From The PACS Designer: “Re: Google Documents. In a challenge to Microsoft Office, Google has expanded its online document offerings. TPD has been using the Google spreadsheet application for some time and now will be testing the new features as well as the usability of Google Presentations and Google Drawings.”

From Rysanwss: “Re: Yale-New Haven. An EVP made a formal announcement to the IT staff that Epic is in their future. No signed contract yet, but they are close.”

From Jobs: “Re: Apple iPad unpacking video. A staple of Star Trek movies is a long, slow tour around the exterior of the ship, showing the exquisite detail of nacelles, the phaser emitters, the gentle curves of the saucer section, etc. This scene is ‘trekkie foreplay’. The iPad video is the Apple version.”

O’Connor Hospital (CA), Orlando Health (FL), St. Vincent’s East (AL), Huntsville Hospital (AL), and UC-Irvine (CA) are recognized for excellence at the annual conference of Surgical Information Systems.

Sad news: Steve Tanaka, CIO of Palomar Pomerado Health (CA), drowned last week while on vacation on Costa Rica. He was 50. The hospital has created the Steve Tanaka Award for Excellence to honor his work and memory.

This story doesn’t inspire much confidence in healthcare IT security. Auditors reviewing the security of electronic patient records of Vancouver Coastal Health Authority found so many vulnerabilities in every area that they buried the report for six months, fearful that anyone reading it could start digging through its systems. “No intrusion prevention and detection systems exist to prevent or detect certain types of [online] attacks. Open network connections in common business areas. Dial-in remote access servers that bypass security. Open accounts existing, allowing health care data to be copied even outside the Vancouver Coastal Health Care authority at any time. Almost all users have some access to confidential information about all clients in the database. Many clients’ full health information is accessible to a large number of users.”

Software developed at Brigham and Women’s Hospital to optimize the schedules of astronauts based on their sleep rhythms may have a role in healthcare, with potential use in creating employee schedules, predicting low-performing times to avoid errors, and using light therapy to  change natural sleep cycles. I found a free beta download here.

From Weird News Andy, who comments on his find as <predictable>The thought of an implantable chip just gets under my skin.</predictable>. PositiveID (formerly VeriChip) strikes a deal with the International Maritime Medical Association to offer its PHR to seafarers. WNA also found this story about the theft of 57 hard drives from BCBS Tennessee, now estimated to include records of 1 million patients.

Jobs: Cerner Build Specialist, Senior Product Marketing Manager, Regional VP Sales – HIT Consulting, Anesthesia Product Specialist.

Epic CEO Judy Faulkner will receive an honorary Doctor of Science degree on May 14 from her alma mater, the University of Wisconsin-Madison.

Sheehan Medical Cork Medical Centre, the first new private hospital to open in Cork, Ireland in 30 years, awards its IT contract to Meditech. The company has several other Irish clients.

Dennis Quaid has produced and narrated a documentary called “Chasing Zero: Winning the War on Healthcare Harm” that will air on the Discovery Channel next Saturday, April 24. It was inspired by the near-fatal heparin overdose given to his infant twins at Cedars-Sinai.

An Army doctor faces court martial after refusing deployment orders to Afghanistan, stating his belief that the orders are illegal because President Obama was not born in the US and therefore cannot serve as his commander-in-chief.

University of South Florida will hire 100 “e-ambassadors” for its stimulus-funded PaperFree Florida electronic medical records initiative.

Christoph Lehmann, MD, a Johns Hopkins neonatologist, is chosen as founding medical director of the Child Health Informatics Center, an American Academy of Pediatrics informatics group created in October 2009. That group will design a prototype model electronic pediatric health record.

A former medical records clerk of St. Peter’s Hospital (NY) is arrested for stealing patient information and shopping online using their credit card numbers. He was caught after ordering merchandise and forgetting to change the default shipping address, sending a package to the house of one of his victims, who realized someone else had ordered it using his credit card.

Oppenheimer upgrades shares of open source vendor Red Hat to outperform, while UBS flags the company as a compelling takeover target.

Odd lawsuit: the sister of a man accused of beating his parents to death sues the hospital for negligence in the death of their mother, claiming “wrongful death”.

E-mail me.

HERtalk by Inga

Danville Polyclinic (IL) selects Sage Intergy EHR for its 40-provider practice. The clinic already employs Sage Practice Management and Practice Analytics.

Enterprise Software Development changes its name to Enterprise Software Deployment to better reflect the company’s evolved breadth of EHR implementation services. You can check out their good-looking new logo and ad to your left.

mPay Gateway says more than 800 physicians signed up for its patient payment system during the first quarter of 2010.

I don’t think I’d be starting a career in PACS sales any time soon, assuming the results of this CapSite Consulting study are accurate. Currently 96% of hospitals have already own PACS solutions and only 17% of the surveyed hospitals have plans to buy a new or replacement system. The biggest imaging IT spend in coming years will be for image archiving and storage, plus voice recognition tools. Almost half of hospitals with PACS cited functionality as the biggest weakness of their PACS.

