highly useful. 

Welcome aboard to DIVURGENT Healthcare Advisors, a Platinum Sponsor of HIStalk. The company, which was started by healthcare veterans (I noticed that a pharmacist, PMP, revenue cycle expert, and physician are on the team) who strictly follow standard project management and project quality methodologies. Services offered include strategy, project management, vendor selection, clinician adoption, CDM, benefits realization, training, optimization, medication management, and interim leadership. You can also check out their white papers and blog. Job seekers might want to shoot them a resume since I see they are hiring. Thanks to the folks at DIVURGENT for their support of HIStalk.

Harris County Hospital District (TX) fires 16 employees for inappropriately accessing patient information and violating HIPPA (sic – see their internal form above), some of them doctors and nurses. Some of the employees got into the records of a first-year female resident who was shot in an attempted robbery in a Kroger’s parking lot. She’s expected to recover.

The controversial report on the Cerner FirstNet rollout in New South Wales by Professor Jon Patrick of the University of Sydney (Australia) is back online (warning: PDF) after would-be censors demanded it be removed. The new version takes a more academic tone and has more details, most of which are not flattering to Cerner’s product and, to a lesser extent, the people involved in choosing and implementing it. Some major points it contains: Cerner paid little attention to its Australian clients because the product is primarily driven by the US market, Cerner left a vital report writer application out of the contract that cost NSW an extra $1 million, and physicians hated nearly everything about FirstNet and its impact on their workflow. Who asked the university to pull the article down? Apparently the CIO of NSW Health, the FirstNet customer, at least as I read between the lines of this story. He claims he contacted the university, but didn’t ask to have it removed, but I’m having trouble believing that (I’d also be somewhere between surprised and shocked if somebody from Cerner wasn’t prodding him, but that’s wild speculation on my part).

Speaking of Jon’s article, a couple of readers said I shouldn’t have criticized the recent report by the Harvard people that found EMRs have had little cost or quality impact. I disagree. That article and Jon Patrick’s above are not rigorous clinical studies backed up by specifically required measurements and analyses, so readers need to look carefully at their data and methods. Both sets of authors are open source advocates and proprietary system critics, so when they rip commercial systems while lauding open source ones, you have to think about the subject they chose to write about, whether their data are optimal or simply conveniently available, and whether their conclusions are supported by their facts. In my opinion (and it’s only that), neither article is bias-free — no different than when readers complain that a vendor VP’s HIStalk guest article is “an advertisement” even when it’s fairly objective. And there’s reader bias, too – those who defended the Harvard article are themselves outspoken EMR critics. Both articles are useful and thought-provoking, but more open to challenge than if their authors had no known strong feelings one way or another. 

Providers are the main reason that EMRs haven’t met expectations, readers said (although not overwhelmingly). New poll to your right: have information systems improved patient safety nationally?

Ms. Adventure was telling you back in February that Dubai’s economy was in a free-fall, affecting its ambitious healthcare construction projects (“In one short year things have changed so much, from a thriving and booming town to a town that may not have a tomorrow.”) She had e-mailed me that she probably wouldn’t write more, giving me the feeling that she felt she was in some kind of professional or personal danger. In any case, she was right: Dubai is $60 billion in debt and that news is dragging down world markets (which seems quaint considering the free-spending US government is something like $12 trillion in the red and digging the hole deeper every time the bailout-happy Congress meets).

Marin Healthcare District (CA), awaiting the June turnover of Marin General Hospital by Sutter Health, says it will have to spend $1.1 million to convert PACS images because Sutter wouldn’t give them up without first going through court-ordered arbitration. The newly created district also has to replace Sutter’s systems and will pay ACS $55 million to install McKesson Paragon and support it for seven years.

It’s RSNA time, which I always forget until someone sends me announcement. lifeIMAGE will demonstrate its diagnostic imaging sharing platform, in use by Continuum Health Partners (NY) and Montefiore.

