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Monday Morning Update 6/7/10

June 5, 2010 News 21 Comments

strike

From Aldous Snow: “Re: possible Twin Cities nurses’ strike. If it happens, it will be interesting to see how the out-of-state nurses being hired will deal with the EMRs.” The nurses’ union threatens a one-day walkout Thursday over staffing concerns and benefit cuts, news of which flooded the Board of Nursing with out-of-state applicants willing to replace them temporarily. You are right — how do you get thousands of one-day replacement nurses trained on software? If the strike really happens, someone should document how many help desk calls result, how many patient incidents occur, how much information is recorded on paper until the A-team comes back the next day, etc. Since we’re talking a lot about software usability lately, this might be the ultimate test of it.

nuance

From Dr. Daneeka: “Re: Nuance’s physician-only weekend. I went last year as the lead for my employer and found the experience worthwhile. I think it would be good for those who support doctors as well. I think early reg was extended to July. Disclosure: I own a few hundred shares of Nuance stock, but it’s because I like the product.” Nuance’s healthcare user group meeting will be held in Boston November 7-10, with the physician-only part starting the Saturday afternoon before. Thinking ahead, if the Red Sox were to win the World Series that could end the week before, you’d be right in the middle of a big party like I was one year when I went there for recreational purposes. This wasn’t an anonymous post, by the way – it’s from a real doctor and friend of HIStalk (not a Nuance PR plant, in other words).

From The PACS Designer: “Re: 4G wireless. We’re going to be seeing and reading more about fourth-generation (4G) wireless in the near future. As a refresher, it all started in 1981 with analog wireless (1G), then advanced to digital wireless (2G) in 1992, and finally in 2002 we got spread spectrum transmission wireless with multi-media support (3G). Some early 4G wireless applications over the last few years where mobile WiMAX and long-term evolution (LTE). The new 4G wireless brings all-IP packet-switched networks, mobile ultra-broadband (gigabit speed) access, and multi-carrier transmission. A 4G system will provide for a secure all-IP (Internet Protocol) based solution that features IP telephony, ultra-broadband Internet access, gaming services, and streamed multimedia for users.”

From Parker Selfridge: “Re: HIT purchasing decisions. Who makes them in private practices and in hospitals? I can’t find anything that says specifically. Is it doctors and nurses?” I don’t have any physician practice experience, but in all the hospitals I’ve worked in, doctor and nurse selection team members had little say beyond expressing a preference that was overridden in every case. The clinician demo score sheets, site visit notes, and architecture reviews were weighted minimally compared to CIO/CFO gut feeling about non-clinical vendor factors such as business performance, industry word of mouth, alleged product integration, perceived risk, and an anecdotal review of what other hospitals (of the “informal benchmark” category) were buying at that moment. There was also strong resistance to buying what the cross-town competitor used because that would appear imitative (interoperability advantages notwithstanding). Certain vendors relied on the urge of C-levelers to override the white coats, knowing their poorly designed products would play better in PowerPoint in a plush conference room instead of in the uncarpeted hospital areas. Predictably, the clinicians resented the time they had wasted in providing ignored guidance and were therefore lukewarm in their adoption of the also-ran.

From V.B. Shadow: “Re: e-mail update. I read most of my e-mail by iPhone and prefer content that is viewable directly instead of sent as a link.” My experience with HTML e-mail isn’t so good – spam filters kick them out a lot and readers get a huge file instead of a text link. But I’m sensitive to vox populi – who would rather see the full post in the e-mail instead of just the link?