CareTech Solutions doubles its number of Web Products and Services clients in fiscal year 2010, now serving over 150 hospitals.

Cardiology Associates (AL) picks Allscripts’ EHR for its 38 providers.The practice will tie the EHR into its existing Allscripts PM and document management systems.

Complete Women’s Imaging (NY) selects Merge Healthcare to provide a diagnostic imaging workflow solution, including Merge’s Fusion RIS/PACS MX.

Desert Orthopedics (OR) plans to implement SRS hybrid EMR for its 10 physicians.

The Heart Hospital of New Mexico chooses TeleHealth Services for interactive patient education services.

IDC Health Insights takes a peek at 14 HIE vendors and provides assessments on their offerings (for $4,500, you can get a copy of the report and fill us in on the details). For the most part, the 14 vendors were the ones I would have expected (Axolotl, dbMotion, Medicity, etc.) One surprise vendor was eClinicalWorks. I knew they had an HIE product, though it’s not heavily promoted. On the other hand, I know other ambulatory vendors like NextGen and Allscripts are trying to establish an HIE presence, yet were not included. A quote:

Typical of nascent markets, the HIE vendor market is volatile with new entrants and market consolidation. We can expect dramatic changes in the next 12 to 18 months as HIE technologies become a commodity and dominant players acquire their way into a crowded market currently made up of many small, privately held vendors.

The California Telehealth Network awards AT&T a $27 million contract to build a telecommunications network to connect hundreds of providers throughout the state.

Spheris wins court approval to sell its assets to fellow medical transcription vendor CBaySystems Holding for $116.3 million, which includes $98 million cash.

Here’s a good tax day story for you. The president of a San Diego medical billing company pleads guilty for failing to pay $2.5 million in employment taxes, even though the taxes had been withheld from employees pay checks. Anthony Vacchi, Jr faces up to five years prison.

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Sanjaya Kumar, MD, MPH is president, CEO, and CMO of Quantros.

Can you give me a two-minute summary of hospital-based pay-for-performance programs and how your applications help manage them?

It’s interesting that you say hospital-based pay-for-performance programs because I think the overall industry graduated into pay-for-performance, from the managed care all the way down to the physicians really having to basically be working within those programs. Now, definitely the hospitals are in the fringes of that, but I think, firmly, in my opinion, pay-for-performance now is moving into pay-for-results and pay-for-better-outcomes.

The way that our applications help support those needs for the hospitals that are participating in those programs is that we allow ready capture and aggregation of all of that data, either from secondary data sources, or they can actually input it into the applications for the different metrics that are supposed to be reported for the pay-for-performance programs from either CMS or Joint Commission. Primarily CMS. That data is reported quarterly.

The added benefit for our clients is that they can review all of that data in near real time, as well as compare and benchmark themselves with other hospitals in a blinded fashion, very readily. That’s one of the added values that we provide, so even before they’re able to see their results publicly reported out there for pay-for-performance, they can gauge and see how well they’re doing in comparison with others.

What impact do you think the publicly reported hospital quality and outcomes measures will have on the industry?

In the way that the information currently is made available, I think the impact is relatively slow in terms of its uptake. However, what it is a doing is that it’s increasing the degree of transparency around the reporting of all of these metrics and measures and education to the consumer of healthcare, in terms of their importance and their significance. Really, the metrics aside, I think the overall programs are helping to influence consumers in the way that they seek care, or where they seek care from.

I think it’s going to continue to shape that industry in terms of the transparency that needs to be there. It’s going to drive and motivate more and more hospitals to actually disclose some of all of the results to their local constituents and local marketplaces in order to influence purchasing behavior of either employer groups or health plans, in terms of how they’re contracting with them or in terms of where the consumers are seeking care from.

I think it will have a bigger influence, perhaps five years down the line, as this data begins to get even much more attention and begins to get publicized that much more. Today, the healthcare consumer is still very naïve about some or all of this.

Do you think they know the data’s out there and just don’t have much of a choice of where they go? Or, do you think they’re really unaware that there even is such a thing?

To a large extent, I think the awareness is coming about, but I think it’s slow on the uptake and slow on the marketing of some of all this information. The government could do, perhaps, more, in terms of highlighting the availability and where the data is made available from. More has to be done. I think more people need to get onto the bandwagon, in terms of shaping consumer attention to this.

Several years ago, the MedMARx database was used to generate a report suggesting that CPOE was creating quite a few medication-related errors. What are you seeing now from the database and with the FDA’s apparent interest in overseeing the whole safety issue with electronic health records, how do you see that playing out?

As you perhaps, know from the background, we actually acquired the MedMARx database about two years ago from the USP. We now currently manage that data registry. It’s got over 2 million records on medication errors and adverse drug reactions.