An attorney whose accusations of patient abuse in a New York for-profit mental hospital led to $110,000 in fines is suing the hospital, claiming the hospital retaliated by intentionally revealing mental health information about a relative and threatened to do the same to any patients who joined a 2007 class action lawsuit against it.

E-mail me.

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An HIT Moment with ... is a quick interview with someone we find interesting. Greg Smith is a Certified Product Safety Project Engineer (NCE) and quality assurance manager for the MET SE Headquarters.

Your article, Not Suitable for Medical Use, suggests that special interests pressured OSHA to allow medical devices with unproven electrical safety to be used in the OR. How did that happen?

There are a combination of reasons that contribute to this, but the main reason is a perception that having this equipment correctly built and tested to national and international safety standards is too expensive. In reality, having a compliant product certified can cost as little as $5,000-$10,000, then between $2,000-$4,000 a year for testing laboratory audits to make sure the manufacturer is still building the units per the certification report and performing electrical safety testing before the equipment leaves the factory.

This cost, when adjusted to the hundreds and thousands of, for example, computers, is not a significant cost factor. The fact is, sometimes it costs more that this because these manufacturers are turning out non-compliant and hazardous equipment. We see this every day in the testing lab and during the unannounced factory inspections during the year. Our records show that if manufacturers were allowed to "get it right" on their own, they will, in most cases, not get it right. Most manufacturers making a product for the first time do not even know what standards apply to their products.

These special interest groups are pressuring OSHA, along with elected officials who know nothing about electrical safety. At the same time, electrical safety experts are constantly reminding OSHA about the reasons why this is a Federal requirement for equipment in the workplace.

There are no US regulations for imported products to be safety certified. Although the "CE" mark is legal in Europe, the EU is considering moving to a new system because they are being flooded with these "CE" self-declared products from Asia and other places. Why would we move to something like the SDoC (Supplier Declaration of Conformity) when this system is showing problems over time in other parts of the world?

Simply put, these groups want to speed up time-to-market at any expense. In this case, it is at the expense of safety for US consumers and workplace owners. Here is a great article on SDoC.

What are some real-life examples in uncertified medical devices cause harm to patients?

Just last year, a baby was burned at a NC hospital by a non-certified incubator. Some of these incidents really stick out, especially whey they make the news. Many incidents of shock are never reported, are only sometimes recorded in the OSHA logs, and not ever reported unless OSHA has a reason to examine these logs. Also, some incidents are prevented through the diligence of our biomedical technicians, who regularly test and repair equipment.

In recent years, incidents have decreased because many hospitals require medical equipment to be certified as a condition of purchase. At some less-vigilant healthcare facilities, patients are likely killed from leakage current, although this is difficult to prove because it is simply called "death from cardiac arrest". The science of electricity and specifically leakage current tells us of the hidden dangers, especially to patients who are vulnerable (e.g. during surgery). The National and International safety standards for medical equipment are in place because of these known hazards.

A skeptic might say that you have a vested interest in raising concerns about uncertified products since you’re in the certification business. What would you say to convince them your concerns are real?

Those of us who are passionate about safety spend many personal hours addressing these problems. Electrical safety experts include electrical contractors, electrical and other government inspectors, power company engineers, design engineers, and electrical equipment manufacturers. For an unbiased view of these issues, ask some of these individuals.

For example, these issues are discussed regularly in associations like the IAEI, the International Association of Electrical Inspectors, where all types of electrical safety experts help develop consensus positions on these subjects. Go to the IAEI Web site and read some articles on product safety and the need for third party safety certifications, . 

An important question here is: if we don’t ask our electrical safety experts, who are we going to ask? Would you consult a mechanic about an internal organ surgery? In a recent NC court case to exempt equipment from safety inspections, the "Code expert" for the plaintiff was a man who developed a way to get cat urine out of carpet. The electrical safety experts were ignored because science and facts are less exciting than rhetoric and hyperbole. Vested interest? There are many types. Some are based on science and a desire to keep others safe and others are based on haste and pure greed. We are in the business of product safety certifications because electricity kills people. 