From Stanford Blatch: “Re: usability. I agree that usability is a goal, that some systems are more usable than others, and that you can make measurements that are objective. I think the BlackBerry is more usable than the iPhone, but others think the opposite. You can’t ignore the subjective user in usability.” See below – usability does not imply an overarching summary of all possible user preferences, only that they can efficiently complete  a set of defined tasks, i.e. order a lab or review active meds. Products with identical usability ratings aren’t necessarily interchangeable to individual users, and the entire user experience includes more than the specific task definition. And even then, I might prefer a lower-usability product for logical reasons.

drlyle

From DrLyle: “Re: usability. Thanks for pointing out the very real science of Usability. I too thought that ‘usability’ was too subjective to actually be used in evaluation, but have since gotten involved with the HIMSS EMR Usability Task Force and learned how very real the study and reporting of Usability can be. This task force put out a great white paper on this subject of Defining and Testing EMR Usability (warning: PDF) last year.” Also check DrLyle’s blog post and his podcast interview with a usability expert (Episode #17). This is a really good overview paper, with content that’s fresh, concise, and doesn’t kiss up to vendors. Some of its conclusions:

  • Usability may be the key reason that EMRs haven’t been more widely adopted.
  • Usability is directly related to clinical productivity, errors, user fatigue, and user satisfaction.
  • EMR usability is important because clinicians are mobile, doing distractive cognitive work while using the application, and not following a predictably linear progression of system use.
  • Usability principles include simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation (density, color, readability), and preservation of context.
  • Methods of evaluating usability of completed products include expert review, performance testing, risk assessment, and one-on-one testing.

poll060510

That a good segue to the results of my last poll, which are far from conclusive. You said the best way to encourage usability (but only by a microscopic margin) is to publish independent usability reviews. CCHIT has promised (warning: PDF) to do this at some point, but in a manner that’s pretty much worthless (asking a panel of usability experts to rate product usability after watching a vendor’s remote Webex demo, all without clinician involvement). Also, will their standards be absolute or relative? i.e., if all products are bad, does the best of the bad ones get a perfect score?

New poll to your right: from Parker Selfridge’s question, which group carries the most weight when hospitals buy clinical systems? Note that I’ve opened up an “add your own answer” field in case I missed one.

Thanks to Inga for capably covering for me while I took a little break. It’s nice having someone I trust to keep HIStalk going so I don’t have to worry about it. Before my break, I noticed that HIStalk was coming up a bit slowly on weekday mornings when hundred of readers hit the site at once, so I had it moved to a bigger server. Hopefully you’ll notice a positive difference. For my fellow nerds, it’s now running on a virtualized server with dual Xeon processors, 1.5GB of dedicated RAM, and hot-swap RAID-10 drives.

If you know mobile healthcare computing, are an excellent writer (a geeky medical resident would be cool!), and are interested in paid gig (part-time, permanent, fun, flexible) let me know.

Listening: Silversun Pickups, fresh, LA-based alternative rock. I’d call them Breeders meets Nirvana with some Red Hot Chili Peppers thrown in. Like it lots.

invisblebracelet

A Fort Worth ambulance service is testing a service called Invisible Bracelet, in which people carry a uniquely numbered ID card or driver’s license sticker that allows paramedics to access their health history and emergency contacts. Enrollees pay $5 per year and complete an online questionnaire with the needed information. It’s a registry service of the American Ambulance Association.

Sponsor news:

  • New York eHealth Collaborative, a Regional Extension Center, chooses Sage Intergy EHR as a preferred product
  • Picis has chosen Clinical Architecture’s Symedical product, a terminology mapping system, to enable new medication decision support capabilities for the Picis CareSuite high-acuity product line.
  • I should have noticed this sooner: the Web site of healthcare IT consulting firm Quality IT Partners linked to HIStalk and included these nice comments: “Keeping up to date on healthcare news is key for all of us here at Quality, and we are very impressed with the content, contributions, and delivery of the information HIStalk provides.” Thanks!
  • MedMatica Consulting Associates has posted a series of one-page MedMatica Minutes that contain concise overviews of individual topics, with the latest one being on recruiting candidates.
  • EDCO Group is offering a June 29 Webinar on reducing the cost of scanning and indexing documents, which it says averages 20 cents per page.
  • Red Hat announces availability of Fedora 13, the latest upgrade to its free operating system. The company will have a significant presence at the 2010 Red Hat Summit and JBoss World in Boston on June 22-25.
  • asquaredm offers its assessment services with a typical completion timeframe of 30 days.
  • 3M Health Information Systems releases a breach notification tool as part of its ChartRelease and DisclosureTrac applications. It automates the process of notifying patients about data breaches.
  • Stratus Technologies announces (warning: PDF) its Avance 2.0 software, which configures itself to perform hardware and host-level software monitoring, perform fault detection, and resolve 150 critical operating system situations.
  • Philips has demonstrated a prototype of its pathology slide scanner and image management system for digital pathology.
  • Intellect Resources is posting some of it hot jobs on Facebook.

