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Monday Morning Update 5/3/10

May 1, 2010 News 25 Comments

From BestofBreed: “Re: Merge Healthcare. Laid off 80+ people Friday.” I heard that from more than one reader. The Amicas acquisition closed Wednesday, so they obviously didn’t waste any time addressing redundant positions. Steamin’ Pyle says rumor has is it that no years-based severance was offered to the expungees, meaning nobody is supposed to get it in the future.

HIStalk sponsors have posted quite a few jobs on the new Job Board, so you might want to check it out. Healthcare IT hiring is definitely picking up.

Sam Patton is named chief quality and regulatory officer of medical device integrator iSirona.

poll050110

Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm. New poll to your right for those working in a provider setting: which systems will your organization buy within the next two years?

CHIME sends comments to ONCHIT on EHR certification, expressing concern that certification capacity needs to be adequate to handle the rush of vendors that will be trying to get their products certified at the first opportunity. It also says any program that monitors real-world EHR performance (presumably including any new FDA oversight) should not not be “overly prescriptive”. You’d think CHIME was supporting its 70 big vendor members instead of its 1,400 CIO members with those comments, but that’s the HIMSS model at work.

David Blumenthal, speaking at a Boston conference, says that reports of EMRs causing patient harm have been “anecdotal and fragmented” and should not affect their aggressive rollout.

Sentry Data Systems has an upcoming Webinar on decreasing data center costs by using cloud computing.

rickscott

Columbia HCA and Solantic founder Rick Scott announces his candidacy to become governor of Florida. His campaign site says things were great at Columbia/HCA when left, but fails to mention that he was fired after the FBI raided its hospitals and the company was charged with the biggest healthcare fraud scandal in US history, eventually costing Columbia/HCA $1.7 billion in fines. His FAQ makes that travesty sound like a valuable lesson learned under fire that makes him a better candidate for public office:

Since I’m not a career politician or a political insider, I’m going to lay it out for you as simply as I can without spin or fancy words. Let me start by being crystal clear about this… I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader. Lessons I will bring to the Governorship with your support and vote.

An audit finds that University of Iowa Heart and Vascular Center failed to bill patients for $11 million worth of charges in November. Officials claim it wasn’t their new Epic system that was at fault, but declined to speculate further until an investigation is complete.

The usual housekeeping facts: put your e-mail address in the signup box on each site (HIStalk, HIStalk Practice, and HIStalk Mobile) to receive instant updates when we run something new. The “Search All HIStalk Sites” box to your right lets you search all those sites at once. Check out the industry event calendar, where you can also post your event for free. The hideous green  “Report a Rumor to Mr. HIStalk” button lets you send me anonymous, secure information, including any attachments that you might want to include. Please support HIStalk’s sponsors by checking out their ads to your left and clicking on those of interest – Inga and I appreciate their support. And lastly, I thank you for reading, writing guest articles and comments, and making those 3 million HIStalk visits possible by spreading the word. The incredible support I get from sponsors and readers keeps me going through all those after-work nights and weekends when I’m lashed to the keyboard.

The VA says it has figured out the problem responsible for incorrect data displaying when its employees accessed the DoD’s AHLTA system: an interface server change from a single to multiple processors. The description sounds as though it was a transaction timing issue, but that’s just my guess. VA and DoD are back to fax and e-mail for patient information inquiries until a fix is installed.

Carolinas HealthCare (NC) announces several changes in top management, including bringing on Brent Lambert from Carilion Clinic as VP/CMIO.

tomah

An ED nurse at Tomah Memorial Hospital (WI) is arrested for using patient information to divert narcotics logged out for 600 patients. The hospital has notified the patients that their information was breached but probably not exposed, other than they were charged for drugs they didn’t receive and will be credited (not that patients usually care since they aren’t paying with their own money anyway, so they probably won’t get a refund).

Shares in athenahealth dropped 18% Friday and bounced off a 52-week low after announcing a surprise Q1 earnings shortfall after the market close on Thursday. One analyst said the company missed expectations in nearly all areas, while another termed its Q1 performance as “disastrous”. Market cap is now under $1 billion.

Odd lawsuit: a woman trying to kick her husband as they walk along a Chicago street loses her balance and crashes through the window of a beauty salon. She admits to have been drinking beforehand, but is suing, claiming the business and building owners knew that drunk pedestrians on their way to or from Cubs baseball games could fall through the window. She’s also suing the hospital that treated her, insisting that a radiology tech stole her BlackBerry and $6,000 worth of jewelry while preparing her for an MRI.

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Currently there are "25 comments" on this Article:

  1. CHIME’s response to Certification is really disappointing, but is consistent with what we should expect from HIMSS. There is not one single sentence about helping purchasers. Their entire approach involves minimizing problems for vendors. HIMSS continues to complain that there will be more than one certifying body. Well, at least somebody (ONC) is finally saying NO to HIMSS!

  2. true “Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm.” But I wonder how many are aware of mistakes made under old paper systems?

