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Monday Morning Update 4/19/10

April 18, 2010 News 17 Comments

From MisterEd: “Re: Yale-New Haven. The bulk of Cerner management is on site with CIO Mark Anderson. Epic’s not a sure thing yet.” Given Cerner’s ongoing dismal sales performance against Epic, plus the fact that YNHH has already been talking up Epic, I’d say Cerner’s chances are minimal, even though they offer the software for free to try for a rare big-hospital win. If I were YNHH, I’d consider Cerner only if I couldn’t find the money for Epic.

rackspace

From The PACS Designer: “Re: iPad productivity apps. The iPad may not be on your list of must-haves, but you might change your mind if you saw some of the productivity apps for the iPad. TPD thinks that IT personnel may like a feature such as server management that Rackspace has designed for the iPad.”

epic_ipad

From Dr. M: “Re: iPad. We found out that the iPad runs Epic! I am going to have to get one! Blanked out the patient and physician names.” Looks good on there, I have to say.

From Gotta Love Neal: “Re: Cerner. Is Cerner planning to manipulate HIT regulation to block small companies and upstarts from entering the market? This Duke distance MBA paper by a Cerner strategist provides a clue.” The PDF has been pulled down, apparently (the paper’s a year old) so the link is to a cached image of it I found. I wouldn’t put too much stock in an MBA paper that isn’t part of company policy, but here’s the part Gotta Love Neal called out, which doesn’t seem far from how it actually played out:

In the current environment, much of the strategy concerning the ARRA stimulus package depends on the details of government regulation. Specifically, the outcome of the definition of “meaningful use of EHR” will greatly impact the strategy that Cerner should adopt. The higher the regulatory burden placed on vendors the greater the advantage is to incumbent vendors. Therefore, it is a critical time to influence the direction of regulatory decision regarding “meaningful use”. In the coming months as Congress and Health and Human Services decide the details of the regulations, Cerner should invest resources to understand the direction of proposed regulations and partner with other incumbent firms to lobby the government to raise the regulatory hurdles as high as possible. Using the Healthcare Information and Management Systems Society (HIMSS) classification scheme for EHR adoption, Cerner should influence policy makers to set the meaningful use bar around stage 4 of 7 stages. This level would encourage even large academic hospitals, which currently average stage 2.5 adoption, to adopt new technologies to qualify for government incentives. It would also erect significant barriers to entry for new firms and encourage small, less technically capable and financially limited firms to exit the market. The message to government officials must not appear to be for the purposes of establishing barriers to entry, rather, it must suggest that meaningful cost savings and quality improvements cannot be achieved without a high standard of “meaningful use.”

Listening: Phoenix, indie pop from France. They’ll be at Bonnaroo and Lollapalooza. I’m not a big pop fan, but I like this OK.

VA renews its agreement to use McKesson’s InterQual evidence-based clinical content application.

I’m looking for a couple of HIStalk sponsors to test a sponsor-only job board that I had built. If you are interested, let me know.

An article in the just-published issue of Lancet looks at diabetes screening criteria using the Archimedes large-scale modeling tool that reviews EMR data such as physiology, disease, and interventions. The authors claim that a randomized clinical trial to generate the same information would have required following one million people for 45 years. It’s the first Lancet article based on a mathematical model rather than a clinical trial.

Thanks to the 191 hospital readers who have completed my three-question survey so far. If you haven’t, would you mind doing a quick, anonymous response for me? All it asks is your job description, employer, and employer’s location. It helps me understand who is reading. Thank you.

Forget my last poll in innovate HIT vendors since unknown pro-Eclipsys parties spammed it. New poll to your right: how many docs who buy EMRs will get all the HITECH money they’re expecting? Note that you can also leave comments on the poll itself, just in case you’re trying to sway someone.

Off topic: I’ve seen the future of TV and it’s not TV. Netflix now offers free, unlimited streaming of a pretty large library of movies and TV shows with any level of its traditional DVD-by-mail subscription. $8.99 per month gets you a free DVD that you swap out by mail as often as you like, but the streaming is the real draw. All you need is an WiFi capable DVD player, a videogame system (Wii, PS3, or XBox 360), or a $100 Roku HD streaming video player and you can watch a ton of video on demand 24×7. It’s fast, reliable, has some nice features like creating your instant queue on the Web, and is pretty high quality. I’m thinking about getting the Roku box since I played around with it this weekend and was instantly hooked. You don’t need cable or dish, you don’t need to buy channels you don’t watch, and you don’t have to watch commercials.

onfocus 

Nashville-based onFocus, which offers performance tracking systems for healthcare management, raises $3 million in Series C funding.

phaseforward

Oracle buys pharma drug development software vendor Phase Forward for $685 million, expanding its health business unit and possibly signaling its interest in other healthcare-related acquisitions.

