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June 17, 2010 News 16 Comments

From I Told You So: “Re: patients accessing their own records. One in a thousand did. ‘Wicked problems’ were prevalent.” Researchers find little benefit with England’s Summary Care Record and the patient portal view of it. Only one in 1,000 patients who were invited to open an account bothered to do so; many of them tossed the informed consent letters into the trash unread; and those who used the portal found it pretty much a waste. What the researchers found evidence of: improved quality in some visits. What they found no evidence of: improved safety, faster visits, number of referrals, more personalized care, increased patient empowerment, better management of chronic conditions, improved health literacy, positive impact on data quality, and reduced cost.

xray

From Samantha: “Re: Inga. I saw this and just had to ask – is this what Inga’s been up to lately?” Could be — those shoes look familiar. It’s a cool pinup calendar an agency designed for a medical imaging vendor. Inga is still cavorting beachside, although apparently with connectivity since she checks in periodically.

From Winston Zeddemore: “Re: software usability. Software used by 911 operators in Pittsburgh is a likely contributor to the death of a three-week-old.” A 911 operator keys an @ sign instead of # to indicate the apartment number address given by the frantic mother of her dying daughter, which is a reserved keystroke that the software uses as a command to change the address. The software moves to the next alpha address, the misrouted paramedics take an extra seven minutes to arrive; and the baby dies an hour later. They don’t know if the delay contributed. Implementation of the $10 million system is scheduled to be finished in August.

hmessing

From Mr. Science: “Re: Howard Messing of Meditech. He’s now the chairman of the board of the Museum of Science in Boston.” Funny – I had just gotten off the phone with Howard when your Rumor Report came through. I could have asked him about that, although he’s a man of few words. I’ll have the interview I was doing with him up shortly.

gawande

From p_anon: “Re: Atul Gawande. He gave the commencement speech at Stanford’s School of Medicine last week.” It’s excellent. Here’s a snip:

Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses—13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies—remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.

From Techsan: “Re: Epic. I can confirm that Epic is supplying new customers with their interview tools, which I understand are self-developed, and recommending hiring college grads to staff projects. One of our clients just completed using the tool for internal candidates and will be interviewing college grads soon as they near the beginning of their implementation. I am also working with a new Epic client and Epic made the same suggestion.” The debate rages: are inexperienced youth the best choice for implementing sophisticated clinical systems? You can’t argue with the results – Epic’s implementations almost never fail and those of their competitors often do despite having lots of experienced hands on deck. I’ll make the argument that Epic’s methods make it not just possible, but desirable to use easily managed, job-appreciative noobs who don’t bring any preconceived notions or egos to the table (not to mention “experience” that’s mostly with bad vendors or hospitals). As a non-noob, I’m as threatened and offended by that fact as anyone, but you can’t argue with Epic’s results and it’s never Epic’s implementations that are implicated in the patient-endangering case studies you read about. Plus, it gives them endless scalability because it takes little time to bring in a fresh wave of troops. I think it’s brilliant as long as it continues to work.

Listening: The Young Veins, dead ringers for the cheery Help-era Beatles, but from Topanga, CA and featuring two former members of Panic! at the Disco.

klas

Someone sent me a copy of the just-released CPOE Digest from KLAS. I’ll keep it high-level since they’re charging vendors $14,850 for a copy and I only glanced briefly so I wouldn’t be tempted to spill the beans, but I was looking to see how specific vendors did. Providers get the report for $980, by the way, and for those in the market for a system, I’d say it’s worth every penny since there’s a ton of detail.

  • Cerner – CPOE adoption fairly low but growing, but not so good with physician documentation.
  • Eclipsys – has a higher percentage of its customer base using CPOE and making progress in pharmacy and the ED.
  • McKesson Horizon – shallow CPOE usage even where it’s mandated and prospects are steering clear (and customers are considering defecting) because of worries they can’t get to Meaningful Use with it. Complex to maintain (iForms). Good with bedside barcoding.
  • Meditech – OK in CPOE, very strong in bedside barcoding.
  • Soarian – the weakest of all vendors for CPOE adoption. Too many marginal implementation people. Great at barcoding, poor in physician documentation.
  • Centricity – decent CPOE usage, but it’s still the bottom-rated EMR.
  • Epic – nothing you haven’t heard a zillion times before. It’s light years ahead of everybody, with huge CPOE utilization (over 90% in both inpatient and clinics). The score difference between Epic and its competition is shocking.

