Brigid O’Gorman is a junior at Connecticut College in New London, CT, majoring in cellular and molecular biology as a pre-medical student. She is captain of the women’s hockey team, a registered emergency medical technician, and winner of a $10,000 Davis Projects for Peace grant for her project to implement electronic medical records in rural Uganda. Connecticut College is contributing $3,000 as well.

While traveling to the airport with a group of Connecticut College students leaving on a medical mission to an orphanage in Kaberamaido, Uganda in the spring of 2009, a drunk driver struck the van in which they were riding, injuring several of the students and killing the trip’s organizer, who would have graduated in 2010, and in whose memory the clinic in Uganda has been renamed to the Elizabeth Durante Medical Clinic.

 
Brigid O’Gorman
Photo: The College Voice

Tell me about yourself.

I’m from Eden, New York, just outside of Buffalo. I live on a farm. It’s really fun, I love it. My dad’s a physician, an internist. My mother has her own flower business.

I went to Nichols School in Buffalo for high school. It’s a private school. I was captain of the women’s hockey team there. I also played soccer and lacrosse there. Then I came to Connecticut College and I’ve been playing hockey here since freshman year. I’m now the captain of the team. I played lacrosse my freshman year, but decided not to do that any more because it was during spring break and I’d rather go to Uganda during my spring break. That was my option and that’s how I got into this whole Africa thing.

Going to Africa has been something I’ve wanted to do since I realized I wanted to be a doctor. I’d always wanted to travel. I’d been to China and Africa was the next place on my list to go. I absolutely love it.

I found out about this opportunity to go in the fall of 2008 through my school. There was a pre-health club meeting which I’m a member of. So I went to this meeting and a couple of girls were up there talking about how they wanted to take a group to Uganda on medical mission. That was like right down my alley. I went to this other meeting and signed up for it and that’s when I got to go last year.

What was it that intrigued you about Uganda?

Nothing in particular. I would have been satisfied to go anywhere in Africa, quite honestly. Uganda is where these two kids started that group to go and they had been there the year before with Asayo’s Wish Foundation. They’re out of Salt Lake City, Utah. They have an orphanage in Uganda.

I ended up going by myself, but what we did last year was go with Asayo’s Wish Foundation. I worked at a medical clinic in this town where the orphanage was. I wasn’t so much interested in children, although that was really a fun experience for me. I worked with a doctor, mainly, and I kind of played around with the kids.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What were your impressions from a medical or public health standpoint?

I got to take blood samples and got to look at the malaria parasite under a microscope. It wasn’t powered or anything, but it just had a mirror that caught the sun so it would shoot light up through so you could see it. Obviously technology is extremely lacking. They only had one of those in this medical clinic.

The doctor had one nurse that helped him out. The way it works over there in these clinics is that the doctor just kind of showed up whenever he felt like coming to work, really. He would just, like, show up and people would hear that, “Oh, the doctor’s in his office, so we can go now.” They don’t set up appointments or anything — people just show up and line up outside the office. They just kind of sit outside on the ground, first come, first served. You get there early and keep it and you get an appointment.

He and myself, we got to give them all sorts of medication. I brought over a lot of antibiotics with me that were donated by my father’s office here, so we got to hand out antibiotics. Most of the people had malaria, so we’d have to hand out malaria medication. There was a lot of STDs, so we had to hand out antibiotics for that.

From a healthcare standpoint, they really need medicine. There’s nothing. There’s practically nothing. I’d say the bulk of the supplies they had I brought over with me. That was kind of special just to donate all those things to the people.

Tell me about the grant you got to set up electronic medical records and how you got the idea.

I got the idea because while I was there last spring, whenever the doctor had a patient come in, he would write down their symptoms and ask them questions like, what are you here for? He’d write down their symptoms and what he thought they had and what he was going to prescribe them in this little blue book. It’s just like an exam book that I take my exams in here, so I was like, wow, that’s really weird that I’m seeing these thousands of miles away from my college. It was used to keep their health records in. I thought that was a little perplexing, to say the least.

After he’d fill it out, he’d give it right back to them and say, hold on to it. It would have their past visits to the doctor in it so he could go back and look and see what they last came in for and if it’s any pattern or relation or anything. A lot of the patients didn’t have these, because the doctor gives it back to them, so most of them lose them because they don’t realize how important these things are. They have no concept of staying healthy or this whole medical record system. They weren’t concerned about holding out to this blue book, so it was often that they didn’t have one, which was difficult to try and figure out if this person had a previous medical condition that you didn’t know about.

When we were there, I also worked in the orphanage with about 180 children who didn’t have any medical records either. I kind of built on that foundation of the blue book they were using. I bought blue books there and we started health records for all these children. We wrote down their name and age. A lot of them didn’t know their age because they were orphans, so we’d have estimate their age from their weight or their height. We started that last year and I’m really hoping that it’s continued and people are doing checkups on them and doctor’s visits and things like that.

This was what got me to thinking that they need a more reliable system, I would say. I mean, how are these orphans going to hold on to these little blue books when adults can’t? I thought, I’m a college student and I know about computers, which isn’t that hard to figure out. It’s not that hard to install them. I’ve done it before and it’s simple.

I was planning on using the electronic medical software, hopefully from MEDENT. I haven’t purchased it yet. I know one of the company’s branches is in based out of Buffalo, so I was hoping to talk to them and hopefully get some donations of this system for my computers. One of my dad’s doctor friends has this MEDENT software at his office and I’m going to go see it. I’ve looked at it online and it’s pretty much what I need. I actually need a simpler form of it because I don’t need X-ray scans, I don’t need all the pictures and MRIs they can set up on these systems. I just need patient assessment, patient information, history, just very general, simple things. I’m going to try to work with them and get that going.

I haven’t bought my computers yet, but I’m going to get four of them from Dell. I’ve already talked to them about it. I’m going to have them sent to my house soon and get the medical software installed at my house and set up this whole little system at my house so that when I get to Uganda, I won’t have to worry if something goes wrong with the computers. There isn’t really going to be anyone there to help me, so I’m just going to try to set it up prior to getting there.

I know they have gasoline over there and can power generators. The electricity they have isn’t a lot. They only had one light bulb that actually worked and they ran it on a gas generator, so I figured that would be easy to power the computers. I’d just get a bunch of generators and I could help them power more and have more electricity at this place. That was my original idea. Then I was talking with one of my advisors here from school and she mentioned why didn’t I think about solar panels? I decided to look into the solar panel idea. I learned a lot about them. It sounds a little complicated, but it’s really pretty interesting. It’s not that difficult.

I’ve located a business in Kampala, which is the capital city of Uganda, that sells solar panels and will install them for you. That’s where I’m going to be purchasing my solar panels and I’ll be doing that when I get there. It’s an eight-hour drive from where they are to where I’m going to be, where it’s extremely rural and there isn’t anything around. They’re going to drive them out there and install them for me, which will be great. I hired an electrician already to make sure that the electricity works. I’ve hired a computer technician. These are all native Ugandans, so we’ll see what I get. I’m pretty excited about that.

 
Brigid O’Gorman, Uganda 2009
Photo: Connecticut College

What will your system do?

I’ll have two facilities. One is at this medical center and another is at the local hospital, which is turning out to be a little difficult because this hospital is a government-run hospital and it’s actually from what I’ve heard and found out from people who are working there right now has ended up being corrupt and things are getting stolen, so I’m not sure how much I want to invest in that hospital, but I’m going to give it a try.