IT departments are often involved with choosing portable computing equipment that includes batteries and electrical connections. What should they be doing to make sure these devices are safe for use in specific hospital areas?

Purchasing departments should specify that only certified products are to be procured. There are many valid safety certification marks and agencies ("CE" is not a safety certification). In these specifications, it should be mandated that patient area equipment needs to carry a UL60601 designation.

Regular (consumer) computer equipment is designed much differently, and even if it is certified, the standards are much different. The IT Standard, UL60950, allows leakage current levels five times as high as the medicals standard, and for good reasons.

Also, consumer IT equipment is not designed for the medical environment, as with laboratory equipment and consumer TVs and appliances. There are computers and monitors specifically designed and tested for patient area use. Typically, IT departments and administrators do not know the difference. Many facilities use isolation transformers in an attempt  to mitigate risk, but the equipment can be easily unplugged and leave patients and healthcare workers exposed to the risk of electric fire and shock or electrocution.

Should hospitals and practices regularly test computer equipment for safety when it is used in patient care areas?

All equipment for patient care areas should be tested on a regular basis. This equipment undergoes heavy usage and is prone to failure through wear, abuse, and environment. If the protective ground is lost, the risk increases, especially for equipment not designed for use in patient areas.

Biomedical technicians regularly see these conditions, providing safety testing and effecting repairs. These electrical safety specialists are on the front lines of patient and worker safety, and should be allowed to do their important jobs. There are regular attempts to cut this testing from budgets, so much attention needs to be paid to this profession and the unseen hazards they prevent.

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From Dolphins Fan: “Re: Accretive Health. I finally had a chance to read the Accretive SEC filings. Ascension Health is their largest client as well as a major (11% stake) investor. I wonder how Wall Street reacts to a situation where the client supplying the largest share of company revenues is also someone who stands to gain big from the IPO? Take that major investor/client out of the revenue mix and this is really a pretty small company.”

From Chanice Kobolowski: “Re: Epic registry. Hospitals that need Patient Registry functionality should look into Phytel. Epic has a great deal of this functionality embedded in their integrated applications, but the true registry functionality is not present, in my opinion. Several Epic clients use Phytel for this need.”

From Kid Rockette: “Re: vendor installations. Is there a free source that says which hospitals are running which clinical information systems?” None that I know of, but I will defer in case anyone has a source. CHIME used to have something, I think, but I don’t know how current or pervasive it was.

From Goin’ Mobile: “Re: blog format. I often read your blog on my iPhone. Have you ever thought of running a WordPress plug-in like WPtouch iPhone Theme? It nicely formats the blog for mobile devices.” I have WordPress Mobile Edition running, although I need to upgrade it. I looked at the iPhone theme but it scared me since it seems to want to take over the master theme, which would displease the 99% of readers who are reading from a PC screen. Maybe I’ll get some expert to figure it out for me since I like the idea.

From Carol Queen: “Re: Flash ads. We are a sponsor and I vote against the flash ads. Let them use a link to tell their story. Flash is annoying and I actually ignore ANY Flash ads, anywhere.” A reader sent over an recent article whose finds were that most Flash ads are ignored, but text-based ads surprisingly aren’t (since they seem to offer solutions to whatever the reader is looking for). The bottom line was that simple ads work best on Web sites. Some sites ban animated ads, but I’m uncomfortable telling marketing pros which ads will probably work best even though I probably know pretty well from experience and personal preference.