The city of Cincinnati, whose declining sales tax revenue leaves it unable to make payments on the two riverfront stadiums it built in the 1990s to prevent the horror of having its pro sports teams bolt for greener artificial pastures, gets an out-of-the-box solution proposal from a county commissioner: chop by nearly 50% the funds the city pays to its big hospitals, University Hospital and Cincinnati Children’s, for trauma and safety net services to the indigent.

Motorola spinoff Freescale announces Intelligent Hospital, a kiosk for homes or public areas that allows sending a variety of instrument-captured vital signs to a doctor or hospital: height, weight, temp, BP, pulse, a one-lead EKG, pulse ox, blood glucose, and spirometry. It was developed in Mexico.

Surgeons in Japan are using the iPad as a display during surgery.

Houskeeping: put your e-mail in the Subscribe to Updates box to your right to get instant updates. The new Search box digs through seven years’ of HIStalk plus HIStalk Mobile and HIStalk Practice, so feel free to see what we’ve said about companies and people. Sponsors post jobs free on the jobs page. If you find Inga and me likeable, feel free to say so by clicking the Like option on our Facebook widget to your right (the one with reader pics, each of them extremely attractive, if I may say). The HIStalk Calendar has many cool events listed and you can add your event for free. I’m always on the prowl for Readers Write articles (500 words, no commercial pitches, provider submissions preferred). Lastly, please take a moment to scour and click the sponsor ads to your left since those companies took the ultimate leap of faith in sponsoring an anonymous, caustic blogger who might take a swipe at them every now and then if they deserve it. Thanks to every reader and sponsor — you have no idea how important you are to me.

Jobs: Business Systems Analyst, Product Marketing Manager, Allscripts Consultant, Remittance Product Manager.

A Weird News Andy find: a Sydney, Australia hospital runs out of food, so the nurses tell an inpatient with a staph infection and IV line to try nearby restaurants for something to eat. He heads out in the rain without an umbrella and walks nearly a half mile to a kebab shop, then returns to the hospital drenched. The hospital says staff didn’t follow policies on obtaining after-hours meals for patients.

ONCHIT announces a new enrollment subcommittee of the HIT Policy Committee that will recommend standards for electronic enrollment of patients in federal and state insurance programs.

A Florida Board of Medicine member wants the board to issue a statewide warning about EMRs, following an incident in which an OB-GYN missed an abnormal Pap smear and blamed the EMR. The OB-GYN punished the EMR by replacing it, while the Board of Medicine punished the OB-GYN with a $20,000 fine, a risk management review, and 100 hours of community service. The board member, a dermatologist, said “"I think the Department of Health needs to put out a warning to physicians that they need to look at their programs’ default settings. This year we have seen as many if not more medical records violations from electronic medical records as we saw from hand-written records violations.”

More executive turnover at athenahealth: COO David Robinson and corporate development SVP Nancy Brown will leave the company, replaced by CTO Ed Park and SVP Derek Hedges, respectively. Market reaction was negative, with shares dropping nearly 9% and closing barely above their 52-week low. Stock price has retreated nearly 50% in five months.

loinc

Regenstrief will release its new version of the LOINC medical vocabulary today (Monday). The free download page is here.

