The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Business Continuity is not Disaster Recovery
By Ed Marx

Colorado 1997. After six tennis matches in two days, I had played my way to the semi-finals of a USTA clay court tournament. The morning of finals, I parked in the lot then went to retrieve my gear from the trunk. I always carried three near-identical racquets to a tournament. If a string busted or the environment necessitated an adjustment, I’d simply grab another and keep playing. A great disaster recovery plan.

This time, however, the trunk wouldn’t unlock. I even tried unsuccessfully to take apart the backseat, which was not a disaster I’d planned for. The match started in 20 minutes, and I had no racket, nor had I warmed up. At least I had my wallet. I found the pro shop and borrowed a couple of demo racquets similar in weight and feel to my own, and then rushed to the court.

Texas 2009. I received a call from work delivering an automated message stating that a disaster had occurred. I immediately joined the virtual command center. Our corporate offices had been shut down and evacuated. This emergency impacted corporate and all our health system facilities within a five-mile radius, which included a hospital and our central business office. Oblivious to the fact our sixth hospital in seven months was Going Live on EHR and a revenue cycle management system, the crisis persisted.

Since corporate was located within five miles of the Dallas Cowboys Stadium, Six Flags over Texas and Rangers Ballpark in Arlington, planning for the worst-case scenario was a must. This drill evaluated how well the ITS division could respond. After significant annual trialing, we had the disaster recovery piece down pat, but we’d never tested our business continuity.

Confidence in our enterprise business continuity, however, could only come after we were prepared. We could never benefit our organization in a disaster if we were personally unable to operate in challenging circumstances.

Here are the lessons we learned:

Leadership

· Pressure reveals character. One whom I thought was a great leader had a complete meltdown. Conversely, one of our quiet leaders surprised the heck out of me. As the one most affected by the drill, she executed brilliantly

· Leaders should never leave their laptops at the workplace

· The borderless office was brilliant in hindsight

Technology

· Ensure you have enough licenses to handle increase in remote workers

· Ensure that all workers have access to systems from home (PC or laptop)

· All departments should incorporate use of remote technology and collaborative tools in daily practice

Communications

· Standardize calling trees and routinely review accuracy

· Call notification system should be branded with a familiar screen ID name so people answer the phone

· Call notifications should incorporate a minimum of 3 touch points per employee (cell; text & call, home phone, work email, home email, etc)

· Call notifications should have the ability to reach successive layers of leadership in the event primary responsible parties are non responsive

· Call plans should be backed up to flash drives and be kept with you always

· Established processes with corporate business continuity leadership to ensure coordination

· Include contractors in call notification processes

· Have multiple options for communications (traditional and 2.0) in the event your primary tools are unavailable

· Given the dependence upon technology in healthcare, set the expectation that knowledge workers are essentially on-call 24x7x365

Logistics

· Develop and routinely review coordination plan with hospitals space availability to house displaced workers

· Code worker badges to allow entrance into all hospitals

· Ensure all workers are comfortable with the remote technology both for traditional and nontraditional applications

· Purchase laptops for all IT workers. This is not the 90s!

Operations

· Ensure the Service Desk in particular is comfortable with business continuity

· Groups less prone to borderless offices tend to be the most unprepared for remote work (Service Desk, Field Services)

· Leaders should conduct more frequent leader-only drills to ensure they can run the organization remotely

· Drills should be conducted quarterly at a minimum so that everyone is mentally/physically prepared for the real thing

· Develop Business Continuity portal with step-by-step instructions on execution

· Seeing as disaster does not discriminate, do not allow exceptions for participation

Other

· Future drills should extend from 3 days to 30 days

· Make sure executives and hospital leaders are aware of the need for IT to conduct business continuity exercises, which may affect operations

· Include executives and hospital leaders in planning and coordination efforts

I was pleased with our first-ever business continuity drill performance, a significant learning experience. As healthcare IT workers, we had a massive responsibility and an obligation to our customers and patients; the show had to go on. I believe the drill better prepared us for the real thing.

Finally, no employee evaluation, leadership assessment, or 360-degree feedback analysis exists that can give as keen of insight as observing people under pressure. Some will search out the spare racquet and win the tournament while others will crumble under the pressure and double fault.

Determine who’s got talent before the next tournament.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

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From Edison Carter: “Re: another one bites the dust. Arizona Medical Information Exchange shuts down.” AMIE runs out of Medicaid Transformation Grant money and will set its sights on grabbing some ARRA cash by reinventing itself as a statewide HIE.

