From The PACS Designer: “Re: an iPad challenger arrives. While the iPad gets all the press briefings, there’s a similar device called the Notion Ink Adam, brought to TPD’s attention courtesy of a posting by Michelle W. on HIStalk. It looks pretty cool, operates using the Tegra-Android platform, and best of all, it only weighs 1.35 pounds.” The company says they won’t release it until Flash works, which is probably a big mistake since the iPad doesn’t support Flash either and they’re letting Apple saturate the market in the meantime. It’s supposedly coming out in June for around $300, which would be an attractive price point if it works as advertised.

From Ex-Cerner Guy: “Re: Millennium and FDA’s MAUDE database. Not a huge surprise. Orders in Clinicals and FirstNet were designed and written by non-clinicians, with implementation done by non-clinicians. Try to find a Cerner Physician Executive in the field with more than two years under his or her belt. The referenced problem was evident at the Children’s Boston roll-out of FirstNet. From a sales standpoint, we used WYSIWYG-YBLI: what you see is what you get, you better like it.” Unverified.

From NorwichSammy: “Re: William Backus Hospital. Their attempt at digital cardiac access using GE’s Muse has been a big flop. It seems that paper trails are more effective for the clinicians.” Unverified.

From NoSleep: “Re: Hackensack University Medical Center (NJ). They successfully went live with Epic on May 1. It was a big bang cutover of all inpatient units, ED, radiology and several outpatient departments including nursing documentation, mandated CPOE, and medical device integration. Epic Ambulatory EMR and Practice Management will go live starting July 1, including both hospital and private practices in the rollout schedule. Rather than hire additional FTEs or engage consultants to implement Epic, HUMC recruited clinical and operational staff from within the organization, consolidated them within IT, and sent them to be trained and certified by Epic. As a result, the project was implemented on schedule and under budget. HUMC will retain its own in-house staff with expertise to support Epic.”

 

From the desk of Weird News Andy: a guy in Austria missing both arms passes his driving test by using a mind-controlled robotic arm. In England, a transsexual challenges NHS’s decision not to pay for her breast enlargement operation, claiming her female social life isn’t that great and that local street kids are calling her names because she doesn’t look like a woman. WNA editorializes a bit: “So, how many cancer patients won’t get the drugs they need to live so she can feel good about her appearance? How about, oh, I don’t know, paying for it yourself?” Lastly, WNA notices that NHS is using fear to convince patients to opt in to its Summary Care Record, warning them that its propensity to lose paperwork may expose them to NHS errors if they don’t sign up. 

SAP will buy Sybase for $5.8 billion. I hadn’t thought about Sybase for years since its healthcare dabblings have been infrequent and uninspired, but maybe I missed something.

Inga and I are a little behind, as evidenced by folks who are re-sending us e-mails when we don’t respond immediately (connected world expectations are sometimes unreasonable, I’ve noticed). We will catch up, I promise, but it may take a couple of days. Darned day jobs.

Abu Dhabi Health Services Company extends its Cerner deal to cover all applications for all of its areas, including its Lighthouse quality improvement solution.

Housekeeping: check out the Jobs Page. Drop your e-mail address in the Subscribe to Updates box to your upper right to get immediate notification when I write something new. The search box to your right now uses the new search engine I installed, so it covers all HIStalk sites (HIStalk, HIStalk Practice, and HIStalk Mobile.) The “Find us on Facebook” box to your right has adorable pictures of HIStalk readers, but also a link to our Facebook page (which Inga and I are using more often) and the thumb-up icon that gives us a Like when you click (thus temporarily soothing our raging insecurities). And as always, please support our sponsors by perusing and clicking their ads to your left, since they in turn will be motivated to continue supporting HIStalk. Thank you.

McKesson signs a big deal to implement PACS in Ireland.

How to tell you’re a hospital fanboy: when on vacation, you can’t resist following the blue signs to check out hospitals you’ve not seen. I knew a hospital executive who carried an AHA guide in his car and would choose routes that would let him check out all the hospitals along the way. He’s probably still doing it, only now with a GPS.

McKesson shares hit a 52-week high after analyst upgrades, although still below their 1998 (pre-HBOC scandal) prices. Thursday’s closing price was $68.99.

Jobs: Oacis – Clinical data Business Analyst, McKesson HED Consultant, Advanced Programmer Analyst – Interface, Meditech LSS Consultants.