Ed Marx is always diligent about updating his CIO Unplugged postings to address any reader questions or comments. He’s done so with last week’s staff retreat one.

This CBS Evening News video shows the security exposures inherent in copy machines, which have hard drives that retain digital copies of everything scanned. Machines purchased used contained everything from police records of sex offenders to a New York insurance company’s machine that contained 300 pages of patient records, one shown redacted on the screen bearing the Montefiore logo.

quickbase

A couple of readers e-mailed me their displeasure about an extended outage of all Intuit Web sites. The online versions of Quicken, QuickBooks, and TurboTax became offline versions when something went wrong (Intuit isn’t saying what). Most importantly to the hospitals, Intuit’s QuickBase project management software was unavailable. It’s not cheap: the lowest monthly price is $299 and goes up from there based on the volume of users, data records, and data storage.

Weird News Andy adds to his body of literature about people who suddenly start speaking with a foreign accent after some medical event (this is his second report of that phenomenon). A Canadian woman thrown from a horse suffers brain damage, temporarily loses her ability to speak, and then regains it but finds she suddenly has an Irish/Scottish combo accent, including the unintentional use of words she had never used such as “brilliant” and “wee.” Maybe I have a wee bit of that since I notice I’ve said “brilliant” a couple of times.

Financial Times says big NPfIT contractors like iSoft and BT got burned for their involvement, but upcoming NHS cutbacks could create a new breed of emerging vendors. Listed: Emis (practice EMR); System C Healthcare (hospital systems, including EMR, patient management, and departmentals); Iris Software (custom development), and INPS (practice PM/EMR).  

Speaking of NPfIT, the head of one trust that opted out of it says it “put back the contribution of IT in the NHS by more than ten years.” His trust, which he calls “one of the bad boys who left NPfIT,” passed on CSC and iSoft’s Lorenzo system, choosing Meditech 6.0 instead in a $60 million project (sounds way high for Meditech).

And speaking of iSoft, its reassurances didn’t help as the stock keeps diving (now at $0.25, but only after a big run-up on Tuesday), layoffs are reportedly being planned, and executive chairman Gary Cohen, who I interviewed in April, relinquishes that role to focus on his CEO responsibilities.

Jobs: Senior Project Manager – East, Clinical Pharmacy Specialist, Soarian Clinicals – Plan of Care, Business Systems Analyst.

I got a copy of an Eclipsys customer e-mail describing how the company will handle enhancement requests going forward and I have to say it’s smart (I probably think so because I’ve advocated something very similar here in the past). Instead of the idiocy of requiring requestors to show up at the user group meeting and then taking a show of hands that rewards the rich hospitals that send lots of attendees, the Eclipsys method first involves an internal selection of the best ideas, which then move to the Invest stage. Each client organization gets $500 in Eclipsys Bucks to allocate among all the enhancements they like best, making it easy and fair for Eclipsys to simply choose the ideas that get the most support. Customers are forced to think like the vendor – do they spend their Bucks on several little changes, or shoot the whole wad on a big change and hope that’s enough to get it approved? One refinement might be to get $500 in Veto Bucks so the practical hospitals can kill off all the lame, site-specific monstrosities that the big academic medical centers always demand that will spoil everybody else’s workflow, but maybe that’s a 2.0 project.

New officers for the EMR vendor trade organization that HIMSS runs: Epic EVP Carl Dvorak (chairman) and NextGen VP Charlie Jarvis (vice chair). Carl says he’s excited to lead efforts related to open standards, which is probably driving Glen Tullman up a wall given his comments about Epic’s lack of openness in my interview yesterday.

Best Buy donates its Geek Squad service to Children’s Hospitals and Clinics of Minnesota, providing and supporting Skype, web conferencing, and video games for the families of patients.

The 45-year-old billionaire founder of Salesforce.com will donate $100 million for a new children’s hospital at UCSF.