From Bob in Accounting: “Re: contest. If you can’t make people buy it, then give it away?” Inga mentioned this on HIStalk Practice: CDW and Cerner pair up to give one lucky (?) physician practice a Cerner EMR. The fine print is interesting: entrants must sign over the rights to use their image and biographies, agree to hold the sponsors harmless for everything in the world, and sign a liability release. Only Cerner would create a multi-page legal agreement requiring a team of lawyers to interpret just to enter a contest giving away an EMR that few want anyway. What are the odds that the winner’s implementation will never happen or will be so unimpressive that you’ll never hear anything more about them? My two-word analogy: free kittens.

From Bridget: “Re: Vigilance iPhone app. Is it FDA approved? It looks like a patient monitor to me. I looked at Acuitec’s Web site and couldn’t find any info on the FDA certification. As a clinical engineer, if it has waveforms and physiological info on it, it better be accurate, and as for alarms, you can’t call it an alarm unless it ‘alarms’ within 10 seconds of detection of physiological condition contributing to alarm status. Thanks for the excellent Web site — I work in the CE/IT interface arena.” Above is shot of Vigilance running on a different device, which I’m including because I think it’s cool. I e-mailed Acuitec and received a nice reply from Lionel Tehini, president and CEO:

Those products of ours for anesthesia charting that require FDA approval have this. In the case of Vigilance, it does not require FDA approval, provided the systems it is aggregating data from and the information being represented in the application have FDA approval. So for example displaying of the wave forms — if we render those ourselves, then it requires the FDA approval (and has it). If those use the rendering services of the vitals sign vendor (Philips, GE, etc.) then it does not, since those are already FDA approved. Yes, I know a complicated answer for such a simple question. But when it comes to the FDA, nothing is simple. My advice is always err on the side of caution and submit the for approval and let them make the judgment call.

From The PACS Designer: “Re: Windows 7 screens. InformationWeek has given use some useful information about what Windows 7 screens look like for us new users. TPD will be testing a Dell Wi-Fi netbook with Windows 7 Home Premium and will post a user perspective of the pluses and minuses for HIStalkers in the near future.”

From Lester Bangs: “Re: ARRA certification. Companies like this one (and they aren’t alone) get checked off on SOME of the ARRA criteria (which are changing) and get labeled as Pre-ARRA Certified by CCHIT. Amazing. And we wonder how folks are confused.” I found CCHIT’s disclaimer more interesting (click the above screen shot to enlarge) since it clarifies that the certification is preliminary, possibly irrelevant depending on the standards that are eventually approved, and possibly worthless since CCHIT may not even be a recognized certification body by them.

From Toadie: “Re: interviews. Some of the interviews read like a press release, while others are interesting. How do you choose who to interview?” Readers suggest some of the interviewees, PR firms sometimes e-mail to say they read HIStalk and can connect us to a CEO, and sometimes I just read about someone interesting and e-mail them. I get turned down sometimes (most recently by Atul Gawande, who was at least polite about it). Each interview is done by either Inga or me and we do our best to ask the right questions and steer the conversation away from self-promotion. It’s worked well, I think, since nearly every interview has redeeming aspects that makes it worth reading. No matter how an interview turns out, I’m always thankful that a busy person will take time to be interviewed by some idiot blogger who warns upfront that (a) the conversation will be published as transcribed; (b) I will not provide my questions beforehand for prep; and (c) I don’t allow proofing or changes afterward. What you read, good or bad, is a real conversation.

Now’s the time to add your event for free to the HIStalk Calendar (Webinars, conferences, etc.) I noticed that five items were listed for today alone, so everybody must be wrapping up before the holidays. Other housekeeping items: if you aren’t getting the e-mail blast when a new HIStalk article is posted, you really should take a few seconds to put your e-mail address in the Subscribe to Updates box to your upper right (you don’t want your competitors and co-workers to scoop you, after all). And, the best secret weapon there is for looking smart isn’t just Google, it’s the Google HIStalk search box to your right. Even industry noobs can sound like battle-weary HIT veterans when talking on the phone by quickly searching for HIStalk mentions of companies, products, and people, then uttering their newfound pearl at just the right moment to an unsuspecting colleague who doesn’t need to know that you used a lifeline.

KLAS announces the best healthcare IT software vendors, with Epic pulling even further away from the pack (I don’t have access to KLAS, so I’m going by the press release). I did learn from the announcement that Epic renamed some of its products, with its pharmacy system now called Willow and RIS renamed Radiant. Several sponsors of HIStalk and HIStalk Practice made the list: eClinical Works, Greenway, McKesson, Eclipsys, Wellsoft (coming soon), Nuance, CareTech Solutions, and Hayes Management Consulting, so congratulations to them.

Listening: The Oohlahs, reader-recommended, female-led punky pop. Reminds me a little of of Throwing Muses. I like it. Mrs. HIStalk is listening to (and watching) So You Think You Can Dance in the living room, which is obvious because I leap a foot out of my chair each time judge Mary Murphy elicits one of her incessant blood-curdling screams for no apparent reason.

