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Monday Morning Update 5/10/10

May 8, 2010 News 12 Comments

From MeHere: “Re: Millennium Medical. I used to work for them. I hope there’s a full-scale investigation into their unsavory activities. The IS guy would write up employees for forgetting to encrypt inter-office e-mail.” An unencrypted portable hard drive is stolen from the Chicago offices of the medical billing company in February, exposing the information of 180,000 people. Patients are complaining that they weren’t notified promptly and that the company is not offering the usual free credit monitoring.

From Nothing More: “Re: UPMC. DOH and CMS found ‘easily resolved differences over paperwork.’ I thought that hospital was paperless.” Inspectors find that UPMC did indeed match transplant donor and recipient blood types, but didn’t document properly because the paper form has only one signature line. Doh! And in other UPMC news, it’s on pace to hit $8 billion in annual revenue this year.

hc2010

From MaxPayneUK: “Re: HC2010 conference. McKesson and Eclipsys were noticed there. Both will focus on the customer base of legacy supplier iSOFT and NPfIT programme player BT/Cerner.”

The Texas Board of Pharmacy hits Parkland Hospital with one of its largest-ever fines ($20,000) for allowing five outpatient pharmacy technicians to steal 370,000 oral doses of drugs in a one-year period. Cases against three supervising pharmacists are pending. The lesson learned is that Parkland did what most hospital pharmacies do — they took drug inventory only occasionally, estimated counts, and didn’t reconcile purchasing records to dispensing records. Parkland says it’s running a perpetual inventory now, always tough to do in pharmacies and ORs.

meditech

Meditech’s Q1 results: revenue up 10%, EPS $0.60 vs. $0.48. Very good numbers. I’ve confirmed that Howard Messing will be given both the president and CEO titles, subject to routine shareholder approval in the next few weeks. The company also announces that students at Northeastern University’s health sciences school will use Meditech’s clinical systems as part of their training.

poll050810

You would expect clinical systems to be a top priority for providers, but I wouldn’t have guessed that portals would score so high. New poll to your right: based on experience, what impact do you think CPOE has on patient outcomes?

gatech

Congratulations to the Georgia Tech Flatliners, a team of graduate students that finished first, second, and third at the NHIN CONNECT Code-a-Thon Challenge held last week at Florida International University. The challenge was to create an online format for a Continuity of Care Document that a primary care doctor could use to take calls after hours. Medicity sponsored the team, which as a condition of its participation was required to donate the resulting style sheets to the CONNECT Open Source Community.

An MIT medical engineering student creates print management software and lands his own university as a paying customer for his new startup. The software is Web-based, does not require installation on print servers or desktops, and encourages “community engagement” by matching user groups as rivals to reduce their printing costs.

I appreciate the several companies that have asked about sponsoring the HIStalk reception at HIMSS in Orlando next year. It’s cool to have people thinking about it this early! Anyway, I’ve chosen the sponsor and we’ve already got the venue, entertainment, and menu locked down, just in case you want to mark your calendar now for February 21, 2011 for what will be a memorable blowout. I truly appreciate the companies who support what I do, not to mention the readers who make it worth doing.

Inga and I are writing up the results of the HIStalk Practice reader survey, which I’ll probably run this weekend. My favorite reader comment: “I just absolutely adore Inga.” Who doesn’t? She is entirely adorable.

I forgot to mention that with the rumored but unannounced demise of ADVANCE for Health Information Executives, Texas Health Resources CIO Ed Marx temporarily became a blogger without a home for his CIO Unplugged writings. He’ll be moving to HIStalk this month and I’ve posted all of his previous writings. I’ve tagged them all in their own category, viewable here.

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Thanks to everybody who has clicked “like”on the HIStalk Facebook widget in the right column. I’m posting to the Facebook page that Inga created each time there’s a new posting and I’m seeing inbound clicks from it, so I think readers are finding it handy. Click the HIStalk logo or link to go to the FB page.

On the job board: Eclipsys SCM Consultant, Market Research Analyst, Epic Practice Manager. HIStalk sponsors post their jobs for free and can contact me to sign up.

The VA’s VistA Modernization Working Group recommends modernizing the VistA system by moving it to open source and dumping MUMPS as its programming language. The group’s chair says VistA is “outdated and difficult to maintain” and that “we don’t think MUMPS is the answer.” That’s an interesting conclusion given that Epic, Meditech, and other systems are written in MUMPS, a programming language that is almost certainly involved in more US healthcare encounters than any other.

And as I like to do occasionally, allow me to acknowledge Meditech’s Neil Pappalardo, who with colleagues created the MUMPS language and thus the HIT industry in 1966. He’s still my #1 choice of someone to interview, although Judy Faulkner runs a close second (both are MUMPS-made centimillionaires, I should note).

The non-profit Kaiser Permanente’s net income for Q1 was $706 million on operating revenue of $11 billion.

Here’s the danger of announcing one of those sketchy correlation-causation EMR studies: an overambitious headline writer summarizes as, “Doctors: Boot Up a Computer to Save a Life.” 

E-mail me.

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Currently there are "12 comments" on this Article:

  1. About MIT print management: Do the printers still keep a record of documents printed which could be extracted when the printer is pitched or resold, broaching privacy and confidentiality?

