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June 1, 2010 News 14 Comments

saintpeters

From Rebecca Bloomwood: “Re: New Jersey hospitals. Big bucks coming and going for EMRs.” A New Jersey paper runs some interesting hospital EMR numbers. Saint Peter’s University Hospital spent $50 million for McKesson Horizon Clinicals, but expects to get $40 million back in ARRA money. Hunterdon Medical Center went with NextGen (for a practice-based EMR, I assume) and expects to get $30 million from federal taxpayers.

From Donna Reed: “Re: consulting. I was a consultant, but took an FTE position due to family circumstances. I want to get back into consulting, but am running into a brick wall with Epic’s partners. Should clients sign these contracts? Should this type of partnership even be entertained?” I’ve never understood Epic’s firm stance on who partners and customers can hire (not to mention which companies former employees can work for). I doubt any of the agreements would be enforceable if legally challenged, but Judy’s got a lot more lawyer money than the average job seeker.

Monday’s post drew a lot of reader comments, some of them heavier on emotion than facts. I’ll be quicker to delete those comments in the future since they just waste everybody’s time. I doubt that will be necessary since I know some/most of the commenters from their previous posts and they have always been passionate, but with sound reasoning and respectful demeanor. I’ll write this one off as a post-holiday, back-to-work-dammit aberration.

A clarification about “usability” – it is not a feel-good, generic term for just asking users how they like an application. It’s an objective science that measures everything from eye movements to keystroke times as users interact with software in a lab setting, also including tests of how well and how quickly users perform specific task assignments. I’m no expert, but I’ve attended a couple of workshops offered by a usability professional organization, so I would differ with anyone who says software usability is subjective, lacks rigor, or favors one application over another. I was hoping to get a usability expert to write an article on that very topic, but I haven’t worked that out yet.

Listening: Sonata Arctica, more of that sweeping, operatic Finnish progressive metal that I love. It might be time for me to visit Helsinki again.

mu

University of Missouri gets a $6.8 million ONCHIT grant to fund the Missouri Health Information Technology Assistance Center, but stresses that despite overlaps with its Tiger Institute partnership with Cerner, the Regional Extension Center won’t favor Cerner when it recommends EMR vendors to physician practices. 

gcarr 

Speaking of MU Health Care, its former CIO George Carr (above) is named CIO of BryanLGH Health System (NE). Hospital operator HMA names Ken Chatfield as CIO. And in Abu Dhabi, former Karmanos Cancer Institute (MI) CIO George Yacoub is named CIO of Hopkins-managed Corniche Hospital.

Point-of-care communications technology vendor Voalté is named as an Up and Coming healthcare IT company by Healthcare Informatics.

For the reader obsessively charting HIStalk’s stats: the summer slowdown always starts in May, so the numbers dropped a little with 79,537 visits and 110,111 page views. That’s still 16% higher than May 2009. The verified e-mail subscriber list is at 5,574. Thanks for being one of the readers who made those numbers possible – I really appreciate it.

jimmelt

Speaking in Japan, GE CEO Jeff Immelt urges that country to “dominate healthcare information technology and home healthcare devices.” You’d think their taxpayers had bailed out GE Capital instead of us. He was also unusually frank in saying that “more money has been wasted on [healthcare] information technology than has been saved by using it.” He didn’t say, but much of that waste no doubt involved the elephant’s graveyard of once-good HIT applications that have withered under GE’s smothering bureaucracy. ADDENDUM: per a GE spokesperson, the company did not take TARP funding, although some of its debt was guaranteed by the federal government. I always refer to this Washington Post article, How a Loophole Benefits GE in Bank Rescue, which describes the special treatment GE received using what the article calls a loophole in the Temporary Liquidity Guarantee Program.

MEDecision will launch its Alineo 3.0 care management platform, which includes a new behavioral health utilization model, at AHIP next week.  

Our friends at ONCHIT are looking for someone who’s smart, creative, and knows HIT (especially emerging technologies) to lead its innovation programs. I’m encouraged by all the folks who have taken pay cuts to work in federal service, so if you’ve ever thought about it, this sounds like a pretty cool job.

UPMC paid its CEO more than $5 million last year, but CIO Dan Drawbaugh did OK too, taking home $1.335 million. Surely that’s an all-time record for any non-profit’s CIO, not just in healthcare.

Australia’s Medicare program, one month away from mandatory implementation of a national patient identifier, has yet to sign a contract with a vendor to create connectivity between EMRs and the identifier service. They have a pretty good excuse: the bill hasn’t been passed yet and debate doesn’t even start for two weeks.

Emdeon announces a free Emdeon Office solution that allows providers to electronically submit workers’ compensation and related attachments.