The federal government sues Oracle for fraud, claiming tens of millions of dollars in overcharges (illegal ones, not just the usual high Oracle prices). A former Oracle employee turned whistleblower claims the company intentionally hid discounts it gave to big customers to avoid giving the feds its best price.

Cambridge Memorial Hospital (Ontario) uses out the Information Builders WebFOCUS BI platform to develop an ED tracking board application.

EnovateIT expands its mobile and wall-mounted workstation into overseas healthcare markets, citing similar demand to the US as EMRs replace paper.

AT&T issues an apology to iPhone fanatics like Inga who had problems trying to get their latest toy (what recession?) Sales were ten times higher than for the 3G last year and they ran out. AT&T says they received 13 million visits to their site in a single day by people checking their upgrade eligibility.

abc

A Madison, WI law firm gets a $1.2 million NIH grant to create an application that will check patient eligibility for government programs. I don’t quite get the business structure: the law firm (ABC for Health) is a non-profit that connects families with healthcare services, but the grant went to its for-profit subsidiary called My Coverage Plan, Inc. I guess they plan to commercialize the result. It actually sounds pretty cool for what it costs, given the huge money being thrown at less obviously beneficial HIT projects (at least if you like the idea of government paying for software to identify more people for which it can pay for healthcare).


 
A vendor demonstrates a 3.7 ounce smart phone that also contains full ECG capabilities at a Singapore trade show. The owner touches their fingers to the phone, their reading is sent to a 24-hour, clinician-staffed center, and within minutes they get a text message back with the results. $100 covers the device and 10 ECGs per month (do people really need all those ECGs?) The vendor, EPI, also offers virtual health records; a global physician network; and a health suite that measures blood pressure, blood glucose, and cholesterol.

The new Kosair Children’s Medical Center (KY) chooses GetWellNetwork’s pediatric health information solution, GetWellTown, for patient education, discharge planning, and patient workflows.

Versus Technology and Iatric Systems partner to bring real-time location system capabilities to Meditech.

Insurance company Wellpoint, most known for cancelling the medical insurance of newly diagnosed breast cancer patients, will offer video chat house calls starting in the fall.

bokamoso

Botswana opens a 200-bed digital hospital that includes an EMR, PACS, a wireless network, cart-mounted PCs, wireless telemetry, and VoIP telephones. I’m not sure its American consultants did them a favor by introducing Western methods: “For example, the notion that in the outpatient setting you get triaged by a nurse, seen by a doctor, then down to lab and radiology for tests, then back to OPD to checkout is a completely different process for them.” I bet they had some really primitive ideas before, like making the freely mobile employees come to the ill patients instead of vice versa.

The suspension of CPSI’s CFO until a misappropriation of funds investigation is complete hurt the stock a little today, with shares down 8.3%.

You can’t make this stuff up: one of the several ambulance-chasing “breaches of fiduciary duty” law firms trying to work up a class action investor lawsuit against Eclipsys is Bull & Lifshitz, LLP.

E-mail me.

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Currently there are "16 comments" on this Article:

  1. About Techsan’s comment

    Looks like all those certifications people get so they might have a shot at consulting someplace else (e.g. “Must be Bridges Certified”) really won’t mean diddly if she can convince new clients they don’t need people with the “skills”, just the “aptitude”. Epic is trying to make it seem now that getting certified won’t land you a choice new consulting gig, but it WILL still require you as a site to go through with all their expensive, spoon-fed training for your staff.

    Judy makes more money (cheaper implementation costs), keeps the hallowed halls of training at Verona in full force, but now minimizes the impact anyone sharing their hard-earned experience at dealing with the fetid, plague-ridden underbelly of certain challenges of installing said application would have on a new organization embracing her “vision”.

    Brilliant. Evil, yes – but the concept of cutting off entire revenue streams of companies that made Epic consulting their bread and butter but STILL maintaining Epic’s own training cash flow? – simply brilliant.

  2. CIPE SMETSYS my not have ever had lawsuits against their implementation but that hardly means they didn’t deserve them. The company has been shown to be very shrewd with their capabilities to manipulate individuals, organizations, and the entire industry. Whether we take the anecdotal reports you post, the comments readers leave (They blackball past employees is the general consensus) or simply note the fact that every other EMR vendor comments on their lack of integration (Which is a choice on their part). I’m afraid I have to agree with the Integrator’s analysis – Simply Brilliant.