  2. EMRs, computers, and stock market punge: the report from the LA Times is similar to what I hear when requesting information from the hospital IT help desk when misleading reports come to my terminal and description inconsistent with what was ordered.

    http://www.latimes.com/business/la-fi-stocks-plunge-20100508,0,7579168.story?track=rss&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+latimes%2Fmostviewed+%28L.A.+Times+-+Most+Viewed+Stories%29 Perhaps the most troubling aspect of the market’s nosedive was that it may have been fueled by a computer glitch, human error or trading programs run amok, and that such technical problems could continue to jeopardize the savings of millions of Americans.

  3. Re: MUMPS. I was teaching a class once, and told the students that MUMPS-based systems were faster for EHRs and other healthcare systems, citing an EHR and LIS at our own institution. Their response was “We’re students in at . We know that relational is best.” LOL!

  4. Correlation-causation is not understood by this professor, quoted in the article under the “overambitious” headline-“As the maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety,” Dr. Del Beccaro was quoted as saying. “The Packard Children’s report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place.” I am puzzled about how much this professor is being paid to promote the results of this study which showed a benefit for rapid response teams and murkiness about CPOE. He works at a Cerner site, I am told.

  5. Hearing from Neil Pappalardo would be a great treat. Maybe the transfer of the CEO title to Howard Messing will give him a reason to talk on the record.

    Many Meditech customers would like to know what is on his mind as we make the tough decision to either go to the new 6.0 system or look for other systems.

  6. $8 billion for a Pittsburgh non profit is not chump change. That is why teams of leaders are earning $ million plus salaries. These funds could be better deployed to add wires and computers to enable accurate reporting of adverse events, hire more nurses and train them better, and to correct the form they claim was confusing to the CMS and Health Department.

  7. Re: VistA Modernization Working Group – MUMPS/M is not just a computer language, it is a database platform. Also, there is an open source M implementation, GT.M, which can run VistA (http://www.fisglobal.com/Products/TechnologyPlatforms/GTM/index.htm).

    The goal of VistA 2.0 being run as an open source project does not automatically exclude the use of M as the underlying database engine, while allowing modules to be written in a variety of languages.

    The reason successful commercial products run on M/Cache is that this type of database engine fits much better with the on-line transaction processing (OLTP) requirements in a healthcare environment than an SQL database.

  8. Great to know that the important things in life (like HISTalk’s next HIMSS party) are well in hand. 😉

    The causation/correlation problem is certainly a headache to wade through. I remember my high school statistics teacher saying on the first day of class that she could take a set of numbers and prove anything with them. Statistical evidence is all about crunching the numbers. It doesn’t “mean” anything in and of itself, yet it’s the number one way we “prove” things. Often, when you read all the conditions of a study and all the numbers, the results are less stellar or overwhelming than the headline claims. Finding a balance between using statistics and being used by them is part of being an informed reader, though it’s hard when the article you’re reading cites a study that you only have access to the abstract.

  9. Re : Causation/correlation. Such a small part of research and science in general. A single study will never prove anything. Then we have the peer review process. Replicating findings is another step. More studies and a reviews of the literature follow. Then you end up with a body of evidence. This process weeds out outliers. It takes the whole process for the system to work accurately. Anybody who has looked at the free, publicly available, literature at sites like PubMed knows in many instances I.T can have huge effects to quality of outcomes and costs. Its oh-so-easy to criticize one paper. Its far more difficult to look at the full body of evidence and not reach certain conclusions. Mr H should do an article on the broader literature, rather than pick on individual papers.

    Re : VistA and MUMPS. It’s FileMan that’s the problem, not MUMPS.

  10. Combining MU requirements that are clearly signaling that consumer engagement is a priority (2011 – digital copy of record in 48 hrs, 2013 – likely provide PHR/portal for consumer access to their records) with the overall trend in consumerism in healthcare, I find it not at all surprising that patient portals rated so high on your survey. Pretty much a no brainer.

  11. At hospitals where patient portals are available. the patient use of portals is negligible. Referring doctors also find it a useless endeavor to scroll through the daily progress of the referred patient, like the mega mecca center will be interested to know that they missed a potassium of 2.5 when pointed out by the referring doctor. These portals are marketting gimmicks. For portals to be included as a requirement for meaningful use is money wasted.

  12. I could see switching away from MUMPS if the VA is going to do a complete rewrite of VistA anyway, but only if they’re doing the rewrite for other valid reasons and not just because they don’t like the MUMPS language. As Joel Spolsky has said, rewrites are almost always a bad idea. However, I’ve heard the VistA code has a very bad reputation among those that have worked with it, so MAYBE the rewrite is warranted in this case; if so, that’s a good time to reexamine which technology it should be built on. For others who depend on the platform, though, building improved development tools on top of MUMPS would probably be a much better plan than discarding decades of work. A couple of things are pretty clear, though: 1) modern MUMPS platforms work well for EHR’s, regardless of what you think of the language itself; and 2) MUMPS is not going away any time soon, it has already outlasted most other languages of its day and shows no signs of being abandoned in the near future. The latter is very important, as it’s hard to say how long more in-vogue platforms (e.g. running on Java and .NET) will be supported. This isn’t just a question of language longevity, it’s the whole platform: for example, a C program written in 1980 is still valid C in 2010 (at least with minor changes) but if it did anything more interesting than simple text processing then it probably won’t run on any system that’s still in regular use without drastic changes. In contrast, MUMPS has remained very stable for decades as a development environment, not just as a language. Will your JSP/Oracle, LAMP or ASP.NET/SQL Server app still work in 30 years? Probably not.







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