Amcom’s messaging platform now supports Android smartphones.

Genesis HealthCare System (OH) will spend $40 million on an unnamed EMR (it’s Epic, of course, which should be obvious given the price and the fact that nearly every major sale is theirs these days).

Long term care operator Advocat names its IT consultant David Houghton as permanent CIO.

I see that Ed Marx’s first column here generated many comments about HIT vendor relationships. I thought both those who agreed and those who didn’t made their points quite well. Inga is sending out Ed’s PowerPoint as promised to all who commented and provided an e-mail address.

Integrated Document Solutions says it has implemented a cloud-based, RIS-less teleradiology system driven entirely by speech recognition and templates, all within 30 days.

A now-fired hospital employee of Perry Hospital (TX) is being investigated by police after allegedly using a doctor’s password to sign off on mammograms. The hospital has contacted 900 patients to have theirs redone.

A Forbes editorial by PatientKeeper CEO Paul Brient notes that all three technologies covered by Meaningful Use have been around for two decades, failed to hit double-digit adoption, and were avoided because they couldn’t pay their own way.

Odd: several dozen New Mexico residents are surprised to find themselves named as plaintiffs in a lawsuit against the local hospital. Most of them signed what they thought was a petition because a local guy asked them to.

E-mail me.

HERtalk by Inga

Henry Schein promotes Keith Slater to VP and GM of Henry Schein Medical Systems.

Northeast Georgia Health System says QuadraMed’s AcuityPlus nurse staffing management system generated $901,000 in first-year benefits. A 60% improvement in nursing productivity goals saved $659,000 in overtime and contract work and another $241,000 in incentive pay.

Diagnostic imaging provider InSight Services Holdings selects MobileMD’s HIE solution to provide electronic orders and results exchange for physicians.

A CIO involved in an HIS search shared with me his observation that the vendors that spent more time in due diligence gave better demos that met the hospital’s needs. A good reminder that cutting corners in the sales process can cut you right out of a deal.

St. Vincent Health (IN) deploys ZynxOrder to standardize evidence-based order sets. The 19-facility health system built over 350 order sets.

Grinnell Regional Medical Center (IA), Providence Kodiak Island Medical Center (AK), and Union Hospital (IN) are implementing eICU tele-health services from Philips Visicu.

Faith Regional Health Services (NE) anticipates a June 20th go-live on Siemens Soarian.

Medical transcription provider MedQuist releases its Q1 financials, which included a 6.3% decline in revenues to $74 million. Net income, however, grew from last year’s $6.8 million to $7.3 million. The company blames the revenue decline on poor February weather, which it says negatively impacted its transcription volume.

South Nassau Community Hospital (NY) selects the Capacity Management Suite from TeleTracking Technologies to manage its patient flow.

University Physicians Hospital (AZ) will use EmergisoftED for ED patient tracking and nursing and physician documentation.

Richmond Memorial Hospital (NC) is live on Wellsoft’s EDIS.

Here’s an interesting project to watch. SunCoast Health Partners is a joint venture between the SunCoast RHIO (FL) and for-profit partners. Using MedLink’s RHIO Financial Stability Model, SunCoast plans to offer products and services to over 500 practices in the RHIO, betting that providers will need clinical data to support their EHR investment. They expect to generate sales of over $4 million year in the first year and more than $7 million in the next four years.

And from a few of our much-appreciated sponsors, here are some quick updates:

• IntrinsiQ and eClinicalWork partner to integrate IntelliDose with eCW’s EMR/PM solution. eCW will offer the IntelliDose chemotherapy management solution to its oncology practice customers.
• ICA aggregates data from all core clinical systems within the HIE of Montana, which includes seven hospitals and more than a dozen clinics.
• Community & Dental Care, an FQHC in Monsey, NY, selects Allscripts Health Center Solution for its 30 multispecialty physicians.
• maxIT Healthcare announces plans to become an Eclipsys Certified Consulting Partner with Eclipsys, providing installation services for Sunrise Enterprise release 5.5.
• EDIMS and Medit Corporation form a strategic relationship to combine the EDIMS ED system with Medit’s MiRapidAccess registration tools.
• IntraNexus appoints Tom S. Visotsky VP of sales and marketing.
• Medicity announces that its iNexx platform will be generally available August, 2010. It will be free for physicians, allowing them to automate referrals to providers on the platform.
• EHRScope releases the beta version of EHRScope Reviews. End users and consultants can add information to their (free) database, so offer your opinions here.  