Everybody who’s worked in a academic medical center will be surprised that this is newsworthy: the worst month to be hospitalized is July, when the fresh crop of medical residents starts making their newbie mistakes. At our place, it’s full alert month as residents starting ordering non-existent drugs and tests, make major diagnostic errors, and fumble their way through their first cases. No wonder the attendings have gray hair.

dell

Free EMR vendor Practice Fusion will partner with Dell to offer hardware, software, and services to physician practices. A package for 3-4 users (PCs, scanners, printers, and connectivity hardware) will cost around $3,000. The press release notes that the company has doubled headcount to 41 since fall. 

Federal CTO Aneesh Chopra writes a Huffington Post editorial, talking up the Community Health Data Initiative and a competition for apps that encourage children to eat healthily. The CHDI work page has downloadable data sets in case you want to build something yourself. I really like that idea, especially after reading this result: “Recently a retired telecom employee in rural New Hampshire won $30,000 by proposing a new, scientific approach to helping forecast solar activity – solving the problem faster than NASA could have by itself and with a novel approach the agency had not considered.”

iSoft says its expected 2010 profit will fall short by half because its UK payments have been delayed over its missed go-live dates and political uncertainty.

Strange: Cannabis Medical Solutions announces its medical marijuana prepaid card, which includes a loyalty reward system.

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Currently there are "21 comments" on this Article:

  1. Wow! Is this ever “spot on”! Why do we bother?

    I don’t have any physician practice experience, but in all the hospitals I’ve worked in, doctor and nurse selection team members had little say beyond expressing a preference that was overridden in every case. The clinician demo score sheets, site visit notes, and architecture reviews were weighted minimally compared to CIO/CFO gut feeling about non-clinical vendor factors such as business performance, industry word of mouth, alleged product integration, perceived risk, and an anecdotal review of what other hospitals (of the “informal benchmark” category) were buying at that moment. There was also strong resistance to buying what the cross-town competitor used because that would appear imitative (interoperability advantages notwithstanding). Certain vendors relied on the urge of C-levelers to override the white coats, knowing their poorly designed products would play better in PowerPoint in a plush conference room instead of in the uncarpeted hospital areas. Predictably, the clinicians resented the time they had wasted in providing ignored guidance and were therefore lukewarm in their adoption of the also-ran.

  2. My experience with EHR decision making is almost the opposite of the apparent hospital process. I deal with private primary care practices and the decisions are almost *always* made exclusively by the owner physicians unless they are being force fed by the local hospital/IPA. Nurses? Eh. Staff? Never.

  3. My experience is similar to Eric Bloom’s. In private practice it’s solely the doctor’s choice, which makes one wonder why they go wrong so often…

    As to usability, CCHIT not only promised, but delivered a Star rating and the jurors are clinicians, including at least one doc. For more details and conversation, hop over to The Healthcare Blog here:
    http://bit.ly/dea32B

  4. The report about the missed pap smear is all too common. The tip of the iceberg is reported on the FDA MAUDE site. There are several reports wich implicate the defective EMR for the same types of errors.

    Kudos to the Florida Medical Board Member: The board member, a dermatologist, said “”I think the Department of Health needs to put out a warning to physicians that they need to look at their programs’ default settings. This year we have seen as many if not more medical records violations from electronic medical records as we saw from hand-written records violations.”

    Ask Dr. Blumenthal if he knows anything about these types of problems, and if so, why does he continue to lead doctors astray as an agent for the HIT industry and HIMSS, the masters of deception.

  5. Great coverage, Mr. H! Keep it up.

    The Florida doctor is being blamed for the errors caused by a defective device causing a flawed system of care–“the Board of Medicine punished the OB-GYN with a $20,000 fine, a risk management review, and 100 hours of community service.”