    The main issue with the strategy CIPE SMETSYS is recommending should be obvious, you may be able to train someone to build in your programming language but without experience they will have no idea when it is important to do anything aside from the standard workflows all organizations use. So this is also a very reasonable methodology to limit having to customize the code. LET ALONE the fact that these are people that are going to fail to be independent thinkers, they will also fail to identify patient safety issues because these will be the only workflows they know. Will you spend less on the revolving door or new employees, most likely not, only a vendor with huge cash flows can afford to throw away talent.

    On one last note, CIPE SMETSYS test takes hours to complete. Much like Sunquest’s. how many people who have industry experience are going to submit themselves to taking a test to even get their foot in the door. This test alone will serve to keep only the desperate and the freshmen straight from college as your only applicant pool.

  3. About Epic’s interview tool…

    This shows a thoughtfulness that is beyond many vendors. Staffing levels for projects are a challenge for everyone and building a methodology around available resources is smart.

    The impact is to consultants, not the providers….

    However, it has to be scary to have your project staffed by folks that say “this is my first implementation.”

    Also about KLAS – CPOE:

    Statistics are a funny thing, they often only tell one side of the story, I would like to see the CPOE adoption by facility type by vendor. I wonder how many of those Epic 90% are in community based facilities that a local physicians using the system, I anticipate that number would not be so high?

    My advise in the clinical solution is to stick with the one that got you there…. there is no magic bullet… CPOE is hard work, the majority of the work is in content creation / maintenance, not the application…..

    Epic has some good press and they have a good story, however it reminds me of the old IBM story of – you can’t be fired for buying IBM……

    My advise is work with your vendor, don’t look for the magic bullet and it is definitely not found in hiring a bunch of college kids to configure your system…..

  4. Regarding the Botswana hospital and the outpatient clinic process, I believe the point is that Bokamoso is the first western style hospital in the country. Patients previously had little to no access to specialists and diagnostic care in the outpatient setting in Botswana and had to travel over 4 hours to Johannesburg, South Africa. By instituting a Western style clinic process at the hospital, patients are now able to get the individually-focused care they need in one facility, without waiting. Moving between closely spaced triage, exam, and diagnostic rooms is not an issue for them. It keeps wait times minimal and is viewed as a proactive and welcome change. This is a great achievement for healthcare delivery in Botswana, and many more residents will receive proper treatment as a result.

  5. Re: patients accessing their own records.

    Idealistic, utopian “solutions”, whether created by far left social justice ideologues or hard right wing capitalists, are doomed to fail due to immutable aspects of human nature.

  6. I’ll make the argument that Epic’s methods make it not just possible, but desirable to use easily managed, job-appreciative noobs who don’t bring any preconceived notions or egos to the table

    Every med mal attorney in the country should be aware of this for when the Libby Zion-level EHR related accident occurs in an Epic hospital.

  7. Regarding: “A 911 operator keys an @ sign instead of # to indicate the apartment number address given by the frantic mother of her dying daughter, which is a reserved keystroke that the software uses as a command to change the address.”

    I keep a whole list of vendors who don’t handle HL7 reserved characters at all. I can’t tell you the nuimber of times some vendor rep has told me to educate the users not to use an ampersand or a pipe in documentation. Really? 4,000 employees? My current versions of SIS, IDX and Epiphany don’t do reserved characters at all. I have other vendors that do it sometimes (field-by-field level).

    What kind of incident is needed to get people to follow the simple HL7 rules for escaping out reserved characters?

    For those of you who don’t have them memorized, these are the HL7 reserved characters (usually): |~^&\

    I always have my users do a “keyboard” test on new installations. The instructions are to use every character possible on an interfaced transaction. I always try to get vendors to fix this fecal matter prior to go-live, but often I am trumped by a project manager.

  8. On the issue of use of college grads in hospitals, it seems the devil is in the details of what these grads are being called upon to do.

    For example, here at Drexel University, a univ. with strong engineering/CS roots, there is a co-op model where students spend time each year working in industry, so that when they receive their degrees they have both academic and applied experience. THis has worked well for decades – as long as the students are not delegated responsibilities beyond their means in an unsupervised fashion.