Just the kind of headlines Harlem Hospital didn’t need after its “unread echocardiograms” fiasco: a unconscious woman being treated in its ED after being slipped a date rape drug claims she awakened to find a medical intern groping her. She confronts him afterward, at which time he admits pawing her but then asks her out on a date, not realizing that she is secretly recording their conversation. He’s been suspended with pay while awaiting sex abuse charges.

E-mail me.

HERtalk by Inga

From Evelyn Castle: “Re: eHealth Nigeria. I read the short article you posted about me and eHealth Nigeria. I wanted to thank you for the publicity. If you wish to keep updated on the project, you can sign up for our mailing list on our Web site. We will also be blogging throughout the trip. Thanks for your interest.” Evelyn is a UC Santa Cruz college student who helped create Nigeria’s first EMR and is heading back to the county later this year automate several hospitals and clinics. As Mr. H pointed out, she’s my new hero even if she did shame me with her selfless accomplishments.

Emdeon submits formal comments to the DEA to support e-prescribing of controlled substances, but cautions that it will take the industry time to make the necessary software modifications.

iknowmed

US Oncology announces its new iKnowMed platform for community oncologists. US Oncology purchased the company iKnowMed in 2004, developers of an oncology-specific EHR, and has added RCM and inventory management components.

TELUS announces that its health space is now available for licensing by healthcare organizations. I didn’t understand the term “health space”, so I did a bit of surfing on the TELUS site (they are a sponsor, so I figured I really should understand what they do). TELUS Health Solutions is a Canadian company that offers a number of software applications, including EHR, claims management, and scheduling, plus the health space PHR.

Healthcare South (MA) selects Allscripts EHR/PM for its nine pediatric and family practice offices.

trinity mus

Trinity Muscatine (IA) takes its ED live on electronic medical records as part of the hospital’s $4.7 million EMR initiative.

In an article that calls Dell the “biggest player” in HIT, industry analysts and Dell execs discuss the company’s market approach to the industry. After acquiring Perot, Dell leaned on Perot’s expertise to develop ways to reduce HIE costs and to sell its technology to a broader segment of the market. Dell is now seeing increased success marketing to small and mid-size hospitals and their network of affiliated doctors implementing EMRs.

Apple says it has sold a whopping 2 million iPads since its launch two months ago. Impressive, especially when you consider that just last week it began selling the units in Canada, Japan, Europe, and Australia. In January, analysts estimated Apple would sell between 178,000 and 778,000 iPads monthly.

Emerging Healthcare Solutions is developing a new iPhone app that will automatically call users at the precise time they need to take medications, targeting seniors. I love the idea and think it could be a big hit, but, I suspect many seniors will need help from a tech-savvy friend or relative to set it up. And if the patient is not interested in using the iPhone for any of its other sexy apps, the $10 a month on top of AT&T’s monthly data fee ($30?) may be a bit too steep for the fixed income crowd.

A jury rules in favor of NYU Langone Medical Center in the case involving the male transplant patient who died of uterine cancer after a kidney transplant. During the medical malpractice trial, it was revealed that the donor’s cancer was not detected until after her autopsy. Furthermore, the hospital argued that their male patient actually developed a form of immune-system cancer as a result of the transplant, and did not die of uterine cancer.

A study finds that a telehealth system combining remote patient monitoring with education support tools reduced hospitalization time and improved the quality of life of patients with severe heart failure.

Here’s a lawsuit that’s right up that with McDonalds serving its coffee hot. A California woman sues Google for giving her poor walking directions from Google Maps. The woman pulled up the directions on her BlackBerry and was directed to walk on a route without sidewalks and with cars moving at high speeds. She was hit by a car and is suing Google for over $100,000 in medical expenses for its “careless, reckless and negligent providing of unsafe directions.”

inga

E-mail Inga.

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Currently there are "14 comments" on this Article:

  1. I am depressed to think that I shall now be subjected to warning indicators that google maps is not all knowing and that any directions may or may not be correct.

  2. “To some, usability is a science. To others, it is an art form. As such, usability is a concept that does not lend itself to a precise and clear-cut definition. Generally, usability refers to the ease of operating a system interface. The simplicity of this statement may appear to be misleading due to the plethora of other, seemingly more comprehensive, definitions of usability that exist. However, most of these definitions are based on this central notion of “ease of use” (Miller, 1971 cited in Shackel, 1986). Since the notion of ease of use is somewhat vague, researchers have defined usability in terms of multiple high-level criteria or attributes.”