My primary facility for this will be this medical center that is on the orphanage property. My plan is to have two computers, one in the patient room when a patient comes in. That will be there for patient visits. The second one will be in another office in the building. That will be for collecting blue books and transferring information from these blue books into the computers. I’m going to have a system where the information is transferred from these blue books to computers, and at the same time, the doctor will be doing his normal patient care. Instead of writing things down in their blue book, he’ll be putting it into the computers, so we’ll probably be tackling two things at once.

I’m bringing printers because they don’t have any form of identification over there. That got me thinking because when I got my driver’s license, you finally have that little card that identifies you. It’s just a huge symbol of who you are to my mind. To make ID cards for these people over there, I really think would have a huge impact on them. I think they would absolutely love it.

We’re going to have webcams to take pictures of each patient, so their information will be in the computer along with their picture so that you can recognize them. The picture and their name will be printed on this card and we’ll laminate it and give it to them. It will all be on the computer, so if they lose it, we can print them out another one.

I was also thinking about making ID numbers for each name, just so that you can enter the number or name either way so the person’s medical files will pop right up. They hand you the card, you type in their number, and you have their medical file immediately sitting in front of you. You know their whole history and you know everything that’s been wrong with them up until now. That’s my goal for those cards — just to give them the thrill of having an identity and something physical to hold on to that says they’re here, they belong here. And also to expedite their gaining of their medical files that are in the computers.

They’re going to be powered by solar energy, so after the initial purchase, so it won’t cost very much, hopefully nothing at all except maybe for maintenance which shouldn’t be too bad because solar panels nowadays are pretty durable.

Part of my proposal, so that the system doesn’t degrade after I leave, is to start training some of the older children of the orphanage. There’s 18- and 20-year-olds living there, so my idea was to start training them on these computers and have a different type of vocational program where I would teach them how to input the information and teach them all about computers and what I’m doing so that they are that much further ahead.

In a country like this, especially in this rural area, having the knowledge to work on computers would be huge for children there. Maybe someday if they wanted to leave that area, they could go and work for the government in Kampala; they could work wherever they want. That’s another piece of my project that I’m really excited about, just to help boost kids up and give them something to do with their lives. 

Elizabeth Durante, 1988-2009, photo overlaid with that of the clinic renamed in her memory
Photo: Asayo’s Foundation

If someone wanted to help you with this project, what else do you need?

I actually haven’t yet bought anything for it. I’ve been trying to concentrate on my school work right now. I’m a junior and I’m taking organic chemistry and it’s not easy, so I’ve been really focusing on my studies right now. I’m not leaving until July 1, so I have a lot of time once school’s over to start getting into it.

I’m going to be needing four computers, two printers, a laminating machine, the solar panels that I’ve already purchased over in Kampala, and any kind of electronic medical record software that I can install on the computers. I’m focusing on MEDENT because my dad’s friend has used it, he’s accustomed to it, and his office likes it, so that way I can get a feel for it from him.

I kind of need everything, but I do have the money for it, so that was really cool and I’m so happy to have this grant.

Other than the fact that the patient carries the record in Uganda, we’re not all that advanced in the US, where your record is in a manila folder on some shelf someplace and people debating whether it should be in a computer instead. What are your thoughts about that?

It’s a debate and there’s a lot of sides to it. I’ve discussed this with my dad because his office runs on those manila folders. They have the hard copy paper and that’s what their patient files are. He has files full of them.

The doctors I go to personally have the electronic medical record software. I work in the ER and that’s what all their systems run on. It’s definitely faster and more efficient, but you also lose the personal aspect of sitting down with the doctor and having them actually writing things in front of you and taking those notes.

It is a difficult debate, but I would have to side with the electronic medical software because it’s permanent and it keeps things safe. The personal aspect of it can be accomplished by doctors actually learning the computer rather than just dishing off information to a nurse or something and having them try to interpret their writing and put it in. If it becomes more familiar to people, it will be really good, but you can’t lose that personal connection between the patient and the doctor. That makes people comfortable and that’s why we’re doctors.

You’ve made time for a rigorous academic curriculum, hockey, and volunteer work. Are the people you know equally involved or are you different?

I never actually thought about that before this whole story started coming out. Recently I was nominated for the Hockey Humanitarian Award, which is given to the best hockey humanitarian student, male or female, from any Division I, II, or III college. That’s what got me thinking that I guess I’m not really normal. I really thought, don’t other people do these things? I really didn’t think it was that uncommon, but apparently it is.

I just do it because I love it. I love to travel. I fell in love with those kids I got to work with last year, so that’s why I really want to go back to this part of Africa. I just really loved the kids there and I’d love to help them.

My pre-med studies are going pretty well right now. Organic chemistry is not easy for me, but it’s OK. My other classes are fine. I’ve been playing hockey since I was four years old. My dad was my coach. That was my first love and I’ve been doing that forever. That got me into school and pretty much filled up my life and who I am.

I found this other volunteering stuff. I volunteer at High Hopes Therapeutic Riding center in Old Lyme. I got there every week once a day, usually Saturdays, for two or three hours. I lead horses around and we help mentally disabled or physically disabled children learn how to ride horses. It’s a therapeutic technique and it’s actually really, really exciting. I love doing that. I started doing that my freshman year and that really got me into volunteering. I coach younger children’s hockey camps and stuff like that in the summer and girl’s lacrosse camps. I like to do all that because I love kids and helping people.

What kind of medical career do you hope for?

There’s so many options. At first, I was thinking I’d like to be a pediatrician because of my experience with these kids over in Africa. That really put me toward that path.

Right now I’m not really looking to settle into a practice anywhere because my primary goal is to get into med school and work with Doctors Without Borders for a few years before I actually grow up or anything. I would love to work with them and travel with them wherever they need help. I would have gone to Haiti in an instant if I were an actual doctor right now.

Then maybe after I’ve had my fill of traveling around and adventure, I’ll settle down and be a pediatrician or maybe a primary care provider.

Does your father approve of your going into medicine?

At first, he didn’t really have much to say about it. He didn’t think that was a choice for me because you really don’t really have a life until you’re out of school, and still you’re a doctor and don’t have a life except for what you do. He wasn’t thrilled about that, but as I’ve been doing these things, he’s really come to see that this is what I want to do. He’ll bring up a topic like, are you doing these things right now and how are your grades and are you ready to do this? He’s really come around. Our entire family thinks this would be great for me, so I’m glad to have the support from them.

What schools are you considering?

Right now what I’m thinking is that my GPA is not exactly stellar. I’m at like a 3.0 right now because of this organic chemistry. Hopefully by the time I graduate I’ll have it up to a 3.3 or something, but medical schools want 3.5 or higher from what I’ve heard.

I’m probably going to do a post-bac program. Drexel has a good program. I think you get a master’s in public health and then they ship you off right into a medical school program from there, assuming you do well on your MCATs and do well in the classes. I’ve been looking at the University of Buffalo. Their medical school is where my father went.

I would like to stay closer to home, just to have that support, but I’m seven hours from home right now in Connecticut. I like that aspect of being away, too. It’s a difficult decision, but I will go anywhere I get in. I don’t really care what part of the country it’s in. I just want to be in med school.

If anyone wants to get in touch with you or offers help, I’ll forward their information to you. And if you have an interest in writing something up or sending pictures, I’m sure people will want to know how you’re doing over there.