My Health Direct, which sells a Web-based referral management system for EDs to send non-emergent patients to other providers, raises $4 million in Series A funding.

Regional Medical Center (SC) says they are happy with their $15 million Cerner go-live, despite significant clinical delays. “Patients have been quite patient,” a board member said without apparent irony.

Abbott Laboratories will acquire Starlims Technologies, an Israel-based lab systems company, for $123 million. It sells systems to hospitals, HMOs, reference labs, and pharma labs. All Web-based, zero client, and high tech, running the presentation code in a .NET control in the browser. Abbott mentions wanting to get into healthcare informatics, so perhaps this has more than the obvious significance.

Barnes-Jewish Hospital (MO) goes live with SIS surgical scheduling, charging, and the SIS Trax tissue management system BJH co-developed with SIS.

I’m on the EHR Scope e-mail list, so I see they’ve made some improvements to their site, fine-tuned their EMR matching system, and are now offering weekly Dragon Medical Webinars. Article submissions for the January issue are being accepted through December 30. I still think their EHRtv is brilliant and darned professional (check out the set in the interview with Evan Steele of SRS above).

The Senate’s health bill will likely not ban the use of prescription data for marketing purposes.

Pfizer’s sales reps will be required to use company-issued tablet PCs when requesting drug samples for doctors, choosing the doctor on the screen to then display a list of appropriate products for sampling. Pfizer has a mighty big meaningful use incentive: the company paid a $2.3 billion fine for illegally marketing its drugs to doctors, so Uncle Sam wants to keep an electronic eye on them.

Is it just me, or does this article about a Serbian EMR vendor have a distinctly AYBABTU quality? “Antamediamedical.com created an amazing software, which helps doctors in different ways. All the software are unique and has amazing results. Medical software is one of the most efficient and workable software, which has sorted a large number of tensions and problems of those people, who are working in medical centers and hospitals. With its installation, the doctors and other medical staff have taken a sigh of relief, for most of other issues have been resolved by it.”

Free (in some configurations) EMR vendor SynaMed announces its free HIPAA-compliant patient-doctor messaging application (the screenshot’s spelling of “Tylonal” suggests that a spell checker might prove useful). The app does look kind of cool, sort of an Instant Messenger tied into the application’s modules.

Hawaii Pacific Health launches its MyHealthAdvantage patient portal. Gee, I wonder who their unnamed vendor is?

The VA posts the raw data behind its 2008 Hospital Report Card on Data.gov, downloadable as .CSV files.

E-mail me.

HERtalk by Inga

From Professor Higgins: “Re: you must talk funny. I love that new iPhone Dragon app and have been astounded by its accuracy. The main limitation is that one needs a good, high speed connection for anything more than a sentence. But for a quick response while driving — perfect! Maybe your voice is just so charming it got distracted? Also, they explained on their app site that while they do collect names only from your contact list, it is to improve accuracy, so when I say ‘John Vinkelgardenhorse,’ they know what I mean!”

With the release of the KLAS end-of-year reports, it’s time to start the  annual discourse on whether or not the KLAS ratings are fair / objective / rigged / irrelevant, etc. I’m sure plenty of vendors lean on their happiest customers, asking them to (favorably) complete the KLAS surveys. Some likely extend honoraria for their clients’ time. That extra tweaking of the process may help move a vendor’s rankings a place or two, but, I think it’s safe to assume that if a vendor was not serving its client base, it would not have enough happy clients willing to provide a favorable report.

MED3OOO appoints Hillary Harlan, an attorney and RN, as its chief compliance and ethics officer.

PatientKeeper closes a $13 million round of funding comprised of equity and debt. The company says it will use the money to accelerate development of physician documentation and CPOE applications and extend its support operations. As part of the financing, Chip Hazard of Flybridge Capital Partners is joining PatientKeeper’s board of directors. Back in August 2008, I mentioned that PatientKeeper secured $7.5 million in Series F funding, which increased its total VC dollars to $75 million. Those funds were designated for R&D and to grow the company’s infrastructure.

3M Health Information Systems releases 3M Mobile Dictation software, a new option for its 3M Mobile Documentation System. The product is available Blackberry and Windows Mobile platforms and allows physicians to review patient detail on their smartphones.

Amcom Software also announces its new smartphone application, Amcom Mobile Connect. The app allows clinicians and staff to use a Blackberry device for messages and critical codes.

Halfpenny Technologies is also jumping on the smartphone bandwagon, introducing its ITF-Mobile application, which allows physicians to securely access test results.

Healthcare Information Xchange of New York selects InterSystems HealthShare software as its core HIE platform.

The Healthcare Authority for Baptist Health (AL) purchases McKesson Practice Complete to handle physician billing and claims management for its employed physicians. Physicians will also use the McKesson-hosted Horizon Practice Plus PM system.