The same patterns that actually used to be there are still pretty much very evident. Meaning, although one of the patterns that has actually emerging and interestingly, we did an analysis for somebody that was actually writing an article in The Wall Street Journal a few months ago  that indicated that errors that basically are implicating CPOE systems definitely do occur, but the more serious type of events are being averted.

I’m meaning that more incidents that actually lead to major fatal harm are actually on the decline with the utilization of CPOE. Although, CPOE is still leading to a number of errors that are basically there within the medication error profiles.

I think that a real interesting conundrum over here is that there are multiple vendors for CPOE systems. I think CPOE systems need to be very carefully evaluated. I know that the Leapfrog Group, for example, has a CPOE evaluation tool that is made available to hospitals. For example, if they’re participating in the Leapfrog survey. I don’t know how much you know about the Leapfrog Group, but they’re all about transparency for safety and quality, in terms of practices that are out there and how safe institutions are. They actually make available a CPOE evaluation tool.

I think the FDA needs to look at tools like that very, very collaboratively, in terms of really encouraging the use of those tools to identify CPOE solutions that are right, that are fit, that are actually ready for use within point-of-care environment. There are a lot of CPOE systems out there that are not necessarily right that actually are leading to a lot of errors, or that are not catching errors, necessarily.

When we implement systems like CPOE, we automatically are almost aligned with clinicians just like a child with a calculator who doesn’t necessarily think through the computation they’re performing, but just believes in the answer that they are getting. That is the biggest problem with automation systems. We’re actually blinding the provider at the point of care with systems like that in order to believe them without having to really think through whether something is right or wrong.

I think utilization of CPOE evaluation type methodologies; critical review of those, the kind of errors that they lead into is very, very important as a go-forward strategy; especially if we are mandating that solutions like this be implemented, which is really pretty much what the ARRA, the HITECH Act, is providing for.

EHR adoption is going to create tons of electronic patient data from all these systems at some point. What do you think the best use is, both at the organizational level, and the population level, for all of that data that we’ll suddenly have available?

I think it will be a blessing for monitoring specific populations of interest. It will be of benefit to actually apply continuous quality improvement methodologies in place. It will be very, very important for organizations to actually utilize some or all of that digitized data to be able to tell more — regarding their own environment, regarding where care is actually being provided, how well care is being provided — from a combination of dimensions of interest: patient safety; quality; compliance with clinical care protocols; and adherence to certain standards of care from the perspective of providers, in terms of their outcomes that are actually occurring; and finances.

I mean, we shouldn’t forget that care should be really provided in a very cost-effective fashion. Today, it’s very, very difficult, for example, for an institution that is actually collecting all of the quality data, to actually even determine what the improved quality-to-cost ratio is. If they’re collecting all of this data to monitor and improve upon care for heart attack patients, if that is actually influencing a decrease in cost or length of stay for the institution, it’s very difficult for them to do that very readily today with the availability of data across all of these different dimensions. For the population-based level, it will become easier and easier to allow for such evaluation to occur.

I know that you have some products that relate to real-time surveillance. What are the results? What are hospitals doing with that?

Real-time surveillance, again, is applicable to only institutions that have good, digitized HL7-formatted data that is regularly available. Naturally, of course, that precludes the utilization of those tools today to perhaps less than 10% of the institutions within the United States. Those kinds of solutions really are easy to use, very readily configurable solutions that allow a clinician to set up rule sets — different rules that are very, very clinically sound, in terms of really what they’re looking for.

For example, a drug-bug mismatch. Based upon the data feed that is coming in from the lab, if a particular microbiology result basically indicated that a patient had a particular bug and was sensitive to a particular medication, it’s now going to look into the pharmacy order entry data set coming into the system to determine whether the right drug was actually being ordered for the patient. If the right drug is not being ordered for the patient, it will raise an alert. It will raise a flag. That flag is brought to the attention of the care provider.

Today, EMR systems do not have that degree of robust decision support rule sets built into them because it’s extremely customized and cumbersome to manage and maintain. The surveillance solutions that we provide take the HL7 data feeds and the clinician configures whatever rule sets that they want and have the alerts go out to the people that really need to be taking care of the patient.

I had one question about one of your products, your Clinical Café. Can you tell me about that?

That’s sort of like a pet project of mine that got conceptualized about three years ago at one of the IHI conferences. Really, the premise behind ClinicalCafe.com was to provide an environment … because Quantros services over 2,000 hospitals, we have a very rich collection of very like-minded people around quality, safety, compliance, operations, CMOs, and the like, that are basically part of the user community.

The idea was — how do we bring all of these people together in an environment where it can provide for them to connect with each other, be able to share best practices or information with each other so that they can collectively learn? Because what is working in one organization will probably benefit another organization. How can they be able to inform each other proactively, by setting up, maybe peer groups and things like that, so that they can collaborate? It’s sort of like creating an environment for utilizing social networking to really provide for a very rich collaboration for learning purposes and improvements in safety and quality. That was really the premise of Clinical Café.

