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Monday Morning Update 11/30/09

November 27, 2009 News 15 Comments

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?

sarasota

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.

sms1 sms2

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.

rouge  

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.

mikogo

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. 

divurgent 

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.

bentaub 

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. 

poll1127 

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

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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Currently there are "15 comments" on this Article:

  1. 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.

    If it was simple and easy it would have been done decades ago, but try these two steps.
    Do the Mayo Thing – all docs must work for the hospital. They get bonus if institution does well, must follow strict protocols, get rid of variability and creativity. Make medicne more science than art…

    and – pass legislation that all people born from this day forward must meet complete ISO 9001-2009 standards with full written specs and maintenance manuals. That should about do it! Fixing people will be as easy as fixing cars.

  2. HIS Junkie shows arrogance, omniscience, and zero understanding of the practice of medicine.

    Furthermore, Mr. H said, in reference to Patrick and Himmelstein work, “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.”

    May I ask, where are the rigorous clinical studies that prove HIT and CPOE products to be safe and efficacious? When was this equipment approved by the FDA?

    About the censorship in Australia,did anyone ever think that there might be greenbacks being exchanged? Hmmm

    Does anyone know of the relationship between RSNA and HIMSS? write it here if Mr. H will publish it.

  3. ++++ about Fish Net___One doctor said: ”I prefer looking at a paper result than the counter-intuitive waste of my time trolling [sic] through the system.” Another said: ”Every single user *hates* it with a passion … ENTERING the data is a pure nightmare.”

    Word is getting out that this problem is not localized to Australia. In the US, Cerner has “deals” such as equity options with hospitals to help keep the doctors’ mouths shut. The problems are equivalent in the hospitals in the states.

  4. No surprise that the Christian Scientists are lobbying for this including “spiritual counseling” as part of Medicare payments. Both the House and Senate bills contain all kinds of niche lobbying that was so prevalent in the last big piece of health care legislation (MMA Act of 2003).

    Frankly, I find it odd how some of the same conservative senators/representatives are who largely rightly questioning some of the true costs of the bill are pushing for reimbursement for a practice that the medical literature has generally shown to be inconclusive to improving various medical outcomes. Effectiveness issues aside, this strikes me as a practice that if reimbursed by Medicare would be riddled with incredibly high rates of fraud & abuse that you only see in certain selective areas of Medicare reimbursement (e.g., certain home health services, etc).

    Republican or Democrat – it largely no difference. Both have different rhetoric but realize they need gov’t spending/pork for their constituencies.

  5. ” 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. ”

    Bias by critics???? Do you think they have sold short or might it just be that they use the inferiorly designed equipment and see the risks to their patients on a daily basis. Does anyone think that Health Reform Czar DeParle (Cerner), Obama buddy Tullman (Allscripts) and the cast of HIMSS and CCHIT are free of bias?

    The country is using taxpayers’ money to buy a pig in a poke. Himmelstein et al have demonstrated that, yet the HIT zealots are sufficviently arrogant that they do not want to believe it.

  6. To Junior Mints:

    I’m sure some of the assets in Bank of America were originally obtained under the name NationsBank, or even C&S. When you buy a company, you inherit it’s success and assets as well as it’s failures and debt. And you take credit for it all.

  7. Praetor, MD: Please don’t take this as a personal attack or insult, (I feel compelled to begin with that, as some in this forum are so quick on the trigger these days), but why is HIS-Junkie’s “Do the Mayo Thing” arrogant with zero understanding? It seems to work well for Mayo and Mayo patients, doesn’t it? Or are you just joking when you said he was arrogant? Also, I’m fairly certain the second of Junkie’s comment was tongue-in-cheek. You know… the part about all people having a standard maintenance manual. Sorry if I’ve misunderstood your joke for a serious answer. Sometimes I do that.

  8. “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. ”

    Wouldn’t that be a de-install of Epic? Or would it not be considered one because the health care system didn’t do it, just the one hospital?

  9. “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.”

    Fire 75% of useless, needless hospital administrators, and outsource IT personnel (oh, wait, the former are already doing the latter.)

  10. “That article and Jon Patrick’s above are not rigorous clinical studies backed up by specifically required measurements and analyses”

    At least they’re not fudged, like the global warming data and the Eclipsys puffery.