From IT_Nurse: “Re: unions. In the September issue of Registered Nurse (a California nurse’s union magazine), there’s a 20-page tirade about the evils of HIT, including CDSS, CPOE, EBM, EHR, HIE, HIT, RCM, RFID, RTLW among others. Their conclusion: the whole industry is just a management ploy designed to replace RNs and should be resisted at every opportunity.” It’s really hard to take a professional group’s union seriously when they are so quick to lash out at everything that’s employer-related, all while using what they claim are the best interests of patients as a hammer to beat management over the head. They probably have a good point every now and then, but as a former manager in a violently unionized hospital, everything I saw first-hand was highly negative. You haven’t lived until you’ve seen striking union lab techs and nurses destroying hospital lab equipment, blocking ambulances and doctors from getting to the ED, and cursing and taunting the family members of patients trying to check on their loved ones. And, the union’s blocking of my attempt to upgrade some of my para-professional staff so I could pay them more  because it “would cause resentment” — meaning my people were paying mandatory dues to an organization who refused to let me increase their wages. Or, like this current example, where the Steelworkers Union (which represents non-professional hospital workers!) is suing a hospital for banning smoking on campus.

Analytics vendor Quantros licenses University of Michigan-developed technology that creates Patient Safety Indicators from discharge diagnosis codes for follow-up.

What’s driving me up the wall lately: crappy online slide shows that magazines put together for some reason. I get a teaser e-mail for “Top 16 Declining Tech Salaries for 2010” (you know who you are, eWEEK), click the link, and only then find out it’s the cheesiest, slowest, dumbest slide show in the world. Not only do I not need to see stupid clip art with what little story is there, I don’t need to click and click and click (of course, they love that since they are probably selling ads based on clicks). I will not waste 10 minutes watching a slideshow that contains content I could have read in literally 20 seconds had they not been so cutesy about it.

The Army creates the Joint Telemedicine Network for a relatively cheap $10 million, allowing X-rays to be transmitted among its far-flung facilities into the AHLTA EHR. Before it was implemented, soldiers being evacuated from the field often beat their X-rays to Landstuhl AFB, making trauma treatment within the Golden Hour impossible. Kudos to those named in the excellent Nextgov article as key players: now-retired LTC Alfred Hamilton, CMIO; LTC Nanette Patton, deputy CIO; Salvatore Granata, project manager; and MAJ Dan Bridon, director of command, control, and communications for the 30th Theater Medical Command at Bagram AFB, Afghanistan.

I’ve mentioned before that HIStalk’s sponsors, in most cases, aren’t just running ads — they are fans of what we do who read it and want to support it. Submitted for your approval: Quality IT Partners, a new sponsor who did a reverse sponsorship in putting the HIStalk intentionally ironic smokin’ doc on their page along with some nice words.

Thailand-based Hospital OS, an award-winning open source hospital systems vendor, is giving hospitals analyzed information back from their data: best practices, clinical guidelines, alerts, and an epidemic alarm system to track disease outbreaks back to their source.

Listening: Supergrass, British alternative that’s been around since the early 1990s. Reader recommended as something I’d like, which it is.

This brilliant MSNBC article speaks volumes: New York medical practices are using separate entrances and providing different levels of service for patients with and without insurance. Example: Lenox Hill Radiology takes insurance, requires 15 days to get an appointment, takes more than a week to give results by mail, and always has 20-30 patients crammed into its waiting room. New York Private Medical Imaging has a four-chair waiting room for its cash-only patients, gives appointments in two days, hands out plush robes instead of flimsy gowns, and doctors read the images immediately and visit personally with the patient immediately after. The separate entrances lead to the same techs, rooms, and equipment because it’s the same company with the same radiologists reading the images. Most interesting is that patients on the boutique side are warned not to tell the insurance patients about “their door” and employees sign a written policy agreeing to do the same.

The EHR of Mater Health Services in Australia holds the records of 1.4 million patients, connects 95 separate clinical systems, and handles 100,000 messages per day, integrated using InterSystems Ensemble.

Michael Nauman is named VP/CIO of Children’s Hospital and Health System (WI). Old news that I missed until now.

I’ve been really busy lately, so I’ve got a backlog of interviews and reader articles ready to go. Soon it will be time for the HISsies voting, additional ideas for the HIMSS event (shaping up nicely, I should add), and maybe some new stuff. It’s been a really good and fun year, even though I occasionally wish I’d done something more than work all the time. The thanks I’m giving, in no particular order: Mrs. HIStalk for putting up with me, Inga for making what we do fun, those in the military for the sacrifices they make, and the people who are in healthcare and healthcare IT for patients and not a bloated paycheck. And of course, every HIStalk reader, sponsor, guest author, and interviewee who makes me anxious to run to the computer as soon as I get home from work every day and stay there for way too long.

