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Monday Morning Update 8/9/10

August 8, 2010 News 39 Comments

From Your Name Here: “Re: Community Health Systems. Medicity wins VOC, beating out RelayHealth.” Unverified.

8-8-2010 8-50-52 AM

From Scotty B: “Re: ACE. I guess you scared the cardboard Mr. HIStalk into hiding today.” The vendor who misappropriated my Smoking Doc logo at the Allscripts user meeting demonstrated at least a little bit of creativity in acknowledging their transgression. Two readers with what I assume are tongues in cheeks are urging me to sue them.

8-8-2010 5-51-28 PM

From Lem Hewitt: “Re: ACE. I wish you would go to Epic’s UGM and do a similar report.” Now that would be interesting — I’m kind of embarrassed that I’ve never thought of doing that. Lem generously offered to cover the hotel costs using his Marriott points. I’d have to swing some time off from the hospital and probably find a customer willing to let me pose as their fake employee. Something to think about although there’s not much time left.

From Dirk Squarejaw: “Re: speakers. Do you know of any dynamite speakers for a CIO-type crowd?” I get asked this question a lot, so I’m appealing to readers to suggest outstanding speakers they’ve heard. The criteria: (a) inspiring; (b) unbiased; (c) not the HIMSS semi-celebrity types who charge thousands of dollars, like the guy who sawed his own arm off or Dana Carvey; (d) not just canned speech-readers riding the rubber chicken circuit. Ideas? I should disclose that I’ve been asked a couple of times to do keynotes, but I always decline – I have nothing insightful left to say that I don’t say right here, so I’m leaving it all on the field, as the jocks say.

8-8-2010 5-56-21 PM

From Ollie: “Re: mobile healthcare. I was getting blood drawn at Emory Midtown and saw an infectious disease MD tapping away on an iPad in the Starbucks line. I asked how he liked it using his Cerner PowerChart EMR that way. He said it loves it, it runs great, he places orders, does documentation, etc. He was happy to share and smiling when he said it. An MD reviewing an EMR, maybe even placing orders, while in line to get coffee … what is the world coming to?” That’s pretty cool. As much as we debate software usability, mobile device capabilities are right up there when it comes to physician satisfaction — just like it is in the consumer world, where the same old e-mail app takes on another dimension when you can use it untethered.

From Geri: “Re: objectivity. How do we know that an anonymous Mr. HIStalk doesn’t have interest that conflict with those of his readers? I’m not accusing, just asking.” Here’s how I would judge anyone running a site like HIStalk: (a) do they have a hidden agenda, like owning stock in a particular company or profiting in some undisclosed way? I have no way of proving it, but I don’t. (b) are they pitching their own profitable endeavors such as consulting, speaking, or landing a board gig? (c) do they shill out every possible revenue source, such as spamming readers with sponsored e-mail blasts? (d) have they ever actually worked in the field, particularly on the non-profit side, or did they just cruise in and hang out a shingle proclaiming to be an expert? and (e) does the author try to use his or her readership to make themselves more famous and influential? Feel free to judge me on any of the above — you have seven years’ worth of evidence to review. Staying anonymous keeps me honest — there’s no way to cash in even if I was tempted, i.e. there’s no such thing as an anonymous celebrity. It’s a fair question, though, and there’s more information on my About HIStalk page.

Listening: new from the highly regarded Arcade Fire.

8-8-2010 6-43-19 AM

It appears that we remain collectively unconvinced that HIEs can figure out how to support themselves financially, like trust fund babies who struggle when daddy’s money (or Uncle’s in this case) is gone. New poll to your right: if you were seeking hospital care, would you care whether a hospital is on the Most Wired list or not?

8-8-2010 5-54-30 PM

Tucson Medical Center’s CEO talks a lot about its Epic implementation in her blog entry about upcoming layoffs that were triggered by a 10% drop in inpatient volumes. One the one hand, “While costly, the investment was worth it because, as we were told by Epic last week, we are far ahead of other hospitals in terms of system optimization,” but reading between the lines, she seems to say that the labor needed to implement it caused the hospital to miss its productivity goals.

Kaiser reports Q2 numbers: $11 billion in revenue and $313 million in operating income. They, too, talk a lot about Epic / HealthConnect, saying that members exchanged 5.3 million messages with their providers in the first six months of the year.

8-8-2010 9-07-38 AM

Looks like the Sunny Sanyal rumor was on the money. He’s at T-System now. Thanks to You’ll Know Who for the original rumor and Mark for telling me about Sunny’s updated LinkedIn profile (done since my original report, apparently, since I checked it originally and it was unchanged).

Somebody breaks into a Texas allergy clinic and steals four PCs containing PHI, although as one of the docs said, “We’re an allergy clinic, so I don’t think there was anything embarrassing taken.” The clinic complains that it cost them $15,000 to send the mandatory breach notification letters to its 25,000 patients, more than the cost of replacing the computers.