Sounds like Ohio is seeing an economic turnaround, at least for healthcare workers. Cleveland Clinic says it’s planning to add 1,800 new jobs in 2010, a year after posting a $62 million loss. New positions include jobs for both staff and physicians. Meanwhile, University Hospitals (OH) plans to add 550 workers and MetroHealth (OH) has 270 full and part-time openings.

A new study concludes that EHRs often fail to achieve expected gains in healthcare efficiency. They often improve auditing and billing efficiencies, but decrease clinical efficiency.

ONC accelerates its timetable for rolling out health IT regional extension centers (HITRECs), planning to announce 30 grants on January 21 and another 40 or so in March. Sounds like a good move, given the amount of work that needs to be done in short order.

athenahealth names Dr. William Winkenwerder to its board of directors. He’s chairman of The Winkenwerder Company, a healthcare consulting company, and a former Assistant Secretary of Defense for Health Affairs.

The New York Post obtains 2008 tax records for several of the city’s biggest non-profit health systems and finds that at least a dozen CEOs received $1 million or more in compensation. Dr. Herbert Pardes of New York-Presbyterian took home a $1.67 million salary plus a $1 million bonus.

Anne Arundel Medical Center (MD) goes live on its $35 million Epic system, to which it gave the obligatory cute nickname (Alec), but at least based it on something more cerebral than a strained acronym (it means “protector of mankind” in several cultures, they claim). They even make pegged their super users as Smart Alecs, making the whole naming thing worth it.

Last year I wrote a little holiday poem for HIStalk, which I must say was very clever. I plan to update my prose this week and ask Mr. H to publish it a bit earlier, before the masses turn off their e-mail for the holidays. Stay tuned.

Holiday poems here.

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Jeff Robbins is founder, president, and CEO of LiveData.

Describe LiveData’s business.

LiveData’s really got two lines of business. Relevant to your readership is our healthcare business. We also got our start, and continue to service, the electric power space with a trusted real-time middleware that’s used all around the world on the electric power grid. That’s actually how we got our start in healthcare.

We were posed a challenge by folks at Mass General, who in collaboration with CIMIT had an “Operating Room of the Future” project. The paradox of new stuff is the more new stuff they brought in, while they had increasing numbers of really great new tools in the OR, the challenge was how to actually pull it all together and use it. So they posed to us the challenge: could we pull all this different kinds of data in real time onto one screen? To which, as CEO I said, “Of course.”

Then we pulled back to figure out, well, how’s that going to work? That launched us into healthcare about five years ago.

What is CIMIT?

It’s a collaborative group that involves Partners HealthCare, the parent organization of Mass General, along with MIT, Draper Labs, and other stakeholders. Their mission is to try to find technology, sometimes outside of the traditional healthcare space, and bring it to bear on healthcare.

I’ve been hearing about “The Operating Room of the Future” for years. Has it produced technologies that are actually being used?

Well, that’s a nice softball for me. [laughs] Certainly one of the outcomes of that project at Mass General was Mass General deciding for their new operating rooms — they put this in their RFP for equipment for the new ORs –to standardize on having LiveData OR-Dashboard in every room. LiveData OR-Dashboard is the product name of what came out of that research.

I should say that the way we were enabled to actually work on this was through a generous grant from the U.S. Army’s TATRC Group. Through the SBIR grant process, we competed for and won a grant that allowed us to take our technology, which was already proven in the electric power space, and tailor it to the healthcare environment.

Everybody’s pushing doctors to use EMRs in their practices. Is anyone advocating OR technology?

The OR, in my opinion, is still in some ways the Wild West or the last frontier. It’s kind of a black box that’s definitely under the dominion of the surgeon. It’s widely recognized that they’re very obviously a delicate area of care. Changes come to it carefully in the hands of hospital administration.

You really do have a dedicated team of professionals among the doctors and nurses who take excellent care of each patient. Trying to get electronic stuff in the mix has all the pitfalls that I’m sure you’re aware of, where you can’t simply create an electronic version of the paper stuff you already have and expect to see better things happen.

You really do have to look at the workflow and find ways, creatively, that automated systems can actually help and reduce workload, not simply add more burden, because now all of a sudden someone’s supposed to not only do critical things on their feet, but then run over to a keyboard somewhere and type a description of it. I’d say that’s what keeps the OR somewhat on the outskirts of a lot of the efforts I read about in your paper.

As you said, physicians often find EMRS cumbersome and not meeting their workflow. Do you find the same challenges with surgeons in the design of your product?

Yes. We set out deliberately to address the gap between the “doing” and the “documenting”. When we started, our product was really a read-only display that derived its information automatically from other systems, be it documentation systems where a nurse was already documenting, or in some cases the physiologic monitor or anesthesia machine. Building up more information out of existing sources without requiring any new typing. That was kind of a first leveled effort to say, “For sure no one’s going to have to do more work with our system. Let’s see if we can’t help anyways.”