    The lack of usability of these devices is omnipotent. This doctors and patients are victims, in addition to being guinea pigs for the government and HIT industry. The culpable HIT products escape without scrutiny.

    This is like pharmacist Cropp being put in jail for a mistake when the defective pharmacy ordering computers were down in Ohio.

    There needs to be a halt in the decorticate march to computerize medical care with defective user unfriendly products.

  6. A white paper from HIMSS?? ” the HIMSS EMR Usability Task Force and learned how very real the study and reporting of Usability can be. This task force put out a great white paper on this subject”

    HIMSS started to feel the heat from the reports of deaths from the devices it promoted with its subsidary’s CCHIT Certification. How many years after it knew about this issue did it take for HIMSS to report on it. CCHIT never gave a hoot about patient safety.

  7. Give em Hell, Suzy. You continue to provide compelling information and ideas.

    Are the Freescale Intelligent Hospital devices approved by the FDA? Just another example of technology in need of an indication. Does any one really want this? Why not spend the money on a couple of good nurses?

  8. Suzy, what is your recommendation for a records system for a hospital and affiliated clinics? Use paper charts?

  9. Regarding the pap smear debacle, I firmly believe that even if an EMR had caused this (and that’s definitely not clear based on the fact that TWO were missed), the use of an EMR proves its benefit given the number of pap smears that are done when they otherwise might not be because the EMR helps in reminding people to get them regularly.

    I thought by far and away the biggest injustice in today’s (tomorrow’s?) report was that about the city of Cincinnati. Shame on them. I hope no one at a Reds game gets hit in the head with a fly ball, because apparently there will be no trauma center to take them to.

  10. Rosy, Suzy doesn’t provide solutions, or even attempt to defend her claims, she just fires up her computer every day to tell us that computers can’t be trusted.

  11. from the source article “The doctor had made a number of mistakes, but they were exacerbated by over-reliance on the data system” What a shocker, the OBGYN is trying to place the root blame on some one else…

    I remember what my first CFO told me” Kid, computers allow you to make the same mistakes you always make, except they allow you to make them faster.”

    I think most EMR’s errors are people not paying attention. AS we progress, we look for our software to read our minds, thus we are becoming more sloppy.

    Any technology is only a tool the person should remain responsible for their use of the tool…

  12. If money were not an issue best of breed clinician driven systems would win out every time. The reality is that IS departments have to “control” purchases in small margin hospitals.

    I am always reminded of the anesthesiologist who made a huge deal if the hospital did not buy a best of breed system AIS. When asked what he would buy for a stand alone surgi-center in which he had an ownership stake he said he wouldn’t, they cost too much and don’t have an RIO.

  13. Our process, 14 years ago: Before the actual selection process started, each department was asked to determine if the choice would affect them and if it would what their requirements were. We had about 30 people from all departments in the hospital who were affected by the choice review the 10 or so options, which got it down to 3 choices. Then, they held demonstrations for the individual areas and requested feedback from the employees & physicians who attended. At that point, 1 of the 3 vendors withdrew. The last two were given a 200-page RFP that was developed based on the needs of the departments. When the responses & the price quotes came back, the selection committee spent about 6 weeks reviewing them.

    One of the remaining vendors essentially eliminated themselves by virtue of the fact that they wouldn’t give two price quotes with the same numbers. In the course of 2 weeks, there were 9 different quotes with varying numbers & options.

    At that time, the selection committee asked the clinical departments, especially the nursing areas, what they needed most and what they felt they could live with. The biggest needs were flexibility and the ability to find all of the clinical results & documentation in one place.

    In the end, MEDITECH won out. They met the needs of the clinical areas and didn’t overly burden the patient access, scheduling or patient financial staff. I was working patient access at the time, and the feeling on the other vendor was that we would have been better off with manual typewriters than with the junk they were peddling. That vendor has since been swallowed up by someone else and the product they sold has been discontinued.