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

Maximizing Vendor Relationships
By Ed Marx

Vendor management can frustrate even the most elite organization. You can love ‘em or hate ‘em, but you can’t live without them.

Over the years, I’ve learned to take a proactive approach that allows both the organization and the vendor to achieve their goals while providing maximum benefits for the health system. Here is our simple structure.

Categorize Vendors

First, stratify vendors into four categories. You may find a better framework than what is presented below, but the point is to define how you team up with each vendor. The following categories and principles work for us:

Strategic. Out of hundreds, the vendors that qualify as strategic can be counted on one hand. Elevate these relationships to partnership status at an enterprise level. Consider them health system partners, not merely IT strategic partners. Our C-suite partakes in the selection and then personally invests time in relationship maintenance. Strategic partners identified: transformational, high-dependence, high-cost exposure vendors, and those with whom we wish to increase business. As CIO, I’m the primary relationship manager. I devote my time and energy exclusively to our strategic partnerships.

Tactical. We work with two dozen tactical suppliers. We’re similarly intentional on how we screen and invite these vendors. Tactical suppliers are typically smaller in cost and exposure and are transactional, yet they’re critical to the success of our organization. My direct reports divvy up ownership responsibilities for these important, exclusive relationships.

General. Given the existing business relationship, there’s nothing negative about this category. On average, however, these vendors supply commodities that provide little opportunity to differentiate. Therefore, we spend less time and energy with them. While we expect to maximize this relationship, we continually remind general vendors that maximization will not reach the same level as with strategic / tactical vendors. Our managers and directors own these general vendor relationships.

Emerging. This finite category of vendors has a small initial presence that we expect to build over time due to great potential. Emerging suppliers may come from our tactical or general relationships or may be a net new entrant. My direct reports manage these relationships closely.

Identify Vendors

As a Baldrige-oriented organization, we have a recognized and practiced process by which we discriminate between vendors.

• Supplier scorecards – service metrics, relationship, business model, technology, pricing
• Business technology alignment – opportunity, potential, direction, vision
• Deeper dive – presentations, discussions, research, vision
• Business technology meetings – share process, share strategies, mutuality, outcomes
• Tactical committee review – presentations, price models, benefits
• Strategic committee review – presentations, cultural fit, vision
• Decision – responses collected, responses aggregated, scorecard, decision

Manage Relationships Proactively

Each strategic, tactical, and emerging relationship is managed intentionally and includes formal controls. We also have codified rules of engagement:

• Relationship owners meet quarterly with strategic partners and conduct an annual, formal score card evaluation of both parties
• We arrange meetings between CEOs
• Strategic partners meet collectively once a year to review our organizational and IT strategic plans, working together to develop solutions. We meet offsite at locations that inspire creativity and innovation. This year we met inside Cowboys Stadium.
• We hold monthly follow-up meetings ensure we advance the collaboration.

(click to enlarge)

Next month, I will lead members of our C-suite on site visits to our strategic partners’ corporate headquarters to enhance the executive relationships. My hope is to bring about opportunities that will help fulfill our mission and vision. Although we are unable to devote equal amounts of energy to all suppliers, we do scorecard every strategic, tactical, and emerging vendor annually.

Measure Outcomes

To measure benefits differently for each level of supplier, consider the following: quality of product and service, shared value, maximization of investment, branding, influence, price points, and innovation. Assessed annually, these outcomes are part of the scorecard process as well as topics of discussion among executives on both sides. This forum for transparency and accountability leads to a win-win collaborative approach.

On a practical note

Suppliers persistently seek the CIO’s attention. I wish I had the energy to meet with each one. Having a structure and proactively managing vendor relationships allows me to treat all vendors fairly and frees me up to focus on what matters most.

By concentrating exclusively on our strategic partners, I can ensure that we exploit both investment and commitment. The described process above values vendor interests while optimizing benefits for our health system, clinicians, and patients.

To encourage comments, I will send a generic version of our strategic partnership framework to all who post. The framework contains significantly more detail.

Update: Response to Comments Posted Through 5/14/10

I appreciate the richness of the responses!