The plastics convention people aren’t just taking their show to Orlando after decades in Chicago, they’re running a Crain’s Chicago Business investigative piece on the authority that runs McCormick Place: (a) the CEO got the job after raising money for Rod Blagojevich and lots of its bigwigs are connected to the Daley political machine, including a former bartender given a $130K HR job because of connections; (b) despite extortionate charges, it loses a ton of money; (c) it taxes citizens directly, collecting over $100 million a year and borrowing $2.5 billion using the state’s credit line;  (d) McCormick Place West was a 2007 boondoggle that will fall short of paying itself by $500 million; (e) they’re laying off 500 people despite having added more senior managers; and (f) companies that contributed to political campaigns got contracts to service the facilities despite their markedly higher bids. If you are shocked by any of this, you obviously don’t know much about Chicago (I like to think President Obama is clean, but the fact that he worked his way up there makes me wonder since honest Chicago politicians are unheard of).

GE gets into the Web-based teleradiology business in India, planning to provide software and hosting to emerging markets.

LogMeIn’s remote support solution wins a healthcare IT award from a company that helps vendor sell stuff (“innovative sales and marketing solutions”). I’m sure there is no connection, especially since “hundreds of IT executives” voted for the winners “after previewing and learning about new technologies and services in private boardroom appointments”.

Nuance announces Q4 results: revenue up 3.9%, EPS $0.02 vs. $0.09, beating expectations. 

Strange: Apple says users void their warranty if they smoke around their Macs since the second-hand smoke is a biohazard for its techs. And, the Turkey Genome Sequencing Project gets a $900K grant to find ways to improve the immune system of turkeys, with the timing of the announcement being fortuitous since I assumed the purpose isn’t to enhance the quality of life for Thanksgiving-doomed turkeys, but rather to keep the cost low and the profit high in selling their carcasses.

What the authors of a Christian Science Monitor editorial hate about the Senate’s healthcare bill: mandatory insurance, HIEs, EDI, analysis of data for effectiveness research, and unprotected PHI.

Odd lawsuit: a woman has surgery without fentanyl when a drug-addicted nurse steals it, replacing it with water. She’s suing the nurse and the hospital.

E-mail me.

HERtalk by Inga

Sarasota Memorial Health Systems recently entered its 50 millionth order into Eclipsys Sunrise. I was having trouble grasping how many 50 million is, so I did some simple math. If you input 27,397 orders a day, it would take five years to enter 50 million orders.

Cascade Healthcare Community (OR) leverages Accenx ExchangeT to integrate its clinical information system to distribute lab results to community clinics and regional hospitals.

The Rochester RHIO says that over 100,000 patients have opted to share their health information with their participating doctors. About 500 physicians are participating in the RHIO, which uses Axolotl’s Elysium Patient Index to manage the patient data.

Iowa’s Medicaid program is the first recipient of a federal matching funds program for EHR. The $1.6 million grant from the CMS will allow Iowa to begin planning the activities necessary to implement EHRs.

The prolific folks at KLAS release a new report examining revenue cycle consultants and whether the returns are worth the investment. Perot Systems was the top performer in the extended business office category.

Meanwhile, KLAS says it’s making its performance evaluations shorter, based on feedback from providers and vendors. KLAS will also begin grouping questions on software into four main categories. The goal of the changes is to eliminate redundancy and focus on questions that best differentiate vendors.

The current poll to the right points out that EMRs have not been shown to improve quality or cost and asks who’s to blame. I think the ever-brilliant Mr. H left out at least one blame category (it’s probably due to all those long hours he has been working). I don’t think the issue is necessarily software nor providers needing to use the software better. Instead, perhaps we should look at implementers (who may be vendors, consultants, or internal staff) who fail to diagnose flaws in work processes and thus promote inefficient workflows. Of course, someone could still say the software doesn’t lend itself to efficient workflow (so blame the vendor) or that providers won’t change (blame hospital management).