Then the next step was to try to see if we couldn’t reduce the amount of work involved in certain documentation steps, with our focus at first being on the Safety Time Out, which has, I think, increasingly gotten press and awareness. 

What’s the value of putting the lists in an electronic environment, as in your Active Time Out function?

There was a by-now famous study that was spearheaded by, among others, Atul Gawande out of Boston here, out of the Brigham more specifically, and also at Harvard. Brigham, being one of the teaching hospitals, it was Harvard. But the study showed that through the intervention of adding specific kinds of checklists to the surgical process, you could reduce errors and ultimately save lives and reduce complications. That’s a wonderful result and everyone gets that we need to make sure that everyone’s doing these checklists properly.

But the study itself raised the question, “How do you engineer durability into the system?” and what does that mean? If you have someone with a clipboard watching you while you work, seeing how well you actually execute a specific checklist and you’re aware of that fact, my guess is like most humans, you would start paying more attention and be kind of on-the-spot and do it.

The question is, when the person with the clipboard leaves, who’s checking to make sure you actually keep doing this checklist? Effectively doing the checklist does help. The question is, what helps people stay on task and actually do the checklist on each and every case? That’s where, again, new ways of doing the checklists using electronic technology to help and augment the process can really make a difference. That’s what we’ve been doing with our hospital customers.

For example, we give the circulating nurse a simple clicker, kind of like a PowerPoint mouse, very inexpensive, very simple. During the Time Out, the nurse literally clicks through the checklist which is up on the wall on a screen. How that differs from having a poster on the wall, let’s say, with the checklist on it is for each step in the checklist, the relevant information for executing that check — like making sure that the proper antibiotics have been given prior to incision, as an example — the system literally scours the records of the documentation to make sure that there’s indeed a record of the proper antibiotic being given and puts that up on the screen.

Simple stuff like patient name, MRN, whatnot. Rather than just having a checklist that says, “Make sure you know who the patient is,” we get the patient’s name and in some cases, even a picture of the patient up on the wall so you can confirm that you have all the salient information to do that step of the checklist.

That’s Part A of it, having all the relevant information available automatically. Part B is, this could sound a little Big Brotherish, but it’s being handled with a lot of sensitivity by our hospital customers — we provide reports for administration as to how long was spent on each step of each checklist item for each case. You actually get beyond the documentation saying, “Yup, we did the checklist; we did the Time Out.” You get some time-based statistics. Did the checklist get done before incision? How long was spent on it? You pretty quickly get a feel, as a team in the room, for what the right amount of time is to spend on a checklist, and you can then start to tell when something really wasn’t done properly.

The hospital that recently got into trouble for not doing surgical time-outs or marking their sites surely knew they should be doing that. What would you suspect caused them not to, and how would your product have made a difference?

Well ultimately “they” — the hospital — devolved into individual surgeons who often aren’t even employees of the hospital, but obviously have privileges to operate there. Our system helps people stay on compliance with the policy and provides a record for each and every case of that actuality. It’s moving, and it’s a culture change, but its part of the hospital making the decision that yes, we shall really see that this happens on every case.

Can the tool change the culture or does the culture have to be ready to accept the tool?

As much as I’d love to say yes to the former, it’s really the latter. No matter what kind of technologies they have, the culture change is ultimately people and processes. Technology is really an adjunct. But again, my point is that technology done right is a useful adjunct that doesn’t add more work. It’s still salient to that discussion about, does the electronic medical record hinder or help our health?

Take me through a typical surgery. What is your product doing and how are people using it?

The product in the OR is part of a bigger suite of products that are all about workflow in the perioperative space. In the OR, the workflow is divvied up into some very high level phases or steps, which we call Set Up — when the room is being set up. The checklist phase. Intraop — the actual surgery is underway; debriefing and some ancillary stages prior to sending the patient off to the PACU. Some of these other phases might be in their own time frame and pop in and out.

For example, there’s workflow associated, on some cases, with sending a specimen from the OR to the pathology lab. The system will, when that’s going on, switch automatically to some information about managing that flow back and forth between the OR and the pathology lab to make sure the specimens had been marked and described the way the surgeon wants; to let the surgeon see where his or her specimen is in the pathology lab’s queue; and then ultimately to get results back from pathology in a way that the surgeon can easily see and have someone in the OR sign off on.

That’s like a detailed dive on one piece, but the major steps again are: the room setup, where the goal is to make sure all the right stuff is in the room. Then once the patient’s in the room, the briefing/checklist phase, to make sure that’s all done properly. Then Intraop is largely details of the case that unfold during the case — highlights of the patient’s vital signs, estimates of any fluid loss; and depending on the kind of case, there might be more details.