  3. Blumenthal is misrepresenting the facts:

    According to the report link:

    “Dr. David Blumenthal, the National Coordinator for Health Information Technology at the U.S. Dept. of Health and Human Services, told a crowd in Boston April 29 that his agency has concluded a preliminary investigation into reports of some 260 HIT-related adverse events over two years, including 44 reported injuries and six deaths.”

    Who did the investigation and when? What were the details of the investigation? Was it the ONCHIT and Blumenthal making up the real truth to suit their goals? Were Dr. Koppel’s reports in JAMA and Han in Pediatrics anecdotal?

    Blumenthal can not be trusted to tell the truth. It is obvious that there was not any investigation of the adverse events reported to the FDA. He is also condoning the egregious violation of the Act. Blumenthal should resign.

  4. Not Quite has it right and HIMSS, and by extension CHIME, continues to show why their model (what I call the “bloated big govt model”) is getting old and could become less relevant as the years roll on. Especially the annual HIMSSXX extravaganza.

  5. Re: anecdotal and fragmented record of adverse events from CPOE

    Expert non users of these devices who cohabitate with Blumenthal at the ONCHIT would never consider that the reports are anecdotal because neither the hospitals nor the vendors (nor HIMSS, who gives out “awards” for getting wired) will disclose the screw ups, while the doctors and nurses have been warned by the conflicted administration and HIT champions not to complain.

  6. I am with CHIME 100% (I am not a CHIME member). The fact is that certification is a distraction and a waste of time. It is not valuable to purchasers in sophisticated environments. There is no way certification can give me piece of mind that any application will be a valuable fit in my environment of hundreds of interfaced clinical applications. The concept, like most things related to ARRA, is too simplistic and does not reflect reality. Meaningful use is the goal, how we get there should not be too prescriptive.

  7. Seeing

    Thirty-nine percent of respondents to my poll said they are personally aware of an incident in which a computer system caused patient harm. New poll to your right for those working in a provider setting: which systems will your organization buy within the next two years?

    and

    David Blumenthal, speaking at a Boston conference, says that reports of EMRs causing patient harm have been “anecdotal and fragmented” and should not affect their aggressive rollout.

    on the same page is a bit jarring.

    Pass out the VIOXX David!

  8. Are there chemicals in chemtrails? Was the president born in America? Who killed JFK? Who was really behind 9/11? Who will sit on the death panels? Who killed the electric car? Are those black helicopters outside my window? Who is really behind the HIM holocaust?

    Everybody is misrepresenting the facts. Nobody can be trusted to tell the truth! They should all resign!

    It’s a conspiracy! Hire more nurses!

  9. Spanky wrote:

    ‘But I wonder how many are aware of mistakes made under old paper systems?”

    Your ethics border on Genghis Khan’s.

  10. The definition of anecdotal.

    “information that is not based on facts or careful study”
    “non-scientific observations or studies, which do not provide proof but may assist research efforts”
    “reports or observations of usually unscientific observers”
    “casual observations or indications rather than rigorous or scientific analysis”
    “information passed along by word-of-mouth but not documented scientifically
    http://en.wikipedia.org/wiki/Anecdotal_evidence

    You know… like the poll. Clear cookies and vote again!

    Do you feel more stupid by reading the comments? Cannot stop looking at that car crash? You are not alone.

  11. Too bad for AthenaHealth – however, they are staying true to the trajectory of HIS vendors that become “darlings”, first big rock hit in the road and squish goes the stock price. Now let’s see Mr. Bush shmooze his way out of this – or, hopefully, answer the wakeup call and manage the company forward.

  12. “Time spent finding missing equipment and misplaced patient records are costing the NHS an estimated £1 billion a year in wasted nurses time.”

    “The UK’s 400,000 NHS secondary care nurses are spending almost four hours each week searching for medication, patient records and medical devices according to the survey by GS1 UK, in conjunction with Nursing Standard.”

    “Only 10% of nurses who responded said they feel they have the time to check patient records thoroughly all the time

    Nearly a third (31%) of the nurses surveyed believe the use of physical patient records, instead of electronic systems, are responsible for causing problems with patient care

    “44% of nurses feel that bar-coded wristbands would reduce patient safety incidents by over 50%.”

  13. Tell me again, how many billions have we paid and are paying for DoD’s AHLTA system? Are we throwing good money after bad? Shouldn’t we consider that there are better alternatives at a lot less cost or are we(taxpayers) stuck ?

  14. In other news commented “Time spent finding missing equipment and misplaced patient records are costing the NHS an estimated £1 billion a year in wasted nurses time.”

    The doctors at UK trusts have demanded deinstallation of HIT systems that they called not fit for purpose.

    This blog rocks. Keep it up HIStalk. Keep the used car sales pitches low key, avoiding sales rhetoric such as “The committee said that nothing it had found would give them any pause that a policy of introducing EMR’s could impede patient safety,” he said.

    This pitch is extended by ONCHIT despite Harvard studies proving no outcomes or costs benefits from what he is selling.