A couple of comments. As stated in the post, we work with hundreds of vendors. By definition this implies that we do not have a single vendor solution. There are so many variables to consider and it comes down to the uniqueness of each institution and culture. For us, we have found that a hybrid approach works well. A handful of broad based vendors and BoB. That said, the point of the post was not a position on either but rather the advice that you must maximize your vendor relationships. One way this can be achieved is with structure. It is not a new concept, but it is yet largely unpracticed.

With vendor partnerships, especially with those that are considered strategic, you need to build in formal controls so that the relationship does not go sideways and either party gets scarred. These controls and rules of engagement address things like kickbacks and do not allow for discounts for “talking up vendors”. I touched on this briefly and those of you who left your e-mail, you will get more detail shortly via the generic framework.

In fact if you like what you receive, let HIStalk know and I will send out our very detailed scorecard and review system. It is hard for me to believe that vendors and customers do not sit down together at least annually and score one another. It leads to some tough conversations that are crucial for shared benefit and success. You are what you measure.

I happen to agree with the sentiment that healthcare IT is so far behind and other industries are more customer-centric. You need to read my post Why Healthcare IT Lags.

One of the things we analyze when considering a vendor relationship is the leadership. I believe our strategic partners have had the same CEOs in place for many years. We look for consistency in leadership, so we have not hit the revolving door issue that someone asked about. All of our strategic, tactical, and emerging vendors have made these reciprocal relationships. If they don’t, it is not a relationship and we will end it.

I smiled when I read the comment that our vendor framework is flawed for lack of physician input. I am fortunate to have three physicians in IT and, trust me, they are not shy and I am thankful for this. In fact, they are one of the main reasons we have been so successful with leveraging IT. We have an IT governance council made up of many other clinicians and our C-suite includes an additional three docs.

I am wise enough to know that customer input is a key success factor. I shed my office 15 months ago so I would not become too comfortable. Instead, I spend more time with my customers in their environments. You don’t know me. Keep reading and you will.

You know, I am not sure on the question about inadvertently creating an internal hierarchy based on which vendor you might work with. I can see the point. None of my team has mentioned this as an issue, nor have I seen any behaviors to be concerned with. But I also know that despite my direct team engagement, I can be sheltered. I will need to watch out for this.

So for my IT colleagues, either manage your vendors or be managed. For my vendor readers, if your customer does not have a framework, recommend one. The benefits are mutual. We need one another. I am fortunate to work with many incredible vendors and feel good that we have a fair and equitable framework from which we can build on.

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

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From Snoop John B: “Re: Cattails MD. Heard its implementation at Ministry Health has been suspended because of poor upgrade quality.” I asked Ministry CIO Will Weider, who says the implementation has not stopped. Three clinics are live and planning is underway for the remainder. They are reviewing their plans and figuring out how to incorporate Meaningful Use. Will was nice enough to provide a summary:

There have been the usual surprises and unanticipated occurrences. So, this won’t be my first flawless large clinical project. In March the system (it is hosted by Marshfield Clinic) had some stability problems. That may be the source of frustration from your source. It was frustrating for us too, but Marshfield Clinic, led by their CIO, has taken ownership of their problems. We at Ministry are also working through our issues. The situation has improved and Marshfield Clinic has bent over backwards to provide us reports to monitor stability. They are also quickly updating their systems to prevent recurrence of the problems. They have been very transparent in their efforts. I have lots of different clinical system vendors, so I can put Marshfield Clinic’s support in perspective. They are better than most, but admittedly, the bar is not as high as I would like. As you can see, I am not afraid to share the good and the bad (hence the blog name candidcio.com). Our contract doesn’t contain a gag clause like many vendors. So, I will email you directly if our plans change.

From 153 Anecdotes: “Re: FDA’s MAUDE database. Updated with additional anecdotes.” MAUDE is FDA’s database of voluntary reports of adverse events caused by medical devices. There are quite a few reports related to Cerner Millennium, although there’s no way to tell if they were filed by one disgruntled practitioner or several concerned facilities. Some (most?) of the reports involve design complaints rather than actual examples of patient harm, such as: “This cpoe product allows doses to be ordered that are not a multiple-s- of the pill size.”