8-8-2010 6-21-39 PM

A reader sent over a note about the death of Christopher Heller, MD, FACS, a co-founder of hospital software vendor MIDAS+. Condolences can be sent to his family via this e-mail address or left on the obituary page.

Encore Health Resources announces its EHRight solution, which helps map EHR technology to the MU requirements, match clinical data elements to quality measures, and assess EHRs.

Medicare’s fraud contractors, which cost taxpayers more than $100 million per year, come under the gun of Senator Chuck Grassley, whose investigation finds that they take six months to send their cases to law enforcement and only seven percent of the suspicious billing they identify is recovered. Also noted: the Program Safeguard Contractors are poor at identifying new fraud trends. The Obama administration, of course, says it will fix everything, with the only announced change so far being to give the groups a new name.

8-8-2010 5-58-31 PM

The travel habits of athenahealth CEO Jonathan Bush are profiled in the Watertown section of the Boston paper. “I literally rent [an] airplane every Tuesday morning, and I hit five cities by Thursday night, every week. I’m cold calling . . . That’s my life now. It’s like any government fiscal stimulus thing — it’s a gold rush.”

Sharp Community Medical Group signs up for the just-announced Collaborative Care Solution jointly sold by IBM and Aetna. I’m not entirely clear on exactly what it is, but it sounds like analytics. I’m always skeptical about IBM’s healthcare intentions even when insurance companies aren’t involved, so I’ll assume it’s a repackaging of a hodgepodge of its existing technologies that will tap into insurance company billing data for clinical purposes (always questionable), with a key motivator being getting stimulus money. Reference is made to HIE-type services as well. They say it will cost less than $1,000 per doctor.

The Milwaukee paper writes up AskHermes, software developed by University of Wisconsin-Milwaukee researchers that uses natural language processing and artificial intelligence to review medical case descriptions to recommend treatments.

A study looks at telepsychiatry, in which patients are interviewed on camera with the resulting video analyzed later by psychiatrists. I found that of minimal interest, but that announcement (and a couple of unrelated ones that talked about video recordings of patient encounters, including remote ICU monitoring) suggest that the multimedia EMR is finally at hand.

Oracle’s punishment if found guilty of defrauding the government by overcharging it for software could reach $1 billion. Imagine being the former Oracle employee who is the sole whistleblower in the case.

Ingenix releases a version of its CareTracker PM/EHR with specific functionality for Federally Qualified Health Centers.

8-8-2010 5-40-30 PM

Incoming medical students at the UC Irvine School of Medicine will receive an iPad preloaded with mandatory course materials and hundreds of medical applications. Interesting: they’re ditching the sage-on-the-stage lecture model in favor of student-controlled learning. That’s the big announcement if you ask me.

MedAptus announces GA of the new version of its Intelligent Charge Capture system, which runs in the iPhone and iPad.

MEDecision releases Alineo 3.0, the new version of its case, disease, and utilization management system.

eHealth Insider reports that NPfIT is about to be scuttled as part of its decentralization, even losing the Connecting for Health name in a program to cut its massive costs. The government is putting CSC on the hook to reduce its costs dramatically and the Microsoft enterprise licensing deal has already been cancelled.

Odd lawsuit: the widow of comedian Bernie Mac sues his dermatologist for not recognizing his symptoms of respiratory failure. The doctor says he told him to get to a hospital and he did.

E-mail me.

Final Thoughts – Allscripts Client Experience 2010

I have to say that I enjoyed ACE a lot, although I can’t pinpoint what I liked about it specifically. I think it may have been that, unlike HIMSS, the attendees had modest egos. I saw no one pontificating, traveling with a sycophantic entourage, or working their pectorals with a foot-long string of “I Love Me” badge ribbons. These are mostly frontline people from practices and hospitals, i.e. my kind of folks. I liked the Allscripts people, too. The logistics were manageable, the lunches and opening reception held in the Hub with vendors was a smart idea, and there were plenty of essentials at hand (restrooms, break-time snacks, and entertainment).

One more full disclosure item: I take my “everyman” role seriously, so I turned down an e-mailed company invitation to meet personally with Glen Tullman. I appreciated the offer, but it wouldn’t be right to claim to be objectively reporting “from the ground” and while meeting personally with the CEO. I came and went anonymously.

Friday’s sessions may have appeased the person I talked to who felt the conference wasn’t detailed enough. In looking back, Thursday’s meetings were heavy focused (intentionally, I’m sure, to accommodate one-day attendees) on Meaningful Use and product roadmaps. Friday moved into deeper topics at a product level. My favorite was one from ColumbiaDoctors on their Enterprise implementation — it was candid and informative about the challenges of changing the culture of a huge organization that is quite set in its ways (one of the more interesting presentations I’ve ever attended, actually). They used the classic commercial above, which even though I’d seen it before, made me inadvertently laugh disturbingly loudly a couple of times, probably jolting the adjoining attendees into thinking a psycho had crashed the session. I think I was overly caffeinated from the readily available soda from the break.