  14. Just had to cancel several thousands of dollars of tests that were ordered but were just done in the past year.

    Neurology attnedings found it was quicker to order new ones than it was to search the silos to find the old reports on the EMR. Now that is an EMR worth its weght in sand.

    Problem is, most of the EMRs and ordering systems are as convoluted. When there is proof that these illegally sold devices are even as good as the systems they are replacing in terms of overall costs and outcomes, you guys and gals can sell to your hearts’ contentment and I will join you.

    Until then, go back to the laboratory and sign the patients up as the guinea pigs and go through your IRBs.

  15. ” The clinician demo score sheets, site visit notes, and architecture reviews were weighted minimally compared to CIO/CFO gut feeling about non-clinical vendor factors such as business performance, industry word of mouth, alleged product integration, perceived risk, and an anecdotal review of what other hospitals (of the “informal benchmark” category) were buying at that moment”

    And then you ask: Why do HIT sales people get paid so much? Why do vendors spend so much on marketing? Why do systems cost so much? Because buyers make emotional decisions for ‘logical reasons’.

  16. Thanks for the video of the Japanese surgeons: I was especially ineterested in how they used plastic covering to make the iPad sterile. If that screen is still easy to manipulate underneath plastic with surgeons using plastic gloves, I tip my hat to Apple. Talk about real usability.

  17. Suzy, the fact that you don’t like your hospital’s EMR system is no reason for every hospital in the country to switch back to using paper.

  18. Sorry RustBeltFan but you and Mr. HISTalk, with his jaded and dated opinions are flat wrong. Stop stereotyping CIOs. I led a CIS selection that included more than 300 clinicians (nusring, physicians and support staff) and selected the system they preferred regardless of my own differing opinions and despite a cost that was significantly higher. The CFO had no say and wasn’t even involved in any meaningful way in the selection process. Oh, and I justified the decision of our clinicians to the board.

    I’m tired of the continued view that ALL CIO’s are dunces who bow down to vendor pressures. You need to expand your view and start looking at CIO’s who are leading strategically. They’re out there if you bother to look. But maybe that’s just too much work or worse that it will show that you don’t know everything.

    [From Mr. HIStalk] I told you my experience in three hospital systems. How is that an opinion? And why should my experience in three hospital systems be any less relevant than your experience in one?

  19. Suzy – How many different EMR systems have you been trained on, and used personally, in the past 8 years? Your opinion about the one implemented at YOUR organization may be very valid – but it may simply be a poorly designed, antiquated system that was also poorly implemented with users poorly trained, made worse by poor policies and procedures and, even worse, supported by staff who do nothing every day to make improvements.

    Going back to paper is not a solution, people. It’s not going to happen, in any way, shape, or form. Automation of our medical records is here to stay. So, find a way to constructively participate in embracing the value, and improving the imperfections in all areas, which INCLUDES the policies and procedures which govern the usage of the system.

  20. RE: Veteran – Unfortunately this has been stated before by myself and many others that follow this blog for the past year (when Suzy hit the scene…I have been following the blog for a few years). Either way, it falls on incredibly deaf ears. I understand that there needs to be criticizing of the current system, but it needs to be constructive. Don’t just complain to complain, but offer solutions as like you and many have pointed out, as well as Mr. HISTalk himself, that Automation of the Medical Record is here to stay. I know it isn’t fair to ask Mr. HISTalk to screen the “noise”, but after awhile if it doesn’t become at least constructive then what’s the point of posting it?

  21. Suzy, why are you asking for proof? Do you have proof that waiting for proof is an effective tactic?
    Great things have been accomplished without waiting for proof…
    …air traffic control
    …rural electrification
    …space travel
    …the Internet
    Have any great societal advances benefited by waiting for proof?
    The argument for electronic records is compelling even if it does not rise to the level of a scientific proof: http://www.baltimoresun.com/news/opinion/oped/bs-ed-health-information-20100603,0,4979716.story







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