First of all, I’d love the help if people would like to help. I have $10,000 in grant money so far and I’m going to be fundraising a little bit more, just to gain a little money for the orphanage itself and try and buy a lot of medications for this clinic that I’m going to be at, because other than this system, they really need the drugs to make everyone healthy again. I’m going to be doing a little bit of fundraising and a little bit of extra money would be helpful.

The electronic medical records software, if anyone comes up with an idea or wants to donate something about that or a simpler version of one of these high tech ones, that would be really helpful.

I’ll definitely get back to you by the end of August or the beginning of September. They actually don’t have Internet where I’m going to be and I’d have to have a lot more money to get it shipped in if I wanted Internet. I am two hours from an Internet site, so obviously my parents aren’t happy since they can’t talk to me very often, but I will be going back and forth from this town to get supplies because there’s basically nothing where I am. It’s just like a store, your orphanage, your clinic, and a whole bunch of homeless people, but I could be able to get in touch with you.

If someone is inspired by your story and would like to make a difference like you have, what advice would you give them?

Do what you love to do. That’s all I’ve been doing. I started out loving to travel, and then that got me out to Connecticut, and then I ended up in China, and then I ended up in Africa and fell in love with a bunch of orphans and taking care of people and volunteering. My advice is just do what you love and follow that because your potential is completely unlimited. Go for it.

 View/Print Text Only

From Sea Pea Oui Couvert: “Re: say it’s not true. This is not supposed to happen when the entire hospital is wired. Millions spent on EMRs, yet they forget informed consent and then cover up the adverse events.” UPMC’s transplant program is cited by state health department inspectors for violating federal regulations, including failing to document organ and blood matches before transplant procedures were started. The state got suspicious when UPMC reported only one adverse even in a year.

From A Tax’ing Employee: “Re: our CEO at Sunquest. He just moved to Tennessee for what I heard were ‘tax reasons’.’ He has never lived in Tucson for the same reason. Is that fair that he is allowed to live anywhere to dodge taxes and we are not?” Unverified. If it’s my money as a customer or shareholder, I’m cynical about work-from-home CEOs unwilling to relocate to the home office. It’s their call, though, and I’m probably more old school in that regard given today’s virtual organizations.

From The PACS Designer: “Re: iPad’s booming sales. Apple has sold one million iPad’s since the recent launch, the fastest sales results ever for Apple. As we head toward the middle of this year, it will be interesting to see if there will be any waning in the monthly sales figures for the iPad Wi-Fi version now that the iPad 3G version is available for sale.”

Several dozen provider organizations, including AHA and AMA, offer HHS their comments (warning: PDF) on Meaningful Use. They and I agree on the parts we don’t like:

1. The all-or-nothing approach, where you either meet all the criteria or get nothing (actually, I’m OK with that part as a taxpayer footing the bill).
2. The aggressive timetable for complex applications such as CPOE and medication reconciliation that aren’t usually front-loaded in implementation projects.
3. The overall short timeline.
4. The underrepresentation of small practices on the HIT Policy Advisory Committee.
5. The two EDI-related non-clinical requirements for eligibility and claims.
6. The definition of a hospital using Medicare provider numbers.
7. The parts I immediately pounced on when the proposed criteria were published  — manual chart pulls are required to arrive at a denominator for electronic performance metrics, such as the percentage of orders placed via CPOE.

Weird News Andy uncovers a gem: two employees of Olive View-UCLA Medical Center are placed on leave after complaints to Joint Commission that they are running a beauty salon out of the hospital’s NICU. They were giving manicures and eyebrow waxes to co-workers, with one complaint alleging that a doctor “had a French manicure right on the high-frequency ventilator.” WNA also likes this research finding: dark chocolate can protect the brain in stroke patients, which means I’m set in an emergency because I like to keep some of the good stuff (more than 50% cacao) around.

Listening: the new CD from just-reunited Hole. Courtney Love doesn’t do it for me and I was hoping to hate the new music, but the band kicks it even though they’re all suing each other and membership changes hourly. I’ll be playing this quite a few times, I suspect.

McKesson signs an exclusive deal to eventually manufacture, implement, and support the i.v.STATION Robot and i.v.SOFT Workflow Engine from Italy-based Health Robotics. It’s pretty hot stuff.

If you are a nurse, happy National Nurses Week, which started Thursday (happy birthday, Florence Nightingale!) I love nurses (literally, since I married one), so here’s a shout-out to the one group of professionals (both male and female) that hospitals can’t run without. I wrote this in 2003 in their honor, obviously from a community hospital perspective since I was working at one of those instead of an academic medical center at the time:

The only critical people involved in patient care are nurses … My experience is that 80% of patient care is directly influenced by nurses, often via skillfully planted recommendations that allow doctors to believe they thought of it themselves. Your patient satisfaction surveys are almost purely driven by the quality and compassion of your nurses. So is your level of patient safety. Nurses clean up the vomit, hug the babies, keep doctors from killing patients, give the drugs, do the Code Blues, and comfort the families. All the rest of us are hangers-on who look like deer in the headlights on the rare occasions when we stray into an actual patient care area where human triumph or tragedy is unfolding with a nurse at its center … Not too long ago, a hospital was basically a clean building in a peaceful setting (!) where patients could rest and mend. That and nurses were about all anyone needed. Hospital work was charity. No MBAs, no arrogant doctors, no government red tape, no formulary of 5,000 drugs, and no cadre of specialists making large salaries to do small tasks. Oh, and by the way, no computers either. You know what? Life expectancy wasn’t that much different (if you exclude the benefits of vaccinations and reduced infant mortality.) Costs were a lot lower. No one got rich in healthcare. Without all the research, the computerization, the fancy architecture, and the lack of John Wayne "I will not let this patient die" heroics, things weren’t really all that much worse when it came to living and dying. If I’m sick, keep the CEO, CIO, PFS manager, and risk manager out of my room and give me the best nurses you have. When you get right down to it, a hospital is still a clean building with nurses. Everyone else is supporting cast, even if their salaries make them believe differently.

Business Week frowns at hospitals that use technology to determine whether patients can afford to pay their bills. Apparently the business publication does not like the idea that customers may actually be expected to pay for the services they consume. I clicked its Subscribe Now link and, given that philosophy, was shocked to find that their subscriptions are neither free nor payable at the reader’s discretion.

Jobs: Epic Inpatient EMR Manager, Eclipsys Physician Consultant, Senior Applications Analyst – CPOE, Epic Clarity Report Writers.

ONCHIT announces $220 million in grants to establish 15 Beacon Communities that will prove the value of HIT. I don’t exactly get that since the message is that they wouldn’t have bothered without the $15 million taxpayer gift (which doesn’t make a strong case for proving value at all), but I gave up long ago trying to dissect the particular pallets on which taxpayer money is being parachuted down over the countryside into greedily outstretched provider and vendor arms. Even the City of Tulsa gets $12 million in federal money to screw around with electronic medical records and see if anything good happens.

I see that Google now has the Google Apps Marketplace that offers third-party add-ins to Google Docs and relate apps. One I noticed contains administrator tools for rolling out Google Apps to the enterprise.

Maybe the doc-in-the-box trend died and I never noticed: Florida Hospital’s Centra Care walk-in clinics now take online appointments, saying it will significantly cut down on wait times. Meaning that if you just show up, which was the whole point, you’ll sit around like you would in the ED except instead of a seriously injured trauma patient holding you up, it’s somebody healthy enough to have made an advance appointment. That and posting ED wait times to troll for non-urgent patients makes me wonder what the heck providers are thinking out there.