Let’s say in an orthopedic case you might have an automated tourniquet pump on for a certain period of time at a certain pressure, and that kind of data can be gleaned automatically and displayed on the wall so everyone can see it, that kind of detail about the work. First of all, we talked to different people in the room and asked them, do they need that? The anesthesiologist has his or her own bank of screens from the monitors; they don’t really need that. The surgeon might think they don’t need that, and often they’ll say that to us, “Oh yeah, I don’t need that.” But once they have it and you observe them during cases, you’ll see they start using it quite frequently just to stay aware.

Most crucially, nurses, some of whom might be changing shifts in the middle of a case or relieving someone who’s going off to lunch, can get kind of a high-level Gestalt of “Where are we in the case?” in one place, versus what they could do in principle, is log into several systems — the record, so to speak — and rummage and try to find out what’s going on that way, or talk to people. But I hope no one’s under the delusion that there’s a lot of that kind ad hoc conversation going on in the OR, because there isn’t — so metaphorically, keeping everyone on the same page.

People have said that critical IT systems should work like a pilot’s heads-up display or as in real-time instrumentation that detects events and alerts. Is the industry moving in that direction?

We feel we have delivered in our product is that heads-up display. I would argue that certain kinds of IT systems already in place in the OR are, correctly, heads-down products because they’re documentation products. Certain things do require a nurse to heads-down and type.

We’re not yet at a point where voice recognition is good enough in that kind of noisy environment, and so there are places where things need to be typed in. That, to my mind, is inherently heads-down, yet there are pieces of what are being typed that are really more high level events that should be monitored and then used.

We use them, first of all, to know what phase of the case we’re in to automatically display the right subset of information. But then, like you say, to have alerts. So if we’re getting to the Time Out before incision and there’s no documentation of antibiotics being applied — sound an alert, let’s find out. You could say, “Hey, you’re actually helping to make sure they gave antibiotics.” Well maybe, but maybe more likely we’re helping make sure that someone actually documents correctly what’s already been done. So somebody’s been given antibiotics, but no one’s documented it yet. Our system serves as a reminder to get that done.

How much overlap is there with traditional surgery or periop systems, and who do you consider to be your competitors?

We’ve actually had discussions with some of the CEOs of the existing periop documentation systems who have told me that they don’t see it as overlapping, and they see it as a logical add-on. Yet if you talk to some of the other larger companies who, it’s all just software, right? At some level they have everything, at least on the drawing board, and they’ll tell you, “Oh yeah, we’re working on something like that.” But I don’t think any of the current well-known companies could claim to have something exactly like this running in a hospital.

Another technology that outsiders seem to be amazed that healthcare doesn’t have is real-time video and data capture for review or teaching or malpractice defense. I noticed your Historian product offers that. How are customers using that?

We’re not directly supplying video recording. What we’re doing is essentially adding automatic data bookmarking to what exists in video logging products. For example, our product is in the market with our distribution partner Karl Storz and they have a line of products called AIDA, which are video loggers. So that’s an example.

In specific instances that hospitals interfaced with other competing video logging systems that other companies do sell into the ORs, there are basically DVD recorders in many ORs replacing the video tape recorders that used to be there. But I think, as you were kind of leading towards, it’s the old-style kind of tape — label it by hand; the surgeon keeps it in his office, maybe shows a clip at a conference.

The next step, we believe, is to make the video part of a richer data record. At the very least, so that you can easily find the salient stretch of tape or image that you want. One of the problems with logging things is you end up with miles of images that nobody ever goes back and looks at. So by merging the data-oriented bookmarks of knowing when the Time Out’s done, knowing when they’re closing, knowing when the physiologic monitor first picked up the pulse-ox or whatever, you can actually rapidly scan ahead to where you want to be instead of wading through a lot of empty air time.

Final thoughts?

I think you already said it for me, but I’ll repeat it. The electronic medical record in many ways seems, from my vantage point, to be somewhat stalled in that documentation phase. It’s really taking that electronic data, fusing it from several sources, applying rules to it, and acting on it that I think starts harvesting the goodness of it and makes it more than just this added documentation burden. Instead, it makes it part of the care delivery system that we’re really excited to be part of. I’d say that’s the exciting trend that is enabled by the correct deployment of electronic records.

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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.

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.
 

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.

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

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From Mogall: “Re: Sentillion. Word on the street is $200 million for the purchase of Sentillion. It will be interesting to see if anyone hears the Sentillion name again.” If I were guessing, I’d say the name will fade away from widespread use since Microsoft likes its own brand, but the technology and the people will do fine under the Microsoft banner, perhaps jump-starting a concept in which Amalga UIS is the “control panel” that launches various applications and databases and tie them together with CCOW (sort of like making iGoogle or MSN your home page). It’s a good strategy — it’s time for the best-of-breed pendulum to swing back, and visual/virtual integration provides customers with a lot of options, including interoperability. Microsoft has been working with Sentillion since at least early summer, so that peek up their skirt must have stirred up some ideas.