    I would ask: what, specifically, are the new college grads being asked to do? If it is basic tasks (workstation installation and troubleshooting, software installs, network troubleshooting, etc.) then there is not problem.

    On the other hand, if it is design or modification of user interfaces or clinical alerting algorithms, modification of clinical datasets or order sets, information security and stewardship or other tasks related to and affecting the legal medical record, or anything that could possibly impair a clinician’s ability to take care of patients, then that is a problem.

    Rather than merely speculate, does anyone know specifics of what these recruits are called upon to do in Mt. St. Elsewhere?

  9. Thank you Mr. HIStalk for putting this up as headlines. Your commentary is eloquent:

    “What they found no evidence of: improved safety, faster visits, number of referrals, more personalized care, increased patient empowerment, better management of chronic conditions, improved health literacy, positive impact on data quality, and reduced cost.”

    The equipment is so unusable and unsafe that people have to wonder about the kickbacks and other favors issued by the industry to “convince” our Congress and White House to waste $ billions.

    Does any one know what N. Pelosi has “invested” in HIT companies?

  10. (and by the way, I have problems with a new-college-grad policy for an entirely different reason. Unless EPIC is taking special pains to balance their hiring including who they reject for positions, I could imagine that a policy preferential to the young at the expense of the “experienced” in today’s unemployment climate could lead to a class action age discrimination lawsuit.

    Big companies actually “balance” their layoffs to prevent just such claims.)

  11. Please inform e-paitent Dave that in the UK, no one uses their records.

    What a waste.

    Does Congress know?

    That is why there are doctors. “Only one in 1,000 patients who were invited to open an account bothered to do so; many of them tossed the informed consent letters into the trash unread; and those who used the portal found it pretty much a waste.”

  12. Its to bad Quadramed can’t get their CPOE sites to respond to KLAS surveys. They were given the Davies award this year for most physician adoption out of any system but KLAS doesn’t even rank them. I wonder where CPSI, HMS and others rank. Probably too small. As for the Epic Cult, yeah that is truly amazing.

    [From Mr. HIStalk] QuadraMed CPR was included and actually did about as well as everybody who wasn’t Epic and their CPOE adoption was very good. Their problem isn’t the product, it’s their management of it. CPSI was nearly as good, but the product falls short for deep CPOE adoption. HMS is clearly behind.

  13. Re: Copier Security

    You can read the full news story over at the CBS website, and I’ve added some information on the subject over at the OccamPM blog. There’s some effort being made by Congress and/or the FTC on the issue, but for the most people just needed to start regarding all their “smart” devices as miniature computers and disposing of them accordingly.

  14. Love the comment by Lacey Underall on vendors who do not support HL7 escape sequences.

    It’s such a basic thing, and it’s amazing how many don’t do it properly across the board. I work in integration and I was actually on a call with our integration engine team trying to work through an issue where one vendor was sending a message to the engine, making the modifications, and then sending on to the other system. This topic came up and the sending vendor said their application cannot properly escape the ‘&’ character in an HL7 field, and the receiving vendor said, “that’s good because our interface doesn’t support the HL7 escape sequences anyway”. Considering how much vendors are willing to charge for interfaces it’s amazing they do not support this ‘SIMPLE’ concept.

    BTW the special characters are typically in this order. |^~\&
    | – Field Separator
    ^ – Component Separator
    ~ – Repetition separator
    \ – Escape character
    & – Sub-Component Separator

    A quick google search for HL7 escape sequences will show you how they need to be escaped.

  15. Have your newly hired 23 year old employees working with your 22 year old EPIC TS – what could possibly go wrong?

    The other issue is the EPIC training classes don’t, at least in my opinion, teach you what you need to know. You learn that from your TS – the problem is the TSs are spread too thin.

  16. RE: HL7 Reserved Characters

    FYI, HL7 reserved characters are arbitrary – they can be (almost) anything. Those mentioned above are the recommended ones, but the ones a message actually uses are specified in the message header:

    MSH|^~\&…

    HL7 processors are supposed to read the message header to find out what the message is using for encoding the message, not just assume they are “^~\&”.

    So that tells you just how far away from compliant these vendors are that don’t even offer hard-coded support for the recommended characters.







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