Interesting: how hacker-resistant are implanted patient technologies such as insulin pumps? In a laboratory experiment, researchers used a computer and radio to access a cardiac defibrillator, killing the simulated patient. Some devices have a 15-foot wireless range with unencrypted signals. They’re talking about tattooing the embedded passwords onto the skin of patients so that caregivers could take control if needed.

We’ve got fresh news and interviews over on HIStalk Mobile for those who care about smart phones, mobile healthcare computing, and similar topics. It has its own e-mail list, so drop your e-mail address in the Subscribe to Updates box at the upper right of that page to jump on.

Doctors in Queensland, Australia are threatening to strike over underpayment caused by implementation of a new payroll system, specifically the Infor WorkBrain workforce management application. Experts from IBM, which managed the implementation, are being brought in from Canada to try to fix the problem.

dmedina

Debra Medina, a libertarian activities, former medical billing company owner, former nurse, and former candidate for the Texas governor’s seat, shows up at a state committee meeting on health information exchange with a camcorder, apparently to call attention to privacy concerns.

Australia’s plan to issue a national healthcare identifier to all citizens starting July 1 is criticized by a senator, who notes that just 10 weeks out, the legislation hasn’t been introduced and vendors haven’t been chosen.

HHS’s open source Connect project that facilitates connecting IT systems to the Nationwide Health Information Network is named a finalist for an award recognizing innovative technologies that improve citizen services.

eClinicalWorks, in need of space for expansion of its headquarters, tentatively plans to stay in Westborough, MA with a move to another in-town site.

E-mail me.

Responses to Reader Question – Will Hospitals Offer Practice-Based Physicians A La Carte Systems or a Standard Enterprise Model of Software and Devices?

Response 1

I believe most will select a "standard" set of systems they feel they can support with their staff and if they have enough influence/control over their staff physicians, they’ll get majority buy-in; especially if they are leasing it at a "reasonable" price. I also think many physicians who admit the majority of their patients at a facility that offers that option will be very tempted because the research is already done and they can blame the facility and it’s system(s) if anything goes wrong and expect the facility’s support staff to resolve the problem without having to beef up their office staff substantially (or sufficiently). That could be a double-edged sword for the facility if they bite off more than they can chew and don’t set proper expectations or possibly don’t write a good contract and SLA. Otherwise, they have standardization and can brag about it. Obviously all this assumes the hospital/facility has done proper due diligence in selecting their vendors and already has good contracts and SLAs. I’ve heard and read of many multi-facility environments that have tried to support multiple systems and almost always talk about trying to migrate to a single set of favored solutions. Right or wrong, most view supporting multiple systems as more costly in the long run and it tends to spread the staff expertise too thinly. Moreover, they want to consolidate their IT operations and usually think they can reduce the headcount through "operational efficiency". It sells well to management but usually doesn’t work out as well as stated.

Response 2

think that the hospitals will offer a standard physician office rollout package, not an a-la-carte selection. After all, if the hospital has to support the physician users, they will want to keep things standardized. Trying to figure out which office uses which applications/features is too difficult.  The hospital’s support staff is probably already stretched too thin to take variability into account. Another consideration is pricing for the services offered. I think hospitals will want to keep this simple as well, so a standard package fits better for the pricing side.

How to Not Suck in an Interview
By Mr. HIStalk

Inside Healthcare Computing has graciously agreed to make this editorial available from its newsletter.

I do a lot of interviews for HIStalk. Like a mother who loves all her children equally, I like to think that they’re all good, but let’s be realistic: I know that some of them have been spectacular duds.

Those clunkers sounded good on paper as I planned them, a no-holds-barred discussion with some vendor executive sporting a big title and enviable credentials. The end result, however, was about as exciting as uncomfortable first date conversation involving the weather. I swear I could hear the crickets chirping while I yawned through yet another boring, pedantic answer to a question that I hadn’t actually asked.