  15. As Chair of the CHIME committee that drafted the CHIME comments I feel compelled to responsed. The committee that drafted the comments was a group of CHIME’s CIO members who were focused on minimizing the impact of certification on physicains & hospitals. Perhaps the statements quoted here in were taken out of context, as both comments were meant to protect HIT user’s ability to acheive and maintain Meaningful Use in a timely fashion and without fear of survellience mechanisms de-certifying their product.

    Please note the main tenet of the entire document was that certification of products should be the responsibility of vendors with consumers or users of HIT responsible for meaningful use only.

  16. How could an organization ‘forget’ to bill $11 million in revenue? Does not Epic have a work flow feature pushing unbilled revenue to the appropriate management personnel? This is a combination of lack of oversight and ‘bad’ features on the revenue cycle side of the Epic solution. I’m sure they can’t comment because their Epic contract forbids them from saying anything negative about Epic.

  17. For accuracy sake, we need to amend the quote to say “Thirty-nine percent of respondents to my poll said they personally THINK they are aware of an incident in which a computer system caused patient harm.”

    Can’t tell you how many times a customer called to complain that an alarm didn’t go off only to show that the alarm did go off but the user dismissed it. Or that a warning didn’t appear, but it did and the user closed the window. Or the decimal in the wrong place was there because that’s what the user entered.

    Most don’t realize that our systems track every click of the mouse and keyboard in an audit history. And when the vendor investigates and demonstrates that it was human error, does that ever get circulated back to everyone who thought it was a computer error? Not likely. Sort of like publishing a retraction on page 10 three weeks after the front page article got the facts wrong – the image is already damaged.

    Systems are not perfect, but let’s not underestimate the human contribution to this equation.

  18. Blah,

    Blumethal issuing a statement that “The committee said that nothing it had found would give them any pause that a policy of introducing EMR’s could impede patient safety.”

    That’s quite a pronouncement for someone to make on anecdotal evidence from a rarely used (for HIT) FDA reporting system – as if this were the sole source of that kind of information.

    The reports of problems, scant as they are, in databases such as MAUDE would give any credible scientist pause and lead to a call for a major national investigation following the best science methods.

    He’s a Harvard scientist and should be ashame of such a statement.

    Did HIMMSS pay him to make the statement?

  19. Dr. M “Most don’t realize that our systems track every click of the mouse and keyboard in an audit history. And when the vendor investigates and demonstrates that it was human error, does that ever get circulated back to everyone who thought it was a computer error? Not likely. Sort of like publishing a retraction on page 10 three weeks after the front page article got the facts wrong – the image is already damaged.”

    I believe that you must also take into account that the vendor should be coding to prevent these slipups. If the warning message is going to the wrong person they will defend themselves by saying that it appeared but what good was it.

    A very simple example of a way most systems could improve is to have a list of all zip codes in the USA and if the zip code entered does not appear on that list do not allow the data to be entered in the field. If they did that programming it would be a simple step to then say that after five characters are entered verify against the table and automatically move to the next field needing data entry.

  20. Jays: File to a freetext field instead, assuming that the freetext field has been properly coded it will accept any data. If you want to take into account the fact that Canada uses 6 digit alphanumeric zip codes you can also code for that. The point is that most programs are lacking the true discovery and data analysis needed to have a stellar product. Sure eventually the big companies will evolve into a decent product at the add catches and overhead to their code to verify the data that it was never designed to verify but if they took a step back and did a true discovery phase and coded to prevent errors we’d have far fewer issues.

    Then again we could also look at QA and how the true fault lies in their hands rather than the programmers.

  21. Jeremy, you didn’t mention anything about an alternative free text field in your initial description of the problem. You just said that the system should not allow users to enter anything but zip codes from a list. Besides, what if the zip code the user wants to enter is a legitimate code, but it just isn’t on the list?

  22. Epic DOES NOT DO BILLING at U of Iowa.

    It looks like these charges got to the billing office and got lost there. Look at what systems are in place in their billing office.

  23. Jays: :shrug: fair enough but if we’re going to talk about what I didn’t mention we’d have a far far larger list because I can think of about 20 different considerations for that one field off the top of my head.

    I’m afraid I was attempting to make a point rather than get into the nitty gritty of my day to day job. If you’d like to hire me I’ll be more than happy to discuss all the boring details of how a system should work. However, most people in the industry know how it should work ideally, we simply don’t live in an ideal world.

  24. Jeremy, I’m not interested in discussing all the boring details, I was just trying to point out, using the example that you provided, that your suggestion that the computer should catch every possible problem is simply not realistic. It doesn’t even work for a simple zip code field. The software can provide warnings and lookups, but in the end it’s probably going to give the user the option to screw things up.

    In any case, that wasn’t Dr M’s point. Dr M’s point is that the user often does not know all the details behind a problem that they might perceive as being caused by the software.







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Reader Comments

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  • HIT Girl: I've worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got m...
  • Joy Goodspeed: So funny about the physician card. I wrote my 3rd HL7 Lab and microbiology interface in my 20-year career this past yea...
  • Anonymous: Did you just compare Healthcare to roofing business ? Imagine a surgeon operating with a body cut open, should they take...

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