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Monday Morning Update 12/14/09

December 12, 2009 News 10 Comments

indianarmc

Indiana Regional Medical Center thanks Congressman Bill Shuster (R-PA) for getting it $350,000 in federal money to buy an EMR. Question: shouldn’t they be thanking the people like you and me who are actually paying for the porkfest? Given the federal spending spree, It’s not shocking any more that at least a half-dozen other hospitals were named in news stories this week for getting federal grant money for EMRs.

prolquo2go

Proloquo2Go makes Apple’s list of the top iPhone apps for 2009, surprising many who didn’t expect to see a medical app on the list. The $189 software helps people with speech problems by converting text to speech.

Quotes from this week’s e-mail from Kaiser CEO George Halvorson (forwarded by a couple of insiders):

Putting medical information in the computer and then leaving it in electronic silos is just as non-functional as putting medical information on pieces of paper and leaving the pieces of paper in file drawer silos. Medical information needs to flow to the caregiver at the point of care. It needs to be available when the patient needs care … We looked to the other biggest and most successful electronic medical record system in the United States — the Veterans Administration (VA) — and we decided to see if we could figure out ways for patients from our system to visit their system — or patients from their system to visit our system — with the medical information following the patient electronically. Our information can follow our patients now, to some degree. KP patients can remotely access their own medical record.We also often give our patient copies of their medical records. Our patients who travel sometimes carry their medical record with them on a thumb drive. That particular experiment has been a success. So we have done some data transfers for some individual Kaiser Permanente patients. But that data did not flow directly to another caregiver, or to another care team. The goal of our VA project was to see if we could design a secure way to transfer that data purely electronically. We managed to do that.

Inga found this news story, which she calls “something Weird News Andy might like.” A man is arrested after speeding down a country road and running over two people, wearing only pajamas and flip flips. He bolts from police in the five degree weather, heading for his wife’s office. But what’s really bizarre is his lawyer’s defense: “caffeine-induced psychosis”. Next think you know, Folgers will be in a class action suit.

Listening: Biffy Clyro, Scottish rock.

Jobs: Account Executive/Sales Rep, Manager Clinical Application Services, EHR Project Manager, Soarian Clinicals Consultants.

Scumbag lawyers: Google QuadraMed and you’ll get three ads with the same headline, all trying to convince QDHC shareholders to jump on a class lawsuit claiming breach of fiduciary duties by QuadraMed management. Google the names of any of the three law firms and the phrase “breach of fiduciary duties” and you’ll get thousands of hits from their previous legal efforts.
 

poll121209

From my last poll, it appears that enough new folks will go to HIMSS to offset those who are dropping out. If it’s a representative sample, you might therefore expect attendance to increase a little. New poll to your right: did EMR vendors and trade associations influence the Obama administration’s decision to spend billions on EMR usage?

A WSJ editorial called Health Care’s ‘Radical Improver’ covers athenahealth. One quote from the editor:

The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can’t link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks … Mr. Bush is less sanguine about the White House cost-control approach of better living through technocracy … he singles out the idea of dispensing bonus payments to hospitals that find ways to reduce Medicare spending. If the bonus is higher than what the hospital would have been paid under the status quo, then Medicare is worse off—but if the bonus is less than what the hospital would have earned otherwise, in what sense is it an incentive to change?

And a fun quote from Jonathan Bush:

It’s probably terrible that all this new bureaucracy is being created. But there’s going to be 50 new Medicaid-type plans in these insurance exchanges, run by the same insurance commissioners, these same sort of glazed-over-looking state secretaries of health. You know, just not really the brightest bulbs in the chandeliers of the world. Medicaid, the worst payer in the country by a factor of four! Mother of pearl! So I feel a little bit like a robber baron. I am going to make oil money dealing with them.

In Canada, Campbellford Memorial Hospital joins several others in abandoning an $80 million project to use a common hospital information system (Meditech). As is happening in the UK, nobody has the money to chase a grand interoperability plan at the moment. Another hospital in Canada just started its Meditech project last week. 

Ten EDs of Orlando Health and Florida Hospital will start sharing data in January in a Central Florida RHIO project.

posit

UPMC’s health plan will offer the $690 Insight Brain Fitness Program software to its Medicare members at no cost.

University Medical Center (NV) notifies 71 trauma patients who were seen on Halloween and the day after that their personal information appears to have been sold to personal injury lawyers. They are now requiring employees to enter PINs on copy machines and may add electronic door controls.