From Nolo Contendere: “Re: does anyone do background checks? [Name omitted] was recently hired as VP of sales for [vendor name omitted]. Here are links to public records. People are sending this all around, making the vendor a laughingstock.” I’m omitting the names and the links since I don’t want to get threatened, sued, or notified that the guy killed himself or something because I mentioned his crimes (theft, drug possession, driving violations, etc. with some jail time and house arrest). Or for that matter, notified that it’s someone with his name but not the same guy. If it is, he’s bounced around quite a few EMR vendors and has also been accused of stealing leads from competitors a la Glengarry Glen Ross.

From The PACS Designer: “Re: Google search enhancements. Google has made over 500 changes to its search capabilities over the last year. TPD likes one of the new search options that now appears on the left when you first begin your search effort.” I noticed the 3D logo, the left column that allows subsetting the results by source, and some minor redesign. I like it.

Listening: She and Him, musically marginal, but I’m crazy enough about about Zooey Deschanel in movies that I’ll listen to her sing.

Weird News Andy runs across PriceDoc, which he calls “Priceline for doctors” where prospective patients can name their own cash price for specific dental, medical, and vision procedures.

I got a really nice handwritten card from Brittanie Good, marketing director of Enterprise Software Deployment, who thanked Inga and me on behalf of Team ESD for mentioning their new sponsor ad. “We are very excited about our growth and refreshed changes, and we are proud to be a sponsor of HIStalk. We love what you do – keep up the great work!” I’m always amazed and moved that I have such supportive sponsors. I’ve stood the card proudly right beside my monitor.

A New York Times article titled The Agenda Behind Electronic Health Records pits athenahealth’s Jonathan Bush against ONCHIT’s David Blumenthal over the issue of whether HITECH is a cash-for-clunkers program for old-line vendors at the expense of upstarts or the logical way to goose EMR usage among reluctant providers. According to Bush, “Established technology is being given a federally funded new lease on life … Traditional health software now is on Medicare, being kept alive like grandma.” Blumenthal’s comment was that the government had to intervene to correct a market failure, saying, “The market doesn’t reward performance.”

Speaking of athenahealth, the company responds to Dr. Deborah Peel’s HIStalk editorial on athenaCommunity and patient privacy.

Jeff Surges, sales president for Allscripts, is appointed to the board of Merge Healthcare.

Voalté releases a white paper covering the use of smartphones at the point of care.

A medical group that provides services to correctional facilities in 25 California counties chooses eClinicalWorks.

Mac McMillan, CEO of IT security consulting firm CynergisTek, is serving (warning: PDF) as a panelist at a HIPAA conference sponsored by the Office of Civil Rights and National Institute of Standards and Technology that started Tuesday. His session involves OCR’s enforcement of privacy regulations.

Evidence-based protocol platform vendor Order Optimizer forms a strategic alliance with EHR vendor Prognosis Health Information Systems. Prognosis will make Order Optimizer’s protocols and orders available to its customers, along with its SaaS-powered merging engine.

Intuit will buy (warning: PDF) Cary, NC-based patient portal vendor Medfusion for $91 million in cash. Intuit (QuickBooks, Quicken, TurboTax, and Quicken Health) says it will use the Medfusion’s technology to enable patients to communicate with providers, review their health information, and track their healthcare expenses. They also mention the Meaningful Use requirement to give patients access to their records. Medfusion founder and CEO Stephen Malik will become an Intuit SVP and general manager. Allscripts announced a deal to distribute its patient portal a year or so ago.

Vanderbilt chooses Allscripts Care Management for discharge planning.

Nuance announces Q2 results: revenue up 19.2%, EPS –$0.05 vs. $0.02 due to the cost of its acquisition of SpinVox, which converts voice mails into text and e-mail messages.

Cottage Health System (CA) expands its use of Eclipsys applications by choosing the PeakPractice PM/EMR and Eclipsys HealthXchange to link community physicians with its inpatient Sunrise Enterprise system. The HIE product is powered by Medicity.

Northwestern Lake Forest Hospital (IL) says it saved $3.4 million in nurse labor costs through its use of the Kronos workforce management system to reduce overtime and agency use.

Hunterdon Healthcare (NJ) uses InterSystems Ensemble to connect its QuadraMed Affinity HIS to the NextGen PM/EMR of its physician groups.

Twelve hospitals in Australia sign contracts for the Emendo CapPlan capacity planning software. The company plans to enter the US market next year.