Inspectors from the VA find lots of problems with the brachytherapy program at the Philadelphia VA Medical Center, among them a VariSeed radiation treatment planning PC that was unplugged for over a year despite regular clinician reports that it wasn’t working. It also wasn’t running on the hospital’s secure network and was used by employees to get on the Internet. 

Merge Healthcare’s Q1 numbers: revenue up up slightly, EPS -$0.04 vs. $0.05. Now they’ve got a couple of hundred million dollars worth of AMICAS acquisition debt to service on top of that. 

E-mail me.
 

HERtalk by Inga

From Celtic Fan: “Re: athenahealth. Don’t know if you saw this article about athena wanting to increase its profile to compete better with the HIT Big Boys. Buried in the end of the article is some information on a new product called ‘athenaCommunity.’ Bet the privacy rights folks won’t think much of it.” athenaCommunity is slated to launch later this year, with discounts for providers willing to share patient data with other providers. Hospitals will pay athena a small fee to access patient insurance and medical information. I asked privacy guru Dr. Deborah Peel what she thinks about the idea. Celtic Fan predicted correctly:

This is an ABSOLUTE nightmare—it TOTALLY violates medical ethics and the patients’ rights to privacy — not to speak of Americans’ well-known constitutional rights to privacy. Physicians who go along with that could well violate state licensing laws which often require adherence to the AMA’s principles of Medical Ethics, as well as violate many state laws that REQUIRE informed consent for disclosures of many kinds of information, from genetic tests, to mental health information, to STDs, to addiction treatment information. athena and all the many vendors who coerce doctors to disclose patient health information without consent will have NO liability. Who do you think the patients will sue for violating their privacy? Their doctor, of course, who chose to use an illegal, unethical EHR system. athena will not pay for this massive privacy disaster —their doctor/users will.

British Columbia’s Interior Health Authority begins its Meditech 6.1 migration with technical assistance from Summit Healthcare.

IBM’s Integrated Health Services division launches a multi-year research project to determine how different actions may affect health. Big Blue will combine and analyze data from a wide variety of sources, looking for cause-and-effect relationships. The project will initially focus on childhood obesity.

Kronos reports second quarter revenues of $177.9 million, a 10% increase over last year. EBITA increased 28% to $41.3 million.

Data storage company Iron Mountain urges CMS to consider expanding Meaningful Use guidelines to include subsidies for digitizing paper records. Iron Mountain’s efforts remind me of similar pleas from the transcriptionist organizations, who think digitized transcription records should be recognized in the final Meaningful Use equation.

I’ve yet to venture to the Apple store to actually touch an iPad, though a field trip does seem to be in order. This HIT writer observed a in-store demo, of sorts, where a Genius was educating a group of healthcare providers on a variety of healthcare-specific applications. Sounds like Apple wants to assure a  piece of the healthcare pie.

Clarian Health is changing its name to Indiana University Health next spring, in part to reinforce its partnership with Indiana University and the IU School of Medicine. Clarian owns or is affiliated with more than 20 hospitals and health centers in Indiana.

PatientKeeper presents Oakwood Healthcare System (MI) with its customer innovation award, recognizing the more than 1,000 users (600 of them physicians) who are using the company’s patient portal since its December introduction.

Hospital CIOs rank EMRs and CPOE as their top IT priorities for the next two years. Other high priorities include database initiatives, bar-coded eMARs, and hospital expansion. Among hospital IT managers and directors, EMR was ranked a mere 7th, far below PC refreshing, security initiatives, and CPOE. Another interest data point: the majority of hospitals were either developing telemedicine programs or already had something in place.

Albert Santalo, founder and CEO of the Web-based practice management company CareCloud, is named the Best Up and Coming Technology Innovator by the Great Miami Chamber of Commerce.

York Memorial Hospital (PA) selects Recondo Technology’s SurePayHealth solution for revenue cycle management.

The Texas Health Services Authority hires CTG to help plan the implementation of statewide HIEs.

Here’s a fun fact to share at your next cocktail hour. By 2020, the amount of digital information created within a year will reach 35 zettabytes. If you put that amount of data onto DVDs, they could be stacked halfway to Mars, making them quite inconvenient to access from your couch.

Gartner reports that Dell has gained the largest market share in HIT, making it the world’s largest provider of HIT services in the world. The ranking is based on 2009 revenues generated by both Dell and Perot Systems.

The 130-provider Jackson Clinic (TN) plans to move from its Misys EMR to Allscripts EHR, integrating it with its Allscripts Vision PM.

Siemens Healthcare appoints former Quest Diagnostics VP John Nosenzo to the newly created role of VP of Zone Customer Relations. Nosenzo will manage the company’s national accounts team and all zone general managers.

Odd: a GE Healthcare employee, having dinner with co-workers, is hit by a stray bullet. The 17-weeks-pregnant woman was sitting outdoors when she felt something hit her in the side. When she stood up, a bullet fell out. It came from a handgun fired from a shooting range that was about a quarter of a mile away. Fortunately, she was only bruised and scratched on her abdomen and both she and the baby are fine. An attorney for the shooting club says a member was at fault for shooting at an unapproved target (clearly).

Researchers at Brigham and Women’s Hospital find that using bar-code technology with an eMAR substantially reduces transcription and medication administration errors, as well as potential drug-related adverse events. The hospital documented a 41% reduction in non-timing admin errors and a 51% decrease in potential drug-related adverse events. Naysayers, feel free to send in your comments pointing out that just because A and B happened together, it in no way implies that A caused B or B caused A — as Mr. H always cautions. I’m just glad someone is taking the time and energy to try to figure out if all this technology really does save lives.

E-mail Inga.

 View/Print Text Only

Amy Andres is chair of the Ohio Health Information Partnership. She was interviewed for HIStalk by Dr. Gregg Alexander.

You have a diverse background. What do you bring to the table for OHIP’s (Ohio Health Information Partnership) Health Information Exchange and Regional Extension Center projects?

I know that a lot of people refer to my background working in the health IT industry, both at Allscripts and for CVS ProCare. I did some work for some software development companies.

Honestly, in this particular project, I think the area where I can be most helpful is my background and experience in the public sector. Bringing people together who may have diverse agendas or may be in a competitive situation, or an adversarial situation, and helping them come together for something that’s for the common good for everybody to cooperate in that environment.

I’ve had some experience with that, both at the Department of Education and also at the Department of Insurance. We have a lot of people with a lot of health IT experience at the table, and although I have it, I think the thing that I bring to the table is helping bring everybody together and see what the long-term good can come out of this particular effort.

OHIP is a public/private partnership. Maybe you could explain that give an elevator pitch on what OHIP does.

The thinking when this project kicked off was that there were the two main funding streams from the ARRA funding. One of those funding streams was intended for states to apply for those funds, and that was to support constructing a health information exchange. The other funding stream was designed for the regional extension centers. 

I think the way the feds thought about it originally was they would have this patchwork throughout the country. Not necessarily within state borders, but just throughout the country, there’d be a support system to help physicians adopt EHRs.

The way we thought about it is two-fold. One, it doesn’t seem like a great idea to have one group working on implementing the support mechanism for the physicians and another group building the system that they’ll be connecting to. It really made sense to bring all of those things together. The federal grant requirements allowed for the states to delegate the authority to apply for the HIE grant if they chose to do so.