Mr. H and I are facing some new competition in the blogosphere with the launch of HHS’s Health IT Buzz. David Blumenthal says he will use the forum to report on the progress of healthcare technology, health information exchange,  and the meaningful use of EHR, plus “create an open dialogue among members of the health IT community.” Kind of like what we do here but probably without Mr. H’s the good / the bad / and the ugly approach. Likely no music or shoe recommendations either.

Speaking of shoes, a special thank you to all our wonderful sponsors who support HIStalk and HIStalk Practice. Without your support, I would be resigned to last season’s shoe fashions, which would certainly make Clinton Kelly cringe.

Zynx Healthcare partners with the Healthcare Solutions division of Keane to integrate Zynx decision support solutions with Keane’s OptimumTM EHR.

The House passes a $10 billion loan program to help doctors and small medical practices purchase EMR and other HIT systems. The bill would allow loans of up to $350,000 per physician and $2.5 million for group practices. The bill has now moved on to the Senate.

Dr. Blumenthal took some time out from blogging to announce HHS’s plans to make $80 million in grants available to help develop and strengthen the HIT workforce. Seventy million dollars will be available for community college training programs and $10 million will used to develop educational materials to support the programs.

The nation’s most stressful job: surgeon. Also making the Top Eight list are general practice physician, physician assistant, and newspaper reporter (no mention of bloggers, though). The least stressful jobs include computer systems analyst and software engineer (i guess when you are creating software you can’t get too stressed about missing release dates or producing buggy software).

In yet another new report, KLAS looks at the anesthesia information (AIS) market, which is deemed “small and immature.”  Of the 100 organizations interviewed, almost all claimed holes in functionality for reporting and integration. However, all products had generally high marks for ease of use. The highest rated products were GE Centricity Perioperative Anesthesia,  Philips CompuRecord, Picis Anesthesia Manager, and Draeger Medical Innovian Anesthesia.

Health Industry Insights releases two separate reports, each assessing the offerings in the ambulatory EMR space. The reports looks at the one-to-20 provider market, as well as the 20+ provider space. Mr. H wasn’t willing to pony up the few thousand bucks required to look at the report details, so we are hoping readers will fill us in. Sage Healthcare reports they did “great, landing firmly in the upper right quadrant on both reports.” eClinicalWorks also says they did “quite well.”

The MGMA sends a letter to David Blumenthal, noting concerns that an inappropriate definition of meaningful use and an ineffective administration of ARRA stimulus funds could result in a failed implementation of ARRA, needless squandering of resources, and significant disruption of the health system. MGMA offered several specific recommendations, including instituting a pilot test prior to the start of the program to ensure that the process of demonstrating meaningful use is achievable and practical. The letter also encourages the National Coordinator’s office to monitor the EHR marketplace for cost-effective and efficient products and to ensure fair business practices. To William Jessee and staff: well-done. MGMA is voicing valid concerns that highlight the many gaps in ARRA legislation, and offers logical recommendations. We absolutely need the meaningful use requirements to be achievable and applicable. And, why not do some testing in advance to make sure that HHS, vendors and providers all agree what meaningful use looks like. I am not sure how necessary it is to have the government provide vendor oversight; I mean, if a vendor doesn’t have a product that works, won’t market forces address that?  Still, MGMA did a good job addressing what are likely major concerns of its members.

I am truly thankful for many things. Near the top of the list are HIStalk/HIStalk Practice and of course Mr. H and our readers. Some days I have to pinch myself to make sure it’s all real, that I really do get to spend my days reading and writing about the fun world of HIT, that people send me notes saying they like my stuff, and that I even make a little bit of money doing it. I’m also thankful for yummy food, good wine, college football, and days off. Happy Thanksgiving!

Holiday greetings or football bets here.

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