Most impressive to me, however, was that Glen made good on his promise to fix the breakfast line problem. It was gone Friday morning. I had a feeling he was serious when he announced in the opening session that he had designated a team to make it happen. Now if only he had a similar chance to re-do the Friday night bash, which involved moving from a huge line to get into the House of Blues to multiple huge lines to get food and more huge lines to get drinks (guaranteeing that either your drink was warm or your food cold in your unsuccessful quest to enjoy them simultaneously as they raced from opposite directions toward room temperature). The house band was OK if you like Top 40 covers (I abhor them, but these guys were adequate) and they had karaoke (I’m not a fan, but that Chris dude who knocked out a deadpan but flawless “Baby Got Back” with beer in hand might have changed my attitude). It was fun, just a little too packed.

8-8-2010 6-01-15 PM

I checked out a demo of the patient portal (Allscripts / Medfusion / Intuit). Well, sort of — they were running screen shots instead of a live demo, which I hate with a passion (I always assume that either the demo people or the product are untrustworthy when they aren’t willing to risk showing it live). It looked good in the screen shots, anyway, showing functions for patient communication, scheduling and charging for online consultations, pulling EMR data into notes for patients, scheduling appointments, and placing incoming patient communication into the chart. I’m a little surprised that Allscripts is trusting another company to provide such an important part of its offerings. I’m just guessing, but I bet Allscripts had a strong interest in acquiring Medfusion before deep-pocketed Intuit came along to push the price into the stratosphere so they could latch onto the financial transaction possibilities it creates.

I saw Enterprise running on an iPad in the Innovation booth. It was really cool — clearly the iPad is just the right size to balance portability with screen real estate. I still can’t figure out how I’d comfortably hold the thing for extended periods, though.

A complaint I heard more than once from both Enterprise and Professional users: Allscripts has experience in implementing all kinds of specialties, yet each implementation starts over from scratch. The plea was to use the content and knowledge from one implementation to expedite future implementations. I’ve complained to vendors about that before — as long as a new client is willing to take the risk of using someone else’s ideas and the old client doesn’t mind, it sure would be nice to start with a non-blank slate and piggyback on their experience.

I talked to an Enterprise customer who was not only happy with the product, but very satisfied with Allscripts support. She said the case backlog was ridiculous at one point, but the company brought in some new leadership and added resources to the point where she’s getting quick callbacks from people who know what they’re doing.

8-8-2010 6-03-08 PM

Funny, but even though the presentations talked a lot about Meaningful Use, I didn’t hear it mentioned much by the attendees. Either there’s just no collective experience to make it worth discussing or practices aren’t all that interested in it. I’m almost concluding that it’s (b). Those of us in the industry who talk about it knowledgably and constantly may be overestimating the HITECH knowledge and interest level that’s out there in the real world. And these are the practices astute enough to send people to a national user meeting, not the average small-practice customer.

I wandered into the area where sessions for users of Allscripts hospital products were meeting. I had to wonder if they felt like orphans since so much of the emphasis was on practice-based PM/EMR. I didn’t connect with any of them to ask. I don’t know if the Eclipsys users will be rolled into the next meeting, assuming the acquisition goes through.

Las Vegas is my least-favorite city. It’s sleazy, tacky, and not even cheap any more. Fake beaches in the middle of dull desert moonscape, fake cleavage, fake celebrity chef restaurants (think your local mall’s food court at 10 times the price), and shows that (as Mrs. HIStalk points out) mostly involve aged celebrity tweeners too passe’ for Hollywood and a only a small step above Branson. I caught the 5 a.m. shuttle and even then the casino had plenty of people (families with small children, two-fisted drinkers, and groups of scantily clad women whose motivations were not clear, making for an interesting but depressing mix). The airport was a madhouse, although kudos for having free WiFi good enough for me to stream Better Off Ted while waiting for my flight. I’ve been to meetings there maybe 4-5 times and am always happy to leave. It was a good setting for ACE, though, since the deals were good and the logistics were outstanding.

When it comes to Allscripts, it came across as a bigger and more polished company than I anticipated. It’s growing fast, maybe a little too fast to stay connected with its customers in the same ways, but scaling well in general and trying to add technology to replace some of the “just call me directly” type of contact that’s no longer feasible. I don’t know how a salesperson would figure out which of the many overlapping EMR products to push at a prospect, a situation that will be more confusing when those from Eclipsys are brought into the fold.

Customers seem to be adapting to the idea that their vendor has changed since they signed up, which is always a challenge (it’s like getting married, only to have your new spouse gain weight, join a cult, and start sleeping around). Unless someone like Oracle buys the company, Allscripts seems early in a lofty trajectory given its ambitions and footprint and it appears to be executing pretty well, with the Eclipsys acquisition being a crucial test. Thanks