What we did in Ohio is said, let’s reach out to the different stakeholder groups that truly are going to be the main participants of not only constructing this, but managing it long-term, and let’s all come together under one organization and do this together. For that reason, the Ohio Hospital Association, the Ohio State Medical Association, the Ohio Osteopathic Association, and the State of Ohio started in talks. BioOhio, who was already a non-profit entity and did some work in the space, also came to the table and offered up help to us get started and help us form such a public/private partnership.

Within a few months’ time, we really pulled that together and had those five entities get started with things. Then, in the fall after we applied for the grants and it became clear that we were going to be receiving some form of funding, we expanded to a full 15-member board that includes payers, behavioral health, federally-qualified health centers … We have consumer advocacy perspective, hospital members, and more, just really trying to bring together a diverse group that could not only give us the perspective for decision-making, but really help pull their communities together along with this process.

Are the other Regional Extension Centers (RECs) across the country working similarly? If not, how do they differ?

We’re not completely unique, but pretty close. I’d say the closest organization to us is a group in New York. Other than that, you mostly have the RECs and the HIE grants being made separately. We have had some feedback from some of the other RECs that that’s already starting to cause them some problems.

We’re one of the largest RECs. In most cases, you didn’t have a whole state form as a group. One thing I will mention about the regional extension center side is OHIP originally applied to cover the entire state of Ohio. So did an organization in the Cincinnati area called HealthBridge. HealthBridge covers the Cincinnati region, also part of Kentucky and a southeastern segment of Indiana. So they took their existing marketplace, both an HIE and they do REC-type services. They applied as well.

So what the feds ended up doing is they ended up reducing our grant slightly and awarding HeatlhBridge as well. For Ohio, it was a good thing because we ended up with substantially more funding, so it requires some level of coordination between OHIP and HealthBridge, which is not a problem. We’ve known those folks for years, have worked with them for years, and on a weekly basis have calls to make sure that we’re staying on the same page.

That’s one aspect that’s a little different, but for the most part, having all of one state covered by a REC is not common. Having it coupled with the HIE, I think there’s only one other circumstance. I guess Wisconsin, I believe is also that way. Other than that, it’s split up.

Is this the uniqueness that you mentioned one of the reasons you think OHIP received such a large chunk of the first-round funds?

I get that question a lot. Lots of people ask, “Who do you know in high places to receive this award?” I have to say this wasn’t a lobbying effort. The effort, really, just stood on its own of the model that we presented.

I do think that it helped that the administration found, and the stakeholders on the physician side came together and agreed to use, some funding that was leftover from a previous program to put up as a state match for the federal dollars in a time of a very tight budget. It was unheard of that entities would come up with that level of money for a match. I think that helps, that we were showing that we were committed to it as well.

I think the real reason that the feds gave us such a strong award is I think they see the merit in the model of having all of the stakeholders’ representation groups sitting on the board, and the level of involvement, not just rhetoric, actually, truly becoming involved. I think the feds recognize this is a model that could actually work and be propagated throughout the country. I think that they made a decision to make an investment in this model to see if it works.

EHR adoption and use timetables are exquisitely fast — very accelerated. Do you think that’s going to increase the odds of making bad decisions or failed implementations as the RECs across the country try to roll this stuff out?

There’s no doubt about it. It’s an extremely aggressive timetable. So aggressive, in fact, that some RECs … There’s definitely been some feedback and folks asking to adjust the timetables.

Here’s what personally I’ve observed in working with folks at the federal level. The interest to adjust timetables is not there. That’s going to stay, but what they have done is absolutely worked with us to try to remove the barriers that are getting in the way of getting there.

Although there was a lot of consternation, especially when everybody recognized at the same while we were in Washington that the timetable for this was really two years, not four years, I have to say that all of our board members — our initial five Board members were there — we didn’t have the same heart attack that some of the other folks had because we know our model. If any model’s going to get us there in this time period, it’s the one that we have.

Concerns over hasty decisions? Yes. When you speed up a project like this, that’s always a concern because you don’t have the time to run down every possibility and mitigate every single risk to meeting a successful project. When you’re in that situation, I think what you have to be open to is making adjustments once you recognize that perhaps a path that you were heading down may not have been the perfect path, and be willing to make adjustments as you go.

I think the other thing that’s key when you’re on this type of time period is to be really open and transparent with everybody about the risks of moving at this speed and establish trust with everybody so that when they see that maybe we made a decision that is not helpful in the process, that we’re willing to admit, yep, a change needs to be made and everybody moves on. I think that when you’re working at this pace, everybody’s got to be open and honest with each other and be willing to make adjustments when we realize they need to be made.

Some have expressed concerns that the RECs are not going to be transparent about how they’re making their decisions for choosing their partners, perhaps leaving some EHR vendors to be shut out. How do you address those concerns?

In our particular REC, our situation, we’re using a competitive process. As a matter of fact, that competitive process is going on right now. We’ve just released an RFP for preferred EHR vendors. We don’t know exactly how many we’re going to select, but we do know it will be more than three and probably less than ten. What we’re trying to get to is allowing for a manageable implementation and pricing that’s attractive for physicians right now.

Probably even most importantly, we’re looking for a commitment from vendors to Ohio. Right now, these EHR vendors, I’m sure, are expressing these concerns. They also have a market of the entire country that they’re trying to grab right now. As a group that has responsibility to make sure that this project doesn’t fall apart, we need to know that they’re not going to overextend themselves in our market, and that they’re going to be here. Once they get started here, they need to finish the job here and really be around to support it long-term.

It’s important for us that we work with vendors that are willing to make a commitment. We’re going to hold up our end of the bargain and do some things to support their efforts as well. There will be, absolutely — and there is already underway — a competitive process and several competent individuals scoring those responses to make our selection. If you’re an EHR vendor and you want to operate in Ohio and you’re not one of the preferreds, you’ll still absolutely be able to operate in this market so long as you meet the ONC certification standards. But we feel it’s important to use a competitive process to select a group of vendors that are willing to make a commitment to Ohio.

Are you saying the selection process is a transparent?

Oh, absolutely. Even though we’re not a state entity, even in the state system — which has probably a very high degree of transparency in the process — while the actual competition is going on, that information’s closed because if that information was released during the actual competitive process, it would give people an unfair competitive advantage. But after the process is completed, all of that information will be made public.

Will there be enough qualified people to help with the implementation, support, and training for all these REC projects? What kind of employees are you going to need with what skill sets and where do you think you’re going to find all these folks?

I have to tell you that that is probably, of everything that is happening within this project, that’s the thing that keeps me awake at night the most. The federal government awards grants to help with that over the long term, and in this project long term means three or four years out. That will be wonderful for long-term sustainability of workforce, but the problem that we have is that the mechanism that they contemplated to implement that through the two-year and four-year colleges does not produce a workforce when we need it, which is during this two-year push. We’re going to need it long term, but we really need some of those individuals right now.

When we were in Washington, it became very clear that the timing of that was going to be a problem. So when we got back to Columbus, the first phone call I made was to the Department of Development and the Board of Regents to see if we couldn’t put together a program for Ohio over the summer to produce, at least, the workforce that’s needed for implementation right now. We met with those folks, as well as a federal program that runs through Job and Family Services called the One-Stops. It’s a retraining program.