    –Constructing the Infrastructure for the Knowledge Economy: Methods and Tools, Theory and Practice, p. 342

  3. I don’t think it’s incongruous to say that there can be scientific rigor around software usability, and at the same time acknowledge that mandating a certain “level” of usability would be very difficult and highly controversial. It’s one thing to measure certain factors of a particular application that suggest usability issues and make changes to improve them, and something different to try to define exact objective metrics for what being “usable” actually is.

    I’m no Judy fan, but I think she understands that much and that’s what was behind her comment (and not that she thinks usability isn’t very important).

  4. Would “Donna Reed” please elucidate exactly to what she is referring: “I want to get back into consulting, but am running into a brick wall with Epic’s partners. Should clients sign these contracts? Should this type of partnership even be entertained?”

    What are these partners and what do they do? Please explain to us lowly and poorly paid patient care specialists.

  5. Clinical usability goes beyond the usual recommendations: Simplistically, Satisfactory Clinical Usability (SCU) is not lines of fine print camouflaging a Dilantin level; nor is it seeing a systolic blood pressure in one column and a diastolic blood pressure in another; nor is it placing the scroll up arrow on the left side of the screen and the scroll down arrow on the right side of the screen; nor is it displaying columns of lab data which comingle dates in the same column; nor is it having to click 6 times to order an aspirin; nor is it comingling the list of out patient medications with the lsit of hospital medications; to mention a few.

    Does Judy have any comment? Perhaps bodies will be dead with these defective features?

  6. If there are vendors out there that don’t do usability testing, then shame on them. I don’t think anyone disagrees that we should strive to make systems easier to use.

    It is subjective though. The process of taking the measurements may be simple, but what to measure & the definitions you use are clearly subjective. Furthermore, the amount of time it would take folks to agree on definitions would simply not be worth it.

  7. Sadly. usability has been neglected by the HIT vendors. That is because they are using old platforms which have rigidity that require doctors and nurses to establish workarounds. These are designed with profits in mind, not usability, and not patient safety.

    In essence, the doctors and nurses are providing the best care they are permitted to by the care limiting usability handicaps presented by these systems.

  8. Its not even just that usability is clearly subjective. Usability is also specific to the way you work, which can be dictated by specialty. Some people may want to see a list of lab results ordered in one way, but infectious disease, who view more labs every day may want it ordered in another way.

    Saying there are objective measures of usability is simplifying the problem.

    Some people actually seem to like using a blackberry and the nipple thing. To me that’s insane, my iPhone is far better. Why doesn’t everybody agree with me? How to RIM keep selling phones?

    You can setup some basic principals that people can agree on. Red for danger. Not too many clicks! Consistency. That’s as far as this goes. The scrolling on the iPhone is a sophisticated piece of software that makes it “feel” right. That’s a hard thing to achieve. The devil is in the detail. Trying to dictate standards beyond this is not only impossible, but would restrict innovation.

    Usability like opinions are subjective, but everybody thinks their opinions are, or should be, objective. Anybody actually working to design these systems knows true consensus within a organization is impossible, let alone consensus across organizations, specialties, roles and opinions. It’s clearly silly to think its objective, or everybody would own an iPhone 😉

  9. ” He was also unusually frank in saying that “more money has been wasted on [healthcare] information technology than has been saved by using it.”

    My guess Immelt had to be refering to the IHC project and IDX purchase! Anyone hear more on the Allscripts acq of GE-IDX?

    And…regarding Faulkner and usability iand all the vitrol it generated…if no one can verify it in the transcripts…I think we owe her an apology.

  10. @Blah – you have a hilarious way of making a very valid point! Wish I had thought of that – could have saved myself a lot of typing!!

  11. Blah, you are spinning like a neutron star to defend the indefensible. See Computer Scientists’s comment in the Monday Morning Update 5/31/10.

  12. All these debates are fine, but hrom HIMSS itself in June 2009 at http://www.himss.org/…/HIMSS_DefiningandTestingEMRUsability.pdf :

    Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level.

    We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context.

    Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost”efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results.







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Reader Comments

  • Allscripts watcher: I agree with Goose Island. I have no dog in the hunt (and am uncomfortable with the Epic/Cerner duopoly - we need as mu...
  • Boy Wonder: More CareOtter (Allscripts side EHR) observations...CareOtter's webpage is suddenly down and the YouTube video reference...
  • Peg Leg Pete: The Allscripts Sunrise implementation at Baptist Pensacola is officially off the rails. The project is now two years out...
  • Redwood: Sounds like Care Otter’s secret sauce is running on top of Microsoft Azure. Not sure that warrants a special project t...
  • Andrew (Hedgeye): Hi Goose Island - Thank you for the comment. You are right about Jefferson Health and Epic. We believe Allscripts is a...

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