It’s especially hard with HIStalk because I run the transcripts of my interviews verbatim. I don’t edit out endless pontification, question-dodging, or rambling answers that tumble off the page like a jackknifed truck full of bricks. If someone says “sort of” every other sentence (and it seems that’s about half the people I interview these days), those warts are going to be out there for the whole world to see unless I’m so annoyed by the result that I break my own “no editing” rule.

It’s not like I don’t warn my interview subjects. I tell them to keep their answers short but animated, illustrate concepts with stories, fight the urge to constantly brag about the company and its products and instead let their answers do the talking, and to speak like a human and not a brochure.

They don’t always listen. They nearly always regret it afterward. And even if they don’t, I do, because readers usually complain.

My Rule #1 is this: when talking to vendor people, I will almost never interview anyone other than the CEO. Some of the worst interviews I’ve done were with VPs, usually because they were (a) clueless; (b) responsible for only a limited part of the business and therefore not really conversant about the big picture; or (c) so scared of being corporately backstabbed that they wouldn’t say anything that deviated from the marketing-approved talking points.

I don’t like interview subjects who over-prepare, which is why I won’t let them see my questions in advance. I want spontaneous answers and the chance to make up questions on the fly based on previous answers. I know I’m in trouble when I hear papers shuffling on the other end since that always means my subject is frantically digging through a stack of carefully scripted notes to find an answer that absolutely nobody will want to read because it’s … carefully scripted.

Executives also sometimes don’t prep, just getting on the phone at the time the marketing person told them to. Since they don’t have a clue about my audience or my own level of understanding, they sometimes dumb down their answers like I was from the local hippie weekly paper. No, I do not need to see your stick figure drawing of what CPOE is, thanks.

I learned the hard way to never allow a second person to sit in on the interview, even if the company is run by two inseparable and equal partners who can’t bear the thought of not speaking as one. It drives the transcriptionist crazy, they end up constantly enhancing each other’s comments pointlessly in an effort to wrest equal air time, and readers have no clue who’s talking and why it took two people to have so few original thoughts.

I’ve also learned by bad experience to never let the interview subject see the transcription draft before it runs. It’s tempting because they might catch a glaring transcription mistake caused by poor audio (usually because they insist on being interviewed on their cell phones), but their insecurity always moves them to convene an impromptu review panel, always led by a marketing person who insists on sticking trademark symbols on everything and making irrelevant punctuation changes (I always put a comma after the second item in a three-item series and no, I don’t care what reference says otherwise since I can find at least one that says it’s OK).

The answer to the first question sets the tone. I tell the subject that I’m going for about 20 minutes and will ask maybe 6-8 questions. The message is clear – don’t prattle on. Several years ago, in one of the worst interviews I’ve done, the guy hadn’t come up for air 10 minutes after I’d asked my usual “tell me about yourself” icebreaker question, still blabbing endlessly about his wondrous experiences at a bunch of companies. I’m pretty sure readers would rather draw their own conclusions about his abilities instead of listening to him recite them.

So my interview advice is succinct: develop a rapport with the interviewer, talk just enough, and always be fascinating. Heck, if you can do that, you’d make a great first date for someone, too.

This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871. Mr. HIStalk’s editorials appear in the subscribers-only version of Inside Healthcare Computing’s E-News Update.

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Currently there are "17 comments" on this Article:

  1. Man, I am so with you on the commas. However, if you don’t let them see it beforehand, do you allow corrections post-publication?

    [From Mr. HIStalk] I will allow corrections if the subject says they were misquoted and the interview recording supports that (always because the transcriptionist wasn’t familiar with the lingo and I didn’t catch her mistake, even though I usually do). Or, if someone says they made an honest mistake and said HIPAA when they meant HITECH for example, and it’s clear to me from the transcription that they really did make a simple verbal error. I rarely am asked to make corrections, however, and I say upfront that I’m going with a verbatim transcription, so I haven’t had any problems.

  2. With you on the Netflix streaming advantages, but they still need to improve a bit. I’ve been a Netflix subscriber for 7 years now and the streaming option convinced me to upgrade to BD-player with internet connectivity. The quality is OK, but don’t expect 1080 or even 720p. I’ve also found that some movies are shown in edited format from the original.

  3. ” I wouldn’t put too much stock in an MBA paper that isn’t part of company policy” Mr HIStalk, you may be kidding yourslelf. It had the company’s logo on the cover page. Read the blog on which this first appeared.

    The removal of the blueprint for strategy of Cerner and HIT industry incumbents to restrain trade should be reported to the FTC and white collar crime investigators.

  4. How simple minded can we get, has everybody gone Epic insane?

    Re: iPad. We found out that the iPad runs Epic! I am going to have to get one!

    Just because you can show an Epic screen on the Ipad does not mean you can really ‘run’ the application? Ipad is driven by touch screen menus – how many of Epics inputs can be done via touch? I don’t there are many.

  5. Since Citrix has an app for the iSanitaryNapkin and the iPhone – you can run any app on them. MS Word, flash, etc.

  6. They do not need to invest much: “In the coming months as Congress and Health and Human Services decide the details of the regulations, Cerner should invest resources to understand the direction of proposed regulations and partner with other incumbent firms to lobby the government to raise the regulatory hurdles as high as possible.”

    Nancy DeParle, for BOD of Cerner, as Health reform czarette, is in a position of influence and authority to make things go Cerner’s way, if you know what I mean. Wink, wink.

  7. Your interviews have always been one of the more interesting parts of this site but reading that article made me realize that your rules would make me think twice were I to ever invited. Thanks for sharing that information though its always valuable to know where they come from.

    On a side note I run linux/firefox and a large number of ads on the right are all “Play Button” boxes. Yet another reason for advertisers to get rid of the flash show!

  8. Neal’s friend asks Is Cerner planning to manipulate HIT regulation to block small companies and upstarts from entering the market? This Duke distance MBA paper by a Cerner strategist provides a clue.” Is this not shocking that this company will pay for an MBA to plan such dastardly strategy? Time to deinstall.

  9. Re: Cerner MBA paper

    Some quotes from Jonah Goldberg’s “Liberal Fascism” book. (Don’t let the inflammatory title fool you, I’m not making a left vs. right political statement.) Until reading the Cerner MBA letter I was skeptical of his thesis regarding large corporations actually wanting increased regulation. But the following sums up that grad student’s thinking pretty well:

    “Just because business thrives under capitalism doesn’t mean businessmen are necessarily principled capitalists.” (pg. 303)

    “…corporations work hand in glove with … politicians and bureaucrats in both parties to exclude small businesses, limit competition, ensure market share and prices, and generally work as government by proxy.” (pg. 308)

    “Industries that once had a proudly free-market stance suddenly sprout arguments in favor of protectionism, “industrial policy”, and “strategic competiviness” once they find that they can’t hack it in the market.” (pg. 311)

    “(The businesses) knew that federal inspection would become a marketing tool for their products and, eventually, a minimum standard. Small firms … who’d earned the trust of consumers would be forced to endure onerous compliance costs, while large firms not only could absorb the costs more easily, but would be able to claim their products were superior to uncertified (EHRs).” (pg. 291)

    Food for thought….

  10. Nathan Arizona writes:

    ‘But the following sums up that grad student’s thinking pretty well:”

    That was no plain grad student. t was a Cerner business strategist getting an online MBA.

  11. I discovered instant Netflix viewing when they opened it up to PS3 users. I dropped my cable and strictly watch television shows and movies through Netflix and other video streaming sites like Hulu.

  12. Let me get this straight – it should be a big shock that an incumbent in an industry with a sizable market share & established presence to tries to establish regulatory hurdles to inhibit new entrants into the marketplace? Shocking. This is different from almost any other industry with well-established vendors how?

  13. Unsure of how much Epic will work on the iPad over Citrix, but from what I understand it is entirely possible. Epic has lots of new touch-friendly items and some have spoken about using tablets already (and I’m sure have). iPad is neat and certainly a different form-factor… but certainly not the first tablet out there and the concepts are the same. The 10-14 hour battery life does a much better job in solving one of the constant knocks of portable device use, though.

    Also, Dr. M. Picture looks ok… but if you wanted something to look a bit better, you can do a “screen capture” on the iPad by clicking the top power/sleep button and the front screen button-thingy at the same time. It saves it to your pictures. You can email it from there.

  14. Lazlo Hollyfeld Says:

    Let me get this straight – it should be a big shock that an incumbent in an industry with a sizable market share & established presence to tries to establish regulatory hurdles to inhibit new entrants into the marketplace? Shocking. This is different from almost any other industry with well-established vendors how?

    I might expect this behavior from a cookie or candy company, or a widget company like Spacely Sprockets or Cogwell Cogs – NOT a medical company.







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