Speaking of which, thanks to Peter Neupert and Rob Seliger for inviting me to chat with them about the acquisition the day before it was announced. A reader had tipped me off, so when Jenn from Sentillion e-mailed to see if I was available, I probably startled her a little by speculating that it must be Microsoft announcement time. I was surprised to see quite a few folks on and reading HIStalk on so early when I posted the article (since I was bound to an after-midnight embargo), so I jotted down some of their locations: UK, Ontario, India, Dubai, Austria, Sri Lanka, Australia, and what must have been a bunch of night shifters or insomniacs right here in the US.

From Fashionista: “Re: Dr. Halamka’s blog. If there was ever a day to read it, today is it. He itemizes each piece of the $1,500 outfit he wore to meetings today … serenity now.” He always says he rarely sleeps, but I think he might need a nap or a jet lag cure judging from his obsessive ensemble: a Gortex suit, a Kevlar shirt, and vegan boots (who knew?), all donned before riding a folding bike to work in sub-freezing Boston blizzard. Maybe the Kevlar is for protection the next time the BIDMC network goes down.

From Tim: “Re: Christmas ornament. Or is that YOUR name?” Inga and I use names sometimes. They aren’t necessarily the ones on our birth certificates, not that it matters.

From TV’s Frank: “Re: AHIP. Surely Karen Ignagni’s hugely oversized income has nothing to do with the health insurance industry and its cost to the system.” She’s the president and CEO of AHIP, a trade group and lobbying organization for insurance companies. According to a Modern Healthcare article, she was paid $1.9 million last year. AHIP lost  $4.6 million after spending $1 million on lobbyists, $2.5 million on lawyers, and $10 million on consultants. AHIP got snippy with a Mother Jones reporter a few weeks back when she asked the company what Ignagni’s coverage and copay is. I’m sure she’s like members of Congress — convinced she is qualified to decide what insurance dozens of millions of us can have, but secure in the knowledge that she’ll never have to stoop so low anyway (that’s Point #16 by Dan Fields – everybody in government should be required to use whatever health system they cobble together for the rest of us).

From Thomas Servo: “Re: Healthvision. A good source says Battery Ventures will close the sale of the company around New Year’s.” Unverified.

From RoadWarrior: “Re: Allina. Heard through the grapevine that they are out for RFP on a new LIS. Rumor is that ‘integration’ has been touted as a high priority, but McKesson and SCC have been engaged.” Unverified.

I mentioned that I like reader pictures related to HIT, so here are a couple from Joe of Clarian Arnett Hospital in Lafayette, IN.

Cerner wins its five-year-old patent dispute with Visicu (now Philips). I enlisted an attorney to give a legal overview of it way back in December 2004.

Keane will implement RCM for Atlantic General Hospital (MD).

Listening: The Volebeats, who must be really obscure since they’re barely on the Web at all. Sounding good, with finely crafted, brooding jangle indie pop like R.E.M. at their best. I’m also anxiously watching the mail for delivery of some DVDs that I didn’t know existed, but now crave: homebrew recordings of Mystery Science Theater 3000, one of my favorite TV shows ever.

Hayes Management Consulting has developed a hospital version of its RAC auditing tool called MDaudit Hospital. Webinar signup is here.

SCI Solutions announces that it signed 51 new contracts with 76 hospitals this year for its Order Facilitator, Schedule Maximizer, and Revenue Accelerator.

CCHIT announces three new board members and five new commissioners: On the board are Lori Evans (ActiveHealth), William Jesse (MGMA), and Stephen Klasko (University of South Florida). New commissioners are Patricia Becker (University HealthSystem Consortium), Barbara Byrne (Edward Hospital), Timothy Elwell (Misys Open Source Solutions), Jay Srini (UPMC), and Grace Terrell (Cornerstone Health Care). That’s a pretty strong lineup considering the heat that CCHIT has been taking. It must have been a quick turnaround for Bobbie Byrne since she just quit her CCHIT job this month, but is now a commissioner.

Vanderbilt joint venture partner Acuitec releases an iPhone version of its Vigilance messaging system for high-acuity providers.

John McInally, formerly of biotech company CollabRX, joins MetroHealth (OH), replacing the retired Vince Miller. He was also CIO of Lucile Packard Children’s Hospital at one time.

A Weird News Andy find, although not a happy one: a woman drinks herself into a stupor while celebrating her 20th birthday and is taken to the ED of Uniontown Hospital (PA). The doctor leaves her passed out on the floor with her legs tucked under her for 12 hours, she claims, with the lack of circulation eventually requiring her legs to be amputated at the knee. She’s suing the hospital and the doctor.