It took about two years to actually gel the idea together. We launched ClincalCafe.com at the last IHI conference in December, the last one that was actually held, in 2009. We launched it over there and now we are integrating it with our applications to invite each and every user into the Clinical Café environment so that they can begin to interact with each other. It’s an open, shared, learning platform. It’s really not a proprietary platform. It’s really for any clinician, any provider, anybody interested in safety and quality, to be able to learn from each other as opposed to, perhaps, going to disparate sort of places.

Normally, learning is amongst each other. We tend to learn from each other much more readily. We share a lot of information with each other. Hopefully, the environment will provide for that. I would encourage you to sign up and become a member.

Anybody can become a member?

Anybody can become a member. The way that I like to introduce it is sort of like a Facebook for professionals within the healthcare community that are interested in improving safety and quality. I think, as of the last count, we had about 1,500 people that had already joined. It keeps on increasing by about 30-40 people every day. Hopefully, we’ll have a critical mass very soon.

This may be a question that you’re not comfortable with answering, but I’ll ask. If a hospital, from your perspective, wanted to make IT investments right now, with patient safety in mind, based on what you know and what you’ve seen and what your data tells you, what kind of technologies do you think would make the most sense?

There are lots of technologies that people are proposing out there for the point-of-care environment that I don’t think are necessarily ready. I think there needs to be a lot more critical evaluation done, in terms of the technologies that are being proposed out there. Very, very few vendors out there have ready technologies that would allow for very effective solutions at the level of point-of-care. A lot of the EMR systems out there are documentation systems. They’re not necessarily aligned for collection of very good, discrete data elements that can be utilized in a very meaningful fashion. We have to still evolve.

We should be very careful because some of these purchases are going to cost millions of dollars and they’re not necessarily that easy to replace because you’re going to embed them within the fabric of your enterprise. A number of people will have to work with them.

The other issue with a lot of point-of-care systems is clinicians are very, very averse to any new technology or change management. I think adoption of these technologies, ready usability if you have some of all of these technologies, is very, very important. I’ll highlight one key important point. For example, if I’m a physician and I’m practicing at three different institutions, and all of those three different institutions are using three different EMR or EHR systems, I now have to learn three different systems to interact with and actual work with. How can that EMR system just basically take my credentials and, perhaps make that into a common user interface for me that is to my liking?

I think technologies like that have to basically be researched, and I think we’re still at the very nascent stages of that evolution.

Over the next five years, what are your plans for the company?

The plan for our company is to continue to confirm our position as an industry leader, in terms of what we provide for furthering patient safety and quality and transparency for some of all of the data that we help our institutions collect and report. Our focus is squarely in terms of how do we bring about more actionable information for key stakeholders within institutions to be able to address patient safety, quality, and their business? The outcomes for improvements related to the implementation of EHRs or EMRs is basically safety and quality. That’s pretty much what everybody is proposing out there.

Our focus is squarely on that, and as a company, we are hoping that we’ll be the majority industry leader, in terms of really providing that very soon, I’m sure that if you follow us you’ll begin to see some of all of that even come about further.

Any other thoughts?

I do want to again highlight the value of environments like Clinical Café. I think in the new day and age of younger people that are actually beginning to interact with learning tools, or collaboration platforms, I think social media has a long way to go with it. I think mobile technology has a long way to go, in terms of furthering some advancements within healthcare that we, perhaps, have not necessarily taken. The work being done by organizations like Cisco in healthcare, with their collaboration platform, is very, very innovative as well as very entertaining to see that come about from a provider of hardware solutions like that.

I think the industry is going to want to see more and more, in terms of solutions like that, because they will provide for the easy, shared learning that needs to be there. We shouldn’t be closeted about certain things that are working within our environment and not really have them readily shared because they will save lives and improve the care that we provide to people. We all need to be able to benefit from all of that very readily.

I think technologies and the adoption that is currently being driven by the ARRA or the HITECH Act, yes, they push it very good. I applaud the push; I applaud the benefits that the government is actually providing for some or all of that. But it could also provide for a very ready environment for very rash decisions that might not necessarily further an organization’s goal because they’re really being pushed to that. Each and every organization doesn’t necessarily have the core capabilities to help address or evaluate each and every solution that they need to be implementing that is being required to meet all of the ARRA or the HITECH Act.

Four years is not necessarily a very long period of time to implement some of all of these solutions. I’m hoping that through your blogs and your talk, you actually are highlighting some of all of that, because it could push the industry in the wrong way as well.

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From Dr. Know: “Re: California Nurses Association. We have been rolling out an electronic health record system and have been confronted with growing resistance from the nursing staff, which is heavily unionized. They continue to refer to this document (warning: PDF) published by the California Nurses Association, which says, ‘Don’t Automate.’” The union’s flyer says that healthcare IT is driven by the desire of employers to control workers, that EMRs are used to spy on employees, and that technology is intended to homogenize health professionals and patients like interchangeable machine parts. I don’t disagree with all of it, but it’s pretty over-the-top.