We’ve got a full team of people from each of the regional partners, from all of the two-year colleges in the state, the Board of Regents, the Department of Development, and the One-Stops. We’re putting together a very intense summer program to train individuals to do the office assessment and workflow support. Then, those individuals will either be employed by the regional partners — the regional entities that are part of our REC — or, they’ll be employed by the vendors. But, we know we need to create that workforce in Ohio. There’s some of that workforce, but not enough to get this job done and it’s a country-wide problem.

As we’re speaking about this, the other thing that we are contemplating is that we don’t want the EHR vendors coming in here bringing people from where they’re headquartered. We really want the workforce in Ohio to be Ohioans, and be people that stay here and support this long effort as systems are implemented. In part of our EHR process when we’re talking about vendors to partner with, one of those requirements would be that they’re hiring Ohioans to do this work. Our role in this is to make sure that there are competent Ohioans to hire for this process.

Every aspect of this project is truly going to have to be a partnership with everybody holding up their end of the bargain. I do, personally, see a lot of jobs being created out of this project. It’s not really something that’s talked about a lot compared to a lot of the other stimulus programs. What more is talked about is the tight timelines and bringing this up, bringing health information exchange structure and EHR adoption up to speed. But, out of all of this, jobs will absolutely be created. We just want to make sure that those jobs go to Ohioans.

A common theme within OHIP is the discussion of community. Why do you see that as being important, and how is the OHIP model addressing that approach?

I think that the OHIP model itself is the epitome of establishing a community around this.

Yesterday I had a speaking engagement with HIMSS. The discussion ended up turning into an hour of questions and answers, in a good way. People were very engaged. They were very excited.

I was there for another hour afterwards just answering individual questions and talking to folks. One woman said to me, “You know, this reminds me of a movement.” She’s like, “This is like you’ve got people coming out of the woodwork looking to volunteer the time and pitch in.” She said, “This truly has the makings of a movement.” When she said that I was thinking to myself, she’s absolutely right.

This is a situation where a lot of people who have wanted this to happen for quite some time see that if this is going to happen, this is it. This is our chance. People on a macro level across Ohio are coming together. What I think we need to make sure happens from this point is that same level of grassroots movement starts to propagate at the individual, local communities level. I think that that is the key to getting this done in not only an aggressive time period, but with less money than truly is needed to ultimately implement this thing. We have to contemplate a different model than the model that’s been used up to this point that, frankly, hasn’t been able to get us there.

The model that not only I believe, but several individuals who are working within OHIP believe, is getting that community level of involvement — getting physicians within their community working together on this and leaning on each other. The idea of bringing together groups of single practices, bringing those individuals together as a cohort and working through this together, it makes it more cost-effective for us to support that effort in that manner. But even more importantly, it gives them a peer group to work with as they’re working through their own problems. Certainly they can identify with each other going through this at the same time. We absolutely think that’s going to be the key to success in this project.

The next step is really bringing those communities together and helping them not only understand where we’re going with this, but understand that there’s support to help their community.

Are there any other points you’d like to bring up?

I guess just the final point, and perhaps I have spoke about it throughout this discussion, but this is one of those situations where you don’t see something like this very often. Where people who normally either are very strong competitors or have very different positions on how they see the world and how the healthcare system should work, or how health information technology should work — to see all of these individuals come together, not just rhetoric, not just the way that they’re speaking to each other, but truly their actions are showing that this is a partnership.

I’d say in my 20-plus-year career, I have never seen anything like this. It’s quite an honor to be involved and to be participating in this. I think a lot of others feel that way, and I think that’s what’s going to bring us to the dedication that’s needed to get this monumental task done on what is a very aggressive timeline. It’s just a pleasure working with folks on this project.

 View/Print Text Only

From Newsies: “Re: Radianse. The RTLS vendor has filed for Chapter 11 bankruptcy as of April 20.”

From Take the Time: “Re: Neal Patterson. The latest kudos.” Neal makes the Forbes list of best-performing bosses and rightly so: quibbles aside, there aren’t many executives who have transitioned successfully from scrappy startup founder to big-company CEO and kept investors financially happy most of that time. He’s a HISsies pie-in-the-face regular, but if I was investing my money in healthcare IT, he’s the guy I’d trust it with. That’s CERN (blue) vs. the Nasdaq (green) above, just in case you’re a hater.

Eclipsys announces Q1 numbers after Tuesday’s market close: revenue down slightly, EPS $0.09 vs. -$0.02. Shares are up a little in after-hours trading. In other Eclipsys news, E-Health insider reports that the company will take Sunrise Clinical Manager to the UK, offering it to trusts looking for an alternative to NPfIT’s systems.

Dr. Dalai and anonymous contributors document what they say is the end of AMICAS as Merge Healthcare does its best to screw it up after buying it. I’m linking to his main page since he’s running new pieces, so read back a couple of articles for the whole story. It’s big business as usual: layoffs of all the people that made the acquired company successful, forced relocations resulting in resignations, and apparent mothballing of previously sound products. He summarizes with a plea to Merge executives:

Bottom line is this: your actions are destroying AMICAS. If you don’t reverse what you are doing, you have just flushed $250 million down the toilet. Don’t do it to yourselves, don’t do it to the AMICAS people, and don’t do it to me and the other AMICAS customers.

I see that some new jobs have been posted on the HIStalk Job Board, so feel free to cruise over and see if any of them look interesting. Each job lists the number of times it has been viewed at the bottom of the page, so you can see which ones are hottest. I should mention, since a couple of folks have asked, that while everybody can view available jobs, only sponsors can post them.

Small-practice SaaS EMR vendor ClearPractice names pharmacist and former NotifyMD CEO Gary Ferguson as CEO. The company offers its entire suite for $425 per month, including revenue cycle management, help with stimulus funding paperwork, and CMS approval as a preferred provider for patient registry. I don’t know much about the company, so that’s just me reading the press release to you in an authoritative, yet know-nothing voice like a clueless TV news anchor.

A couple of readers e-mailed me noting quotes from both Steve Lieber of HIMSS and David Blumenthal of ONCHIT in which they discounted EHR safety issue reports. Blumenthal called such reports “fragmented” and “anecdotal”, not surprising given the lack of a central, well-publicized reporting mechanism for such problems. One reader also noted that problem reporters are often seen as troublemaking whistleblowers rather than staunch patient advocates, not to mention that some vendors prohibit such disclosure in their contractual language. My response to one e-mail was that we need this industry’s equivalent of the Institute for Safe Medication Practices to take up the banner of centralizing problem reporting and disseminating those reports out for everyone’s benefit. After all, the FDA’s medication safety track record wasn’t very impressive until ISMP got involved. Plus, you would think vendors would prefer that to FDA oversight.

Thanks to new Platinum Sponsor FormFast of St. Louis, MO. The company’s healthcare solutions include forms automation, document management, and workflow automation that help eliminate the paper chase. Specific solution examples include RAC tracking and response, admissions, bar coding, positive patient ID, cancer staging, patient self-service portals, e-signature, on-demand document printing, and importing documents into the EMR and saving the cost of preprinted forms, imprinters, embossers, and labels on the way to becoming paperless. The company is offering a free Webinar on May 25 at 11 a.m. Central, a Forrester Research update on Microsoft’s healthcare strategy called SharePoint 2010: What Value Does It Bring to Hospitals? Three attendees will win an iPad, just in case you’re interested. Thanks for FormFast for supporting HIStalk.

Revenue cycle services vendor Accretive Health sets its IPO price at between $14-16 per share for 13.33 million common shares for a market cap of $1.44 billion. The company had $510 million in revenue last year, which you’d never guess given its crude Web site and the fact that you’ve probably never heard of it except maybe when I mentioned their IPO plans back in the fall.