Red Hat will host an online forum on cloud computing on February 10.

Congratulations to the hospital IT people named as Computerworld’s Premier 100 IT Leaders:

  • Avery Cloud, SVP/CIO, New Hanover Regional Medical Center
  • Philip Fasano, SVP/CIO, Kaiser Permanente
  • Stanley Huff, CMIO, Intermountain Health Care
  • Edward Marx, CIO, Texas Health Resources
  • Bill McQuaid, CIO/AVP, Parkview Adventist Medical Center
  • Susan Schade, VP/CIO, Brigham and Women’s Hospital

E-mail me.

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Currently there are "10 comments" on this Article:

  1. So, Bush says that the Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can’t link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product.

    Well, yes, but what he doesn’t say is why there is bad product. Faceless companies don’t make bad product. Companies consist of *people* who make bad product, and the bad decisions start at the top.

  2. Rep. Shuster secures my tax dollars for EMR:
    “Congressman Bill Shuster, R-Hollidaysburg, has helped secure $350,000 in funding for Indiana Regional Medical Center’s development of an electronic medical records system.

    The medical center will use the funding to purchase equipment aimed at improving patient safety, upgrade efficiency and reduce operating costs through the implementation of an electronic medical records system. ”

    They are going to be shocked, literally shocked, to learn that safety, efficiency, and cost reduction will not happen as has been reported by Himmelstein et al, and Jha. Do you think someone should tell Shuster and the EMR ebullient Board and Ceo at Indiana, before they get disgruntled when their costs go up?

  3. Thank you to Kaiser insiders for sending the emails sharing such a
    brilliant idea that no one has previously considered in their multi million dollar EMR devices:
    ~~~Putting medical information in the computer and then leaving it in electronic silos is just as non-functional as putting medical information on pieces of paper and leaving the pieces of paper in file drawer silos. Medical information needs to flow to the caregiver at the point of care. It needs to be available when the patient needs care…”

    Amazing no one else has reasoned that searching through electronic silos is no more likely to be successful than locating a paper chart.

    Until the data is at the health care professionals’ fingertips and there is a silo search mechanism for medicines, procedures, etc, these new medical devices will continue to prove of no incremental value in safety, outcomes, efficacy, and economy.

    Finding data in counterintuitively constructed electronic silos when it is needed is more time consuming than finding the paper chart and searching there. Silo searching transiently distracts and blunts cognition. Paper searches can be done by paraprofessionals or clerks.

    Does any one else experience silo searcher disease?

  4. Bush says, articulately,”The Athena model is superior to most electronic medical record systems, or EMRs, which are generally based on static software that are inflexible, can’t link to other systems, and are sold by large corporate vendors like General Electric. One reason the digital revolution has so far passed over the health sector is sheer bad product. The adoption of EMR in health systems across the country has been dogged by cumbersome interfaces, error propagation and other drawbacks …”

    JB appears to have been reading this blog and Scot Silverstein”s comments here and on his blog. I wonder, though, if JB might be just a bit too enthusiastic about his own device, interfering with his own objectivity. The safety and efficacy of his devices has yet to be determined.

    What is of particular interest is his inside track to Obama HIT propmoters through his cofounder, joining the likes of DeParle and Tullman, and other HIT chearleaders and champions.

  5. Noah, you’re intentionally misleading.

    George’s comments should be taken as intended. Kaiser brought together 8 million records that were previously in 8 million paper silos.

    He’d now like to join his silo containing 8 million records with the VAs silo containing I don’t know how many records – but suffice it to say, a lot.

    What would you prefer? That George not automate in the first place.

    You guys are taking over Mr HIStalk’s forum, which if he doesn’t care is fine, but a pity non the less. It used to be a good blog with real news and information and balanced perspective.

    Now it’s just you and Suzie and Scott.

    If you’re so damn smart why post here? Why not just post on your own blog and if you feel generous put a link or two to Mr HISTalk just to keep his sponsors happy!

  6. athenaClinicals has come a long way in a short time. It was really just more of an EMR-lite application just 2 years ago with limited functionality for most specialties. Still, the biggest advantage that athenahealth has had all along is there ability to more easily adjust their system to whatever the future of healthcare payment holds including mandatory reporting requirements and the ability to more easily merge administrative/clinical data.