A reader in his early 20s asked me for some education and career advice, also suggesting that a good interview question would be to ask industry veterans what they would do if they were starting fresh in HIT. Feel free to comment or Readers Write me on his behalf.

Kansas, following the federal government’s lead of trying to buy its way out of a recession, throws more money at Cerner and Neal’s soccer team, freeing up an immediate $47 million in cash of its $230 million incentive to start construction on the $414 million project.

Maybe lawyers could be our main export, at least to Singapore. A woman who was overdosed on chemo by a hospital receives a cordial visit of apology from the country’s health minister. She said she was touched. Her husband is philosophical, telling the two pharmacists who made the error, “You will have much more to achieve. Do not allow a single mistake to be a permanent psychological barrier. Just focus on helping more patients and serving them well.” He also urged the hospital not to fire them. I can’t even imagine that here. The injuries from the lawyers trying to leap over each other to get to the bedside would be widespread.

The Georgia inspector general gets involved after Business Computer Applications of Atlanta wins a big contract to develop a prison EMR despite a bid that is double that of eClinicalWorks, the second-ranked vendor. Someone from the Atlanta company hinted to an evaluation team member that he might be hired if BCA got the bid. In fact, it played out exactly that way, with the employee going to work for the vendor less than a month after the company was chosen on the basis of subjective evaluation to which that employee contributed.

Interesting conjecture in Charlie McCall’s case: did his high-powered legal team intentionally allow an attorney to be seated on the jury, knowing they might be able to find something to challenge later just in case he lost? Charlie’s team is demanding a new trial, claiming the jury foreperson, an attorney, improperly defined a term for her fellow jurors. The judge doesn’t seem impressed. “Please, Mr. Wells, you knew when you left her on the jury she was a lawyer … This is such a mess you’re inviting.”

iSoft sells its first PACS system to a customer in Germany. The company also said it may hire up to 500 new employees in Australia. The managing director, in complaining that innovative businesses often are acquired or sold to an overseas company, also admitted that half of iSoft’s 4,700 employees are in India.

The FBI launches a privacy investigation at University Medical Center (NV) after a Las Vegas Sun investigative reporter’s source produces copies of patient face sheets, saying they are regularly being sold to ambulance-chasing lawyers.

ONCHIT chooses members of the Health IT Policy Committee’s privacy and security workgroup.

CMA Consulting Services fires its CEO and former New York state Senate Majority Leader Joseph L. Bruno within hours of his conviction on two felony fraud counts. Competing bidders Thomson Reuters and Ingenix protested, the newspaper article says, when CMA was awarded a $159 million contract to build a Medicaid data warehouse despite his indictment earlier this year.

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HERtalk by Inga

The VA awards QuadraMed a $24 million contract for its Encoder Product Suite and training services.

MedAssets confirms its 2009 forecast, predicting revenues of $341 to $345 million. The company also forecasts 2010 revenues of $390 to $400 million.

The Georgia Department of Community Health will use recently awarded grant money to create a State Medicaid Health Information Plan, designed to manage incentive programs for EMR adoption. The $3.2 million in federal funds will promote the state’s to give all Medicaid providers access to an EMR and the ability to participate in health information exchange.

Community Memorial Health Systems (CA) selects Allscripts’ EHR, PM, and RCM products. Community Memorial Health System will host applications for 70 contracted physicians and a pilot group of 12 community physicians. The health system will also use technology from dbMotion to allow physicians access to a virtual patient record that includes aggregated clinical information from all the heath system’s computers.

Speaking of dbMotion, the company was chosen to provide an interoperable EHR for the Canadian province of Manitoba. IBM Canada is also participating in the project.

St. Vincent’s Medical Center (CT) picks Streamline Health’s Contractor Management Solution for workflow management to ensure OSHA compliance. Streamline Health released its third quarter numbers this week: a net loss of $296,000, compared to net income of $15,000 a year ago. Total revenues were $4.1 million, down from $4.4 million.

Streamline Health also negotiated a 45% tax credit from the state of Ohio, valued at about $214,000. The credit will help the company undertake a $2.75 million expansion project expected to create 25 jobs.

A UK study concludes that one in 10 handwritten hospital prescriptions contains a mistake. Poor handwriting, transcribing errors, and ambiguous prescriptions create most of the problems. Most mistakes are minor and few lead to serious patient harm. Not sure if that last part is suppose to make us all feel better.

Hospitalist management company PrimeDoc Management Services signs a three-year contract renewal with Ingenious Medical to provide automated charge capture, practice management, and reporting.

Nuance introduces a Dragon Dictation app for the iPhone that help users create e-mail, text messages, and notes. Despite the warnings that it downloads and stores all your contact, I added it to my phone. While it’s cool, so far it’s been less than 50% accurate for me. Does it mean I talk funny?

Deck Inga’s e-mail.

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