McKesson’s Q4 numbers: revenue up 2%, EPS $1.26 vs. $1.01, but falling short of analysts’ expectations on both revenue and earnings.

athenahealth CEO Jonathan Bush has told me that he started his internal company blog using HIStalk as a model, so now he’s got a customer-facing version as well. Unlike most CEO blogs, it’s actually interesting and sounds like someone other than a marketing department committee talking.

Smartphone application developer Voalté announces seven new hires.

I’m streaming Netflix like a madman using my new Roku box as a defensive move to Mrs. HIStalk’s usual BBC and dancing shows, so a couple of old movies inspired this week’s guest editorial in Inside Healthcare Computing, an opus I called Healthcare IT Leadership Lessons Learned from R. Lee Ermey. Spoiler: I make a convincing argument that Neal Patterson’s famous “tick, tock” e-mail was cribbed from one of R. Lee’s profanity-laden monologues in Full Metal Jacket. I don’t think a Pulitzer is in my future, but at least I snickered while I was writing it.

All the big hospitals in Madison, WI run systems from next door neighbor Epic, so now they’ve decided to share ED records in a pilot project that runs through July.

Brigid O’Gorman, a Connecticut College pre-med junior and captain of the women’s hockey team, wins a $10,000 grant from Davis Projects for Peace to implement electronic medical records in Uganda. The money will go towards four computers, solar panels to run them, two printers, software, a laminating machine, and an external hard drive. The college will contribute $3,000 to allow her to spend eight weeks there to set it up and help transfer information from the paper notebooks carried by patients into the computers. I like her spirit: “I’m not a wiz at the computer, but I figured I could get a system and teach myself how to input the data before I go.”

Mississippi Baptist Health Systems says it has saved more than $4 million by switching to Symantec for storage, backup, and archiving of its 130 terabytes of data.

This was probably embarrassing: Canadian EMR vendor Medworxx issues a corrected press release about year-end earnings when it notices that the date was given as December 31, 2010 instead of 2009.

A couple of recent journal articles try to peg CPOE and EMRs to mortality and cost, at least in the minds of the headline writers. As I always caution, just because A and B happened together in no way implies that A caused B or B caused A, even though folks looking for someone to agree with their anecdotal beliefs will always drag those articles out as evidence.

Surgeons at Children’s Hospital of Pittsburgh are using a video-over-IP system to monitor progress of cardiac transplant procedures from any VPN-connected PC using a zero-footprint software video player. The Haivision Furnace system lets surgeons know when it’s time for them to jump in to do their part.

E-mail me.

HERtalk by Inga

From Sean Fitzpatrick: “Re: Paul Levy’s lapses of judgment. I’m with you on your observation. It’s too easy to write off the little lapses, which typically reveal underlying bigger ones.” I was glad to see a number of readers agreed with me. Apparently the BIDMC board did as well, fining Levy $50,000 for his “poor judgment” and saying it will also consider his “serious lapse” when determining his next pay package (which is over $1 million now). Board member Patrick Ryan is apparently not pleased with the outcome (not harsh, enough I suppose?) and announces his resignation.

From Madrigal: “Re: Meditech. Thought you’d like to know that Howard Messing has been promoted to CEO (his new title is president and CEO). His previous title was president and COO. Neil Pappalardo’s title is now chairman (it was chairman and CEO)” Unverified, though we heard this report from a couple of readers. The company’s Web site still lists Pappalardo as chair and CEO and Messing as president. One in-the-know person suggests the change means little in the short term and is more of a symbolic shift of official responsibilities.

Lucile Packard Children’s Hospital (CA) reports a 20% drop in mortality rates since introducing CPOE, giving it the lowest rate ever observed in a children’s hospital. Until Packard published its findings, no hospital has been able to show reductions in medical errors and mortality from using CPOE. The hospital, which spent $50 million on its EHR project, attributes its success to a careful and well-planned implementation.

Peninsula Regional Medical Center (MD) selects eClinicalWorks EMR for its employed physicians at the Peninsula Regional Medical Group. The Medical Center will also promote eCW adoption with affiliated community physicians and implement eCW’s Electronic Health eXchange as its interoperability tool.

Pantain Holdings Berhad, a 1,500-bed, 10-hospital network in Malaysia, selects Eclipsys Sunrise Enterprise. John T. Mather Memorial Hospital (NY) also plans to add multiple Eclipsys Sunrise products to create a single EHR across multiple venues of care.

Washington County Hospital (MD) replaces 40 interfaces with Corepoint Integration Engine. The hospital runs Meditech and connects to referring physician offices.

Doctors from Catholic Healthcare West will serve as medical directors for 10 CVS Caremark MinuteClinics in the Phoenix area. The new CVS/Catholic Healthcare West alliance includes plans to eventually integrate EMRs.

The 54 providers at Syracuse Orthopedics Specialists (NY) and New York Spine & Wellness Center choose Allscripts to provide EHR and PM across their 11 locations.

Chatham County Safety Net Planning Council (GA) goes live on its HIE, leveraging technology from Orion Health and Initiate Catalyst Patient Registry.

Mark R. Briggs, the former COO of Carefx, takes over as CEO of HIE vendor VisionShare. He was previously with NaviNet, QuadraMed, and LinkSoft Technologies.

Fort Healthcare (WI) will partner with Cerner to create a connected health community through the use of Cerner Millennium solutions. The hospital, ambulatory surgery center, and specialty clinics will implement more than 20 Millennium products and use Cerner for IT management services.

Senior Lifestyle Corporation selects the selection and hiring solution of Kronos to manage the end-to-end hiring process.

MedLink partners with iMedicor to integrate iMedicor’s information exchange portal with the MedLink TotalOffice program. The combined solution will facilitate secure messaging and clinical data exchange. TotalOffice users will also have access to iMedicor’s ClearLobby drug and medical device information platform.

Healthcare analytics vendor Outcomes Health Information Solutions appoints Gary Velasquez CEO. Former Ingenix CIO Jim Egan is also hired to serve as the company’s CIO.

Ingenix and Health Language, Inc. launch Ingenix Global Code Manager to translate between ICD-9 and ICD-10 coding systems.

Mediware releases Q3 numbers: revenue of $12.8 million compared to $10.2 million last year, net income $891,000 vs. $483,000.

E-mail Inga.

 View/Print Text Only

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!

Goodbye Data Warehouse and Cubes, Hello AQL
By Mark Moffitt

For the last two years, I have been researching systems to replace the data warehouse used for report-writing in our organization. This effort has been driven by the desire to provide better service to other departments that rely heavily on data reporting for day-to-day operations.

The idea is to push data to users so they can perform in-memory analysis and display of large amounts of data, a system that would replace the current process of requesting custom reports and spreadsheets from the information services (IS) department. The current process requires considerable resources in the IS department and requests can take several days if the number of requests for reports in the queue becomes large.

The requirements for a new system are straightforward, but somewhat daunting:

1. Put data into users’ hands so they can perform business intelligence.

2. The cost of the system, including license, hardware, and consulting, must be offset by the direct costs of shutting down existing systems.

At GSMC we operate Meditech Magic and use a data warehouse for analytics and business intelligence. The data warehouse stores about nine years of financial data in about 650 GB. The data in the warehouse is updated nightly. SQL reports have been developed to provide reporting across the organization.