    Still, athenahealth demands a nice pound of flesh for their services compared to other traditional alternatives (e.g., outsourced RCM providers) and I would think long and hard if I were a small doc before I would let any EMR company host my data. The bread and butter of any small practice is their clinical data. It is something that I would try to maintain control of as much as possible.

  7. JB may have read my writings, but I am not the person to really credit for the basic premise in them. My epiphany came when I read the prophetic words of Dr. Donald A. B. Lindberg, M.D., now Director of the National Library of Medicine at NIH and primary mover behind the NIH-sponsored medical informatics programs.

    Dr. Lindberg wrote:

    “Computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information” (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21)

    If those words and the writings they’ve spawned by myself and others have helped JB produce better HIT than others (I do not know if this is the case but by the way he writes about the issues, I find it a distinct possibility), then bravo to him, and shame on those who have ignored these issues.

    One additional point: Unless you are in a very senior management spot in HIT, your career is subject to the seemingly capricious and often ill informed decisions of your leaders about how HIT should be designed, developed and implemented. On other words, at risk.

    Been there myself – saw a major pharma’s discovery scientists denied access to the informatics tools they needed to discover new drugs and assure the safety of current ones, by a senior IT executive lacking expertise in biomedicine.

    The company has in the past few years laid off tens of thousands, and has an empty wagon of new products.

    Sooner or later, mismanagement catches up to the little guys.

    — SS

  8. “Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21”

    1969? Wow, you guys are really scraping the bottom of the barrel here. Quoting somebody, quoting a paper from the time when we didn’t have good calculators, let alone computers. Its embarrassing at this stage that we have opinion makers doing this. And its why we are still trying to make the systems fit the needs of clinicians.

  9. Blah, w

    While I agree with your concerns about still trying to make systems fit the needs of clinicians, I disagree the issue is about technology or advancement thereof. Dr. Lindberg’s historical observation seems valid then and now.

    Regarding “good computers”, the lessons learned from these “primitive” machines are unchanged today, the insights gained then about human computer issues as relevant now as then.

    I speak from experience. I started programming on an on-site DEC PDP-8/S in 1970 in high school, along with an IBM1130 at an agricultural research station I worked at in the summer of ’72 trying to fortify milk with nutritional proteins, a CDC Cyber 6600 at Temple Univ. (through begging!) via timesharing, and an IBM 360/95 via timesharing in that same time frame, then an IBM370/165 in college. The availability of calculators is not really relevant to computing issues although I used a Olivetti Programma 101 calculator dating to 1965 in the summer research internship in ’72 to do calculations when the 1130 was occupied.

    I should also point out that the evidence base is increasing that our current approaches to health IT are insufficient, again having nothing to do with the technology. Here is just the most recent:

    ==snip==

    http://www.healthcareitnews.com/news/electronic-health-records-not-panacea-researchers-say

    Electronic health records not a panacea, researchers say
    December 14, 2009 | Diana Manos, Senior Editor

    LONDON – Large-scale electronic health record projects promise much, but sometimes deliver little, according to a new study.

    In a study published Monday in the U.S. journal Milbank Quarterly, researchers at the University College of London (UCL) said they identified fundamental and often overlooked tensions in the design and implementation of EHRs. The study was based on findings from hundreds of previous studies from all over the world.

    Researchers said their findings have implications for President Barack Obama’s election promise to establish electronic health records for every American by 2014, and for other large-scale EHR initiatives around the world.

    Professor Trish Greenhalgh, lead author of UCL’s Department of Open Learning, said EHRs are often depicted as the cornerstone of a modern healthcare, capable of making care better, safer and cheaper. Yet, clinicians and managers the world over struggle to implement EHRs.

    ” Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of electronic health record projects fail – and the larger the project, the more likely it is to fail,” Greenhalgh said.

    “Our results provide no simple solutions to the problem of failed electronic patient records projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world,” according to Greenhalgh.

    ==snip==

    I suggest anyone with an interest in better healthcare recognize there is a problem with our approaches to HIT that have little to do with technology, and much to do with the issues of Medical Informatics vs. MIS, and then become part of the solution.

  10. And by the way Blah…

    Dr Lindberg’s 1969 statement that “computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice” is actually a restricted and narrow statement. In reality *most* non medical professionals of all kinds do not understand medicine (how could they?) and therefore his statement is obvious and self-evident.

    Challenging the obvious is a pointless endeavor. Why even bother?







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