From Minute Man: “Re: Leagcy Health. Dick Gibson MD, senior VP and CIO of Legacy Health System in Portland, OR who spearheaded the purchase of Epic, has been let go. In addition, Carol Edwards, VP of information systems with 20+ years at Legacy Health, was let go at the same time. They both left at the end of March. The Epic implementation has encountered significant costs overruns and delays. The project manager is a consultant who has no prior Epic implementation experience. Interestingly, the same consultant managed the Cerner implementation at Legacy, which is being replaced with Epic.” Unverified.

From The PACS Designer: “Re: iPad first look. If you haven’t purchased and received your iPad yet, you may enjoy the arrival experience by viewing Fritz Nelson’s iPad delivery and first use out of the packaging in his review for InformationWeek. Also, the Apple Insider has a full review of all the features available on the iPad.”

The Methodist Hospital (TX) enhances its online patient experience by launching distributed authorship of content for Web visitors from MEDSEEK.

A hospital in Thailand says it will be among the world’s best after an IT investment of $1.5 million. It will run PeopleSoft financials and HR.

Vanderbilt researchers present a paper describing the privacy method they developed that generalizes genomic data in EMRs to prevent linking patients to their genetic profiles.

I closed out the poll to your right because it was getting spammed hard by respondents (or automated scripts) choosing Eclipsys as the most innovative vendor. The polls usually get around 200 votes and this one was up to 688, with Eclipsys getting 528 of those. You can decide whether you believe that result.

Healthcare Growth Partners releases its HIT market report for Q1 (warning: PDF).

The Wall Street Journal writes up HIEs, profiling the data sharing of Children’s Denver, Kaiser’s Colorado physician group, and Exempla, all of which use Epic and share information.

A doctor and EMR consulting company vendor criticizes Canada Health Infoway’s multi-billion dollar EHR project, citing low physician adoption. Among his criticisms: the “unconscious patient in the ED” is rare and hard to justify as a necessity; investments have been focused on hospitals instead of doctors’ offices where most care is provided; EMRs don’t help with referrals or consultations, which still require paper; and privacy issues and local legislation prohibits the free flow of information that the system was built around.

Speaking of Infoway, the specially created pension plan of its CEO has accumulated $1 million in benefits after six years on the job, not bad for running an organization with only 200 employees.

It’s not just medical doctors who suffer through EMR implementations – veterinarians have similar concerns. “They really pushed big at the conferences. They knew that they were going to be bought and had to make their numbers look good. I just don’t think they were ready to take on a practice like ours.”

The mother of a nationally known activist who died at UPMC Shadyside blames the hospital’s “unreliable and insufficiently tested” computer system, saying its faulty records resulted in his being given soup too soon after surgery, leading to his asphyxiation. She also claims the hospital released his information to a congressman without permission.

If you work for a hospital or health system, please complete my three-question anonymous survey: your job title, the name of your employer, and the location. It’s nice to know who’s reading.

A primary healthcare center and ED launch what they say is the first HIE in Georgia, with the organizations sharing medical records of uninsured patients to streamline delivery and reduce duplication of services.

E-mail me.

HERtalk by Inga

From CowCHIT: “Re: Karen Bell. She was just named Mark Leavitt’s replacement at CCHIT. Don’t know her myself, but … she can’t be any slimier than Leavitt seems.” Sounds like a glowing endorsement. She was most recently SVP of HIT services for Masspro, and before that was director of the Office of HIT Adoption and acting director of ONC. Because of her previous association with ONC, she’ll be unable to lobby for CCHIT in front of federal officials until November 2010.

e-MDs announces it has increased its employee count by 36% over the last year and experienced a 36.5% increase in organic sales since the start of 2010.

CliniComp says that three more US Army and Navy facilities deployed the Essentris EMR during the first quarter of this year.

CynergisTek launches its HIPAA/HITECH Security Compliance review solution for hospitals that qualify for SHIP grants from the Office of Rural Health Policy.

Eclipsys announces the release of Sunrise Enterprise 5.5, which the company says includes significant EHR updates. The new release includes Helios, the new Eclipsys open platform strategy that allows third parties to natively integrate their applications.

The Children’s Hospital at Montefiore (NY) will implement GetWellNetwork’s GetWellTown, the pediatric version of its Interactive Patient Care program.

Foundation Radiology Group appoints Tom Skelton CEO. Last month a reader tipped us off that Skelton was leaving MED3000, where he served as president of technology services.

HIE Health Advancement Collaborative of Central New York signs a multi-year agreement with Axolotl for its Elysium Exchange suite.

Thomas Jefferson University and Jefferson University Physicians select Allscripts and dbMotion to provide an integrated and interoperable EHR and population management solution.