    Here are some that are rigorous:

    National Research Council — “Current Approaches to U.S. Health Care Information Technology are Insufficient”

    UK Public Accounts Committee report on disastrous problems in their £12.7 billion national EMR program

    “e-Health Hazards: Provider Liability and Electronic Health Record Systems” – Hoffman and Podgurski

    Information Technology: Not a Cure for the High Cost of Health Care- U. Penn Wharton at http://knowledge.wharton.upenn.edu/article.cfm?articleID=2260

    Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop (JAMIA)

    Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. – Koppel

    Electronic Health Record Use and the Quality of Ambulatory Care in the United States – Archives of Internal Medicine – as implemented, EHRs not associated with better quality ambulatory care

    And finally, this admonition on ignoring “non peer reviewed literature” from Scott Adams:

    IGNORING ALL ANECDOTAL EVIDENCE
    Example: I always get hives immediately after eating strawberries.
    But without a scientifically controlled experiment, it’s not
    reliable data. So I continue to eat strawberries every day, since
    I can’t tell if they cause hives.

  11. Re: Eclipsys. Both sides of the comments are wrong. Sarasota Memorial has never been a TDS shop. Yes the software turned on in 1998 was HealthVISION’S which Eclipsys purchased not long after, but it’s the same software. All 50 million ordered were entered in SCM.

  12. Re: reader contest. Let’s hear ideas to reduce healthcare costs

    At the risk of opening a political can of worms. Let’s deport the illegal aliens. One swoop 30 million uninsured off the rolls.

  13. HISTalk has made a number of interesting analyses about my essay such as it is “not rigorous clinical studies backed up by specifically required measurements and analyses, so readers need to look carefully at their data and methods.” This comment has been made to me by others. The answer is simple, it never presents itself to be such a study and in fact states clearly it is not. It is a critical review/observational study and a synthesis of a number of different types of information sources that require a critical analysis of evidence, that cannot of themselves be quantified, as is common and valid in the Social Sciences. That is one of the reasons i call it an essay and not a paper, so that the health reader is informed that it is a different type of analysis, given they are less used to this genre of evidence and writing. That does not make it any less valid so the warning in your comments is not reasonable. To accurately create the setting for the type of material it contained you should have drawn attention to the fact that it has in the header line the text “Opinion editorial” and that would be fair comment.

    You question my motivation and imply there is a lack of coverage in my choice of evidence in saying “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.” The article states that it sets out to explain a contradiction between the success of Cerner commercially and the negative attitude of clinical staff to it. Such an objective must clearly provide the evidence for the negative viewpoint given that the commercial success of Cerner is self-evident. Hence by definition of the objectives the negative evidence has to be provided to the reader. However I have provided in the essay EVERY piece of positive evidence that I found from the NSW clinical staff and that sent to me from overseas staff, but not every piece of negative evidence.

    To characterise me as an”open source advocate and proprietary system critic” is invalid by your criteria, that is you have no evidence for that as a generalisation. It is quite true I have advocated open source would solve the problem of vendor lock-in and I also believe that open source is important for State wide mission critical software systems in Australia given that the majority of our hospital services are provided by the State, but I am only a critic of Cerner Firstnet ( or Farcenet as it is being called here) AND the deployment methods used by NSWHealth/Cerner. I consider systems such a state wide build of an Emergency Department Information System as part of a health infrastructure and so the idea that the State cannot maintain such a system in its own manner as inappropriate. I have not criticised any other software manufacturer and my Lab works on other commercial systems where our research software is deployed to add enhancement functionality for Clinical Data Analytics (see CLINDAL on our web site, http://www.it.usyd.edu.au/~hitru).

  14. Thank you SeriouslyFolk yes, T in C it is…

    If humans were as ‘simple’ as cars or computers, we would have outsourced healthcare to foriegn countries years ago and saved a bundle.
    Oh wait a sec, I just read where India is doing that very thing!

  15. HIS Junkie writes:

    “If humans were as ’simple’ as cars or computers, we would have outsourced healthcare to foriegn countries years ago and saved a bundle. Oh wait a sec, I just read where India is doing that very thing!”

    Outsourcing’s got to stop. Hospitals should control health IT locally. Outsourcing may be appriopriate for an IT call center, but not for care and feeding of health IT.







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