Apollo Hospitals, a private hospital operator in India, signs a deal with Cisco to deploy desktop-based telemedicine applications to rural parts of the country.

All Children’s Hospital (FL) will expand its use of GetWellNetwork’s education and entertainment system, courtesy of a donation from a local entrepreneur.

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Thoughts About athenahealth
By Deborah Peel, MD

Another misguided, uninformed EHR vendor will discount the price of EHR software for doctors willing to sell their patients’ data!

How is it possible to be so unaware of what the public wants? The public doesn’t want anything new or earth-shattering, just the restoration of the right to control who can see and use their medical records in electronic systems.

Not only is the practice of selling your patient’s data illegal and unethical, but the new protections in the stimulus bill require that patients give informed consent before their protected health information can be sold. So selling patient data without consent is now a federal crime.

Quotes from the story:

• athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use athena’s health record software.
• athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from athena’s network.
• Caritas Christi [Health Care] initially launched athena’s billing software and service in October and then revealed in January that it decided to offer the company’s EHR to physicians.
• How many patients would agree to sell their health records to help their doctor’s bottom line AND at the same time put their jobs, credit, and insurability at risk?

Health information is an extremely valuable commodity, so people are always thinking of new ways to use it.

What will athena’s informed consent for the sale of health patients health data looks like? Will athena lay out all the risks of harm? Will athena lay out the fact that once the personal health data is sold, the buyer can resell it endless to even more users? Will athena caution patients that once privacy is lost or SOLD, it can never be restored?

I guess some people are so out of it they do not realize what a barrier the lack of privacy and lack of trust is to healthcare. HHS reports 600,000 people a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Another 2,000,000 refuse early diagnosis and treatment for mental illness for the same reasons.

Check out slides from a recent conference at the UT McCombs Business School on the subject of patient expectations, privacy and consent.

Deborah C. Peel, MD is a practicing physician and the founder of Patient Privacy Rights.

Thoughts About athenahealth
By Truth Seeker

Um, I think we need to settle down here, folks. I may be wrong, but I believe when athena refers to athenaCommunity and the exchange of information, they are referring to the following hypothetical scenario:

A patient whose primary physician is an athena customer needs to be admitted to the hospital. athena delivers to that hospital a clean, clinically accurate, and up-to-date record of that patient’s medical history and charges the hospital a few bucks. athena is able to charge the primary care physician a lower fee for their EMR service because they are shifting some of the financial burden to the hospital. And intuitively, this make sense for a couple reasons:

The push towards electronic medical records is to enable greater exchange of information and better coordination of care, etc So when athena talks about athenaCommunity, I’m fairly certain that they’re not talking about a sinister plot to share info with hospitals so they can refuse to admit high-risk or expensive patients. (Seriously, the conclusions people draw from articles like this without doing their homework can be completely ridiculous, but I suppose that casting baseless aspersions is just the nature of informed discussion in the Internet era.)

They’re just talking about handing the patient over to another provider and making sure that the new provider has a completely accurate and up-to-date record of that patient’s medical history, and of shifting the financial burden from the handover away from the primary care physician. What a "privacy disaster" … a sheer outrage!

And second, I’m no healthcare economist, but I’m pretty sure that a) the hospital really wants and needs that patient’s medical history and that athena is probably better positioned to deliver it in a more useful format than a lot of their competitors; and b) it’s probably worth a lot more to the hospital than a few bucks. 

I’m not an athena employee or other stakeholder, but I do think that they continue to think of innovative new solutions to problems, bottlenecks, and inefficiencies in the healthcare system. Unfortunately, they seem to have a bulls eye on their backs right now. I for one am happy that we have smart people like Jonathan Bush out there coming up with creative new solutions. 

Why Emergency Physicians Prefer Best-of-Breed IT Systems
By John Fontanetta, MD, FACEP

According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use.

This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system. The resulting systems have their own interface issues.

Like many of my fellow ED physicians, I have found that a first-class BoB system tailored specifically to the needs of the ED, in our case EDIMS, offers a number of advantages. For example:

• Workflow in the ED is measured in seconds and minutes rather than hours or days. The fewer clicks required, the faster the care. At Clara Maass Medical Center, we can issue complete sets of orders in as few as three clicks, enabling our physicians to be more productive.
• Trying to retrofit an inpatient IT system to the ED is difficult because the ED is just so different from the floors. Customized ED order sets with a linked charge capture system means less delay between treatment and billing, not to mention a more accurate capture of charges, which has dramatically increased our per-patient revenue.
• In the same way, customized alerts that tell the ED staff what they’re forgetting to document cuts back on the number of claims denied due to missing or inaccurate information. At Clara Maass, we have slashed such denials by 75%.