Eight thousand Vancouver Coastal Health (BC) employees are now live on workforce management solutions from Kronos, including time and attendance and employee scheduling.

Catholic Health Initiatives chooses RelayHealth RevRunner for patient eligibility verification.

David Blumenthal wins his second big award in just over a month. In early March, Blumenthal won top HISsie honors as HIStalk’s Healthcare IT Industry Figure of the Year. He has now been named the Most Powerful Physician Executive in America by Modern Physician and Modern Healthcare readers. I’m sure the latter award, while not as prestigious as a HISsie, will still be coveted.

Only 7% of US residents use personal health records, but that’s up from 2.7% last year. Younger individuals with more education and higher incomes are more likely to use PHRs. I’m assuming I am just too old / uneducated and/or poor since I don’t have one. Mostly I am PHR-less because it seems like far too much work to maintain. However, just today I was thinking that it would be kind of cool if I had a PHR. I’m trying to buy health insurance and am needing to provide the evil insurance company TEN years’ worth of medical history. As in, every antibiotic for every strep throat or bronchitis attack, every outcome to every dermatologic encounter, and every little medical incident that I have either forgotten about or don’t care to share. Seriously? I have a new theory about why so many Americans are uninsured but that’s all a can of worms I don’t care to open. Suffice it to say that maybe – maybe — I’ll start looking into using a PHR.

A man sues medical device maker Stryker, claiming its artificial hip destroyed his sex life. He alleges that while having an intimate moment with his wife, the act was interrupted because the squeaking made her start laughing (how insensitive). About 750 individuals have also filed lawsuits, including a fellow who put a video of his squeaky hip on YouTube. If you check out the video, let me know if you think this guy is wearing Superman pajamas.

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Working with ONC on HITECH: Some Observations

I have spent a large portion of the last eleven months working with the Office of the National Coordinator for Healthcare Information Technology (ONC) to develop the regulations and grant programs that resulted from the HITECH legislation. This time and this work have led to four major observations.

The Power of Meaningful Use

For decades, the healthcare information technology industry has tracked adoption. How many hospitals have adopted CPOE? What is the adoption rate of personal health records?

While adoption is a measure of industry uptake of a technology, it has an obvious flaw. Adoption does not mean that providers are using the technology or that care is being improved. Adoption does not, per se, lead to complete problem lists or providers doing a good job of managing the health of their patients.

Meaningful Use is a very potent idea. It says that if our goal is care improvement, adoption is only relevant if the technology is used well.

Meaningful Use also stops short of initially basing incentives on changes in care outcomes. While providers must report quality data, early stages of Meaningful Use do not require that specific improvements in care occur. It was understood that broad care improvement will take more time than is likely to be achievable under the initial HITECH timetables. And it was understood that while EHRs are an essential foundation for care improvement, additional factors must also be present.

Most importantly, payment reform must happen — reimbursement that explicitly rewards providers for improvements in care quality, safety, and efficiency. The recently passed Health Reform legislation begins the process of the implementation of payment reform for federal programs.

Meaningful Use moves the industry away from a focus on adoption, but does not overstep that movement by leaping all the way to outcomes.

The Joint ONC/CMS Approach to Regulation/Rule Development

After HITECH passed. there was a need to develop the regulations (also known as rules) that translated the legislation into specifics, e.g., what are the specific things a provider would have to do to be considered a Meaningful User?

As it writes rules, the government must follow a core protocol. Those who are drafting the rule cannot talk, outside of government, about the draft language. The draft rule must be reviewed and approved by several government departments such as the Office of General Counsel. And the government must ask for comments, on a draft of the rule, from the public and it must read those comments.

While it followed that protocol, ONC (and CMS for Meaningful Use) made a critical strategic addition. They leveraged the Policy and Standards Committees (which were open to the public) to develop recommendations of the rule content. The Meaningful Use Work Group defined an approach to the 2011 (Stage 1) objectives and measures. The Certification and Adoption Workgroup developed recommendations for a new EHR certification process. The Workgroups of the Standard Committee developed recommended data, transaction, quality measures, and security standards.

Most of the time, government does not do this. Generally government staffs do not precede rule writing with external committee (and public) input.

Why did ONC do this?

First, the rule content is likely to be better if it is based on the contributions of individuals who represent the broad spectrum of stakeholders in healthcare. These individuals “live” the delivery, financing, supplying, and management of care every day. And their experiences and knowledge cannot help but make the rule better. Moreover, the discussion of rule specifics from different perspectives helps to ensure that the rule balances, as well as it can, the variety of stakeholder interests.

Second, it is good government. Good government is transparent. Government is put in place by the people and it exists to serve the people. The people should be able to “drop in” on regulation deliberations and government should minimize the times it closes the doors.