IS at GSMC is bombarded with requests for new reports. These requests come in the form of specialized requests for data that often require modifying an existing SQL query or writing a new query. The process is iterative that starts with gathering requirements for a report, modifying or writing new SQL queries, generating a report and sending it to the customer.

Typical turnaround times are variable and are highly dependent on the number of reports in the queue to be developed. Best case scenario is four hours, typical is two to four days. Often the customer will, upon review of the report, ask to include or exclude specific data. This back-and-forth typically occurs several times until the report meets the customer’s needs.

The IS department at GSMC has several analysts who spend a good part of their time responding to requests for data. It is a never-ending demand.

We researched the use of OLAP (online analytical processing) cubes to provide data to users. The advantages of cubes is well documented and includes the ability to drill down to details and analyze data in ways simply not possible with reports or spreadsheets. The disadvantage to cubes is that data must first be aggregated. If a user needs data not included in the cube, then the cube must be rebuilt. Also, a data warehouse is required. Finally, building and maintaining cubes require personnel with specialized skills.

About seven months ago, I read on HIStalk about a new company named QlikView. I researched the software and it sounded too good to be true. However, I was intrigued that QlikView doubled revenues in 2008, not an especially good year for selling enterprise software as the national economy was in a major recession.

On the surface, QlikView is a business intelligence solution that consists of a data source integration module, analytics engine, and user interface. QlikView is based on AQL and is completely different from other OLAP tools.

Through AQL, QlikView eliminates the need for OLAP cubes and a data warehouse, replacing the cube structure with a Data Cloud. A Data Cloud does not contain any pre-aggregated data but instead builds non-redundant tables and keeps them in memory at all times. Queries are then created on the fly and are run against the Data Cloud’s in-memory data store.

Under AQL, all data is stored only once, and all data associations are stored as pointers, so a Data Cloud database becomes more efficient at retrieving records than do OLAP databases. A Data Cloud database is also much smaller since records are not repeated through aggregation and its structure never has to change. The architecture allows for a flexible end-user experience because it doesn’t require aggregation or pre-canned queries that try to cover every possible analytical scenario a user can create, unlike data cubes that require both. (1)

Data Clouds run in memory and AQL reduces in-memory storage requirements by about 75% as compared to source data. In-memory Data Clouds can be stored as AQL files for archiving. AQL disk files are 90% smaller than source data. Think of an AQL file like an Excel file where data can be added and deleted and the file saved with different names for archiving purposes.

The price point for the software is about $150,000 (one-time fee) for our health system. Hardware costs are about $15,000 for a server with 98 GB of memory. We expect consulting fees to total $150,000 for a SME in hospital financial data with QlikView experience. We worked with RSM McGladrey on a consulting proposal as they have well-qualified personnel in this space.

If you know much about the BI/Analytics space, you may question the low cost of the software and consulting services. This has everything to do with the AQL model. RSM McGladrey quoted a revenue cycle effort at eight weeks and includes:

• Transfer data from existing systems to QlikView
• Data validation
• Census analysis
• AR analysis
• Insurance contract analysis
• Hindsight analysis
• Train IS staff on data extraction

The revenue cycle statement of work is only one component of the $150,000 quote for consulting services from RSM McGladrey for implementing QlikView at our organization.

The total cost for QlikView at GSMC is $315,000. That will be directly offset by shutting down a data warehouse, savings from using QlikView for analytics versus another system where the cost of consulting services had already been quoted and budgeted, and other savings. We expect additional direct benefits from having deep analytic capabilities with our revenue cycle data.

QlikView has a number or healthcare customers. I believe you will be hearing more about the company in healthcare in the years ahead as they achieve market awareness of QlikView software’s capabilities and price point.

We have not yet purchased the package. If we do, I’ll write a follow-up article on our experience.

1 “Qliktech, IBM Provide New View Of OLAP”, Mario Morejon, Technical writer for ChannelWeb, July 18, 2003, http://www.crn.com/software/18839582

Mark Moffitt is CIO at Good Shepherd Medical Center in Longview, TX.

Humpty Dumpty Leaves Wonderland to Visit Health Information Technology
By Jim Kretz

Suppose I told you that “voting” henceforth would mean you would only be shown a ballot, period. No more selecting your preferred candidate.

Now suppose I told you that your consent to disseminating clinical information did not mean your granting permission, but only your acknowledgement that you saw my information policy — take or leave it. This may remind you of Humpty Dumpty’s scornful assertion, “When I use a word it means just what I choose it to mean — neither more nor less.”

Surprisingly, the insanity of “…use the term ‘Consent’ to mean the acknowledgement of a privacy policy, also known as an information access policy. In this context the privacy policy may include constraints and obligations.” comes from an IHE (Integrating the Healthcare Enterprise) policy paper “IHE IT Infrastructure Supplement 2009” that was taken up  (line 157) by the IT Standards Advisory Committee Privacy Workgroup, April 23, 2010.

The authors of this paper — the American College of Cardiology, the Healthcare Information and Management Systems Society, and the Radiological Society of North America — are not mean-spirited, uninformed, or confused. What could result in their clearly having tumbled into a conceptual rabbit hole?

Jim Kretz is project officer at the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services. His comments should not be construed to reflect the official position of SAMHSA.

Massachusetts HIT Conference Thoughts
By Bill O’ Toole

I had the pleasure of attending a National Conference hosted by Massachusetts Governor Deval Patrick in Boston last week. The conference was billed as Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality. 

Keynote addresses were provided by David Blumenthal, MD, National Coordinator for HIT and Vice Admiral Regina M. Benjamin, MD, MBA, Surgeon General of the United States. Health IT Policies and Standards were addressed by a panel that included John Halamka, MD (CIO, CareGroup and Harvard Medical School), Marc Overhage, MD (CEO, Indiana Health Information Exchange), Paul Tang, MD (CMIO, Palo Alto Medical Foundation), Micky Tripathi, Ph.D (CEO Massachusetts eHealth Collaborative) with Tim O’Reilly (President, O’Reilly Communications) moderating.  

Another panel discussion on Health IT, Business Opportunities and Job Creation featured leading Massachusetts vendor executives Girish Kumar Navani (eClinicalWorks), Howard Messing (Meditech), Richard Reese (Iron Mountain), Bradley J. Waugh (NaviNet) moderated by Chris Gabrieli (Bessemer Venture Partners).

I could go on and on, but the list would be too long. I mentioned those above to give readers a sense of magnitude and to perhaps share in this small article the profound comfort I felt that "we" are doing this right. Many other highly qualified participants shared their knowledge on all things HIT- and ARRA-related.

What impressed me most was the overwhelming sense of momentum. The stimulus package and its future incentives have so far done exactly what was intended, serving as the spark that has set this massive project in motion. Remaining at the forefront of it all, though, is the goal of better medical care for all. That theme was never lost and was frequently repeated.

As one who until now has found certain parts of most conferences to be extraneous (ok, boring), I felt obliged to inform the far-flung readership of HIStalk that I was extremely impressed with every minute of this two-day conference. If the energy, knowledge, and sincere interest and enthusiasm expressed by those involved in this conference are carried forward to the project at large, then we are truly in for a remarkable change in our industry.

Congratulations to the Massachusetts Technology Collaborative and its Massachusetts eHealth Institute, the Massachusetts Health Data Consortium, and Governor Patrick for organizing this special event. It should serve as the model and be repeated whenever possible throughout the country.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

 View/Print Text Only