One of the most important things about a good ED system vendor is responsiveness. The vendor should be able to quickly accommodate the ongoing changes in standards and regulations. For example, at Clara Maass, when the H1N1 virus first appeared in 2009, we had templates for recommended care and discharge instructions built into our system by our BoB vendor within 24 hours. And when we decided to create an observation area, they promptly responded with observation-specific templates and order sets and created a secondary note option for the observation physicians.

The EMR system has enabled us to make a number of other improvements in our ED. For example, we have reduced the average patient turnaround time by over 30%. We have boosted the number of EKGs we perform within five minutes of a patient coming through the door from 46% to more than 90%.

Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden. 

CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.

John Fontanetta MD, FACEP, is chairman of the department of emergency medicine at Clara Maass Medical Center, Belleville, NJ and chief medical officer of EDIMS.

Digging for Gold in your HIT Applications
By Ron Olsen

Over the past few years, hospitals have focused IT budgets and resources on purchasing applications to enhance their HIS. Many facilities have spent tens or hundreds of thousands — millions for the larger hospitals — on licensing, maintenance, and ongoing professional services.

In the feeding frenzy to continually acquire and implement the latest healthcare information technology, most IT/IS teams are neglecting to ask basic but important questions about their existing applications, such as:

• Are we using the software to its fullest extent?
• Have we turned on every feature we’re currently licensed for?
• Are HIT products meeting the needs we identified when planning the deployment?
• Have we asked users what they’d like to see added to the product, and if so, has that been communicated to the vendor so they can include it in a future version?

Asking questions does not cost anything and end users are usually very vocal about what they’d really like to see software do for them. Their invaluable real-world input is useless if there’s no feedback mechanism, or if your team refuses to incorporate it into product roadmap discussions with vendors.

In a time in which hospitals’ funds are tighter and IT budgets frozen or cut, it’s time to double back and review what products you have purchased and their capabilities. Maybe re-present the product to different areas of the facility explaining existing functionality again, and introducing new features that have been added since the initial implementation. Now that the users have gotten a refresher, they may identify functionality that was not implemented initially and would now prove useful.

Healthcare technology vendors are always eager to showcase new features and theoretical uses for these at sales presentations, but IT/IS admins often overlook “hidden gems” in the software that other hospitals are actually using. If the vendor has a user group, listservs, or an online forum, these are great places to start, not to mention that they cost nothing and consume very little time.

These collaborative tools may enable your team to discover other use cases that even your vendors have not thought of. There are a lot of people in the healthcare IT trenches creating workarounds every day. There may be capabilities within current products to join with other systems within your tool bag to create a new or improved process that is, again, a freebie.

One of the most over-used buzz words in healthcare IT is “interoperability,” a is really a big word that self-important people use to describe data transfer. When thinking about data transfer at a basic level, almost every HIT product can output to a printer. A printer can be easily set up to print to a file. So now you have data in a file format.

Scripting tools can manipulate those files, turning them into almost any format imaginable. With the correct format, data can be transferred to disparate systems, individually or concurrently, via a data stream. This could be a raw text file, compressed zip file, encrypted e-mail file, FTP, or an HL7 file.

This method is easily applied to an enterprise forms management system. If it has a decision engine, you could print a form set from it and then have the engine input the data to a database for audit trails (you should be able to choose the data points). Next, the engine sends the data to a file and launches an application to text the ordering physician that the patient just presented, based on the data in the text file.

If you’re a budget-conscious healthcare IT professional who wants to better meet the needs of your user community, I implore you to take another look at the systems you’re already working with. In my many years as a system admin at a community hospital, getting more out of the tools available to me (instead of just relying on new purchases) helped me deliver more effective tech solutions to my users, positively impact patient service, and keep decision makers happy by saving money.

You, too, have gold nuggets hidden in your existing software. It’s up to you to find and use them.

Ron Olsen is a product specialist with Access.

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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.

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’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.

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?

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.

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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