Third, it is a terrific example of risk mitigation. It is very difficult to develop, for example, the specifics of Meaningful Use in a way that understands the complexity of healthcare; its current reality and its aspirations. By seeking the advice of experts through Committees and Committee testimony and inviting the comments of all, the Government is asking about areas where the proposed rule may have unintended consequences or could lead to sub-optimal outcomes.

Fourth, it helped the industry know, as early as possible, the direction that the rules were likely to take. The recommendations of the Committees were presented in the summer of 2009. The draft rules were unveiled in the winter of 2010. Through its use of the Committees, ONC was trying to give the industry as much of a lead time as it could.

The Complexity and Scope of the Challenge

HITECH has resulted in two classes of ONC efforts: definition and implementation.

HITECH required that specifics (and hence rules) be defined for

• Meaningful Use
• The data, transactions, and measures standards needed for health information exchange and quality reporting
• Certification standards and the certification process, and
• Privacy and security.

While essential, rules are not enough. Other actions are needed if we are to have the broad achievement of Meaningful Use by providers across the country.

Most of the care in this country is delivered by small physician groups and hospitals; they do not have an IT staff. Regional Extension Centers have been established to provide necessary support to those providers.

A health information exchange infrastructure needs to be in place to support the secure movement of data necessary for the care of an individual patient and the management of populations by public health organizations. Funds have been given to the states to establish this infrastructure and a plan to establish an over-arching National Health Information Network (NHIN) is being developed.

The country will need to increase the size of the work force available to support the broad achievement of Meaningful Use. Funds are being awarded to educators to provide necessary training and curricula.

Beacon communities will help us understand how best to leverage the technology to improve the health of a community and will teach us how to address important issues of governance, data use, and coordination of care.

Advanced health information technology research centers (SHARP) will provide ground breaking research into the critical areas of security, new architectural models, decision support, and secondary uses of data.

These implementation activities are breathtaking in their scope and sophistication. And the activities are the result of a very astute assessment of the range of “levers” that should be applied to achieve Meaningful Use.

However, initiating that many diverse initiatives that individually and collectively have a significant impact on multiple parts of the industry comes with some risk.

It is not possible to launch this much activity of this scope with this many actors and have great certainty about the outcome. This uncertainty will be magnified by the actions of the private sector — hospitals, health plans, suppliers, and others that are engaging in a diverse array of often very imaginative implementation activities.

The ONC implementation plans are very good plans. But they bring complex and substantial change to the industry. Change of this magnitude will bring very real progress, but it will also bring a period of time that is likely to be bumpy.

When significant change is introduced, one plans as well as one can, ensures that one has a realistic appreciation of the uncertainty, and preserves the agility to change course as needed. And, most importantly, one makes sure that there is ongoing dialogue with all stakeholders about issues, answers, and progress.

The Caliber of Federal Government Employees

Perhaps like many of you, I might have had this mental image of a typical government employee — a person with a rubber stamp in their hand and a scowl on their face. That mental image is wrong.

The people I worked with at ONC, CMS, NLM, NIH, FDA, DoD, VA, and a host of other government agencies and departments are exceptional. They are very smart and skilled. They work incredibly hard. They feel a sense of urgency. And they care deeply about making the country better. They listen thoughtfully to the comments, testimony, feedback, and articles from those who care about healthcare because they want to get it right.

They made me proud of my government because my government (and yours) is them.

John Glaser, PhD, FCHIME is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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From Thad: “Re: Allscripts. Word is that an inside e-mail leaked out to a wider audience of employees than planned. It mentioned the pending merger of Allscripts with Eclipsys.” Inga tried to chase this rumor down, but of course nobody’s saying anything to confirm or deny. Several people have told us Microsoft will make a move on Eclipsys very soon, but I’m always skeptical about Eclipsys rumors because they come up every year or so. But if you asked me if either event is possible, I’d say yes, even though I don’t see the value in either scenario. ECLP announces results on May 4, which may or may not be relevant.

From J-Hi: “Re: meaningful use. Does anyone know a source that lists the 25 objectives and the comments submitted to CMS for each?”

From Tangelo: “Re: AFCEA military HIT conference. Between the speakers from HHS, VA, and DOD and the large government contractors lining up to suck on the HITECH teats, it’s embarrassing to see how disconnected they all are on the real issues of implementing HIT (meaningful use and HIE) at the community level.”

From PortlyChap: “Re: QuadraMed. Quadramed lost the last of its Affinity clients in Kentucky recently. Pattie A. Clay Regional Medical Center in Richmond recently signed a contract with Meditech. The only other Kentucky Quadramed Affinity client signed a contract with Meditech in December 2009.” Unverified.

Transcription provider Transcend bids $78 million for the bankrupt Spheris, slightly upping the $75 million offer on the table from CBay and Nuance. And in another interesting development, Oracle CEO Larry Ellison is apparently protesting the potential sale of Spheris to that second group because Oracle is a Spheris bankruptcy creditor and he doesn’t want its software transferred to the new owners. The auction for Spheris starts today (Monday).

I’ve almost finished getting the new search engine running. There’s a new “Search This Site” box to your upper right if you want to try it. It indexes all HIStalk-related sites in one search (HIStalk, HIStalk Practice, HIStech Report, and HIStalk Mobile).

I did a survey two years ago in which I asked readers who work for hospitals to tell me their position and where they work, just to give me a feel for who’s out there. I shared the list of hospitals here. It’s time for an update! If you work for a hospital or health system, please complete my survey that asks only three anonymous questions: your job title, your employer’s name, and the city/state it’s in. Thank you.

Opinion is mixed on the likely impact of the iPad on healthcare, which is still pretty good considering it’s primarily a consumer device. New poll to your right: which of the big hospital systems vendors is the most innovative?

Clarian Health Partners (IN) chooses MedVentive for its Clarian Quality Partners clinically integrated network, where its product will be used to analyze patient data for quality analysis and care improvement opportunities. Clarian Health Ventures will also invest in MedVentive, jumping into an oversubscribed $10 million Series C funding round that raises the company’s total to $18 million.

Not much has gone right lately at Miami’s Jackson Health System, so maybe this was inevitable. Its Lawson payroll conversion causes most of its employee paychecks to be incorrect, although by minor amounts. Lawson says the problem was in the system it replaced and its amounts are correct; the hospital says the new checks underpaid employees for working overtime.

Some of the rags got irrationally exuberant over the marginal news that McKesson will sell its Asia-Pacific subsidiary to Medibank. The editors should have known better – all that subsidiary does is run healthcare-related telephone hotlines and call centers in Australia and New Zealand. Impact in the US or to McKesson’s bottom line: pretty much zero.

I notice that Cerner shares are on a solid rise lately, including a 2.4% jump Friday. You could have doubled your money if you’d bought in exactly one year ago. Neal’s stake is worth right at a half billion dollars.

Misys turned in pretty good Q3 numbers Thursday, with its Allscripts ownership stake offsetting a soft market for its banking software.

A small but interesting study in Australia finds that informed consent delivered interactively via computer with illustrations and quiz questions improves patient understanding and turns the usual “sign here” paper process into a valuable educational too.

I really enjoyed the discussion about which systems a 200-bed hospital should consider. Here’s the next reader question that would benefit from your feedback: when hospitals are rolling out systems to physician practices, will they offer a menu of a la carte system and implementation options, or will the hospital offer only a standard enterprise model of software and devices? E-mail me your thoughts and I’ll compiled them as a follow-up.

St. Francis Hospital (OH) implements the Priority Consult patient navigation system for its breast care patients. The company, which I hadn’t heard of, has software to support patient-focused nurse navigation models for spine centers and breast care, facilitating intake, triage, and care coordination.

Pardee Hospital (NC) replaces its two forms management solutions with Access Enterprise Forms Management when it finds the original systems couldn’t product a patient wristband barcode small enough for newborns.

Justen Deal follows Canadian HIT more than I do, so he caught this story that I would have missed. Quebec’s opposition party says its EHR project is dead last in all of Canada. The pilot, due to be completed in 2008, “still isn’t working” even though all of Quebec was supposed to be live this year. It appears that 75% of the original $563 million budget has already been spent, critics say it’s going to cost at least $1 billion, and everybody who originally supported it is trying to distance themselves from it. Justen always cites my 2007 Universal Rules for Big EMR Rollouts, saying they should have read them up there, so I’ll repurpose below just in case anyone missed them the first time around.

Speaking of which, I love this Toronto Star article, Malawi’s $1 Million eHealth Miracle. It points out that while Ontario was spending $1 billion on eHealth with “almost zip” results, dirt-poor Malawi has the records of 1.1 million patients accessible in 10 locations throughout the country, thanks to a computer network put together by a non-profit created by a Canadian aid worker and his wife for a total cost of $1 million from their office above a 7/11. He bought obsolete computers from eBay, converted them to touch screens, and developed the patient registration app, which uses “health passports” that cut the hours-long lines. “It’s hot, dusty and hydro is intermittent. Health clinics are in the open air with no doors. We needed a computer system that would work in those conditions and be used by people who don’t have computer skills. The system works on the premise that if you can work a mobile phone, you can use a touch-screen computer.”

A Harvard research team finds that electronic medical records haven’t had much impact in improving care or reducing costs. The authors seem to begrudgingly acknowledge that there’s no turning back now that the government is throwing endless money at EMRs, acknowledging that meaningful use requirements will at least encourage them to be used and not just purchased.

Central Washington Hospital gets a local newspaper writeup for its Cerner go-live. I’ve been there – nice place, lots of apples at the right time of year.

E-mail me.

Mr. HIStalk’s Universal Rules for Big EMR Rollouts (From 2007)

1. Your hospital will pledge to make major process changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

4. You’ll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You’ll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you’ll refused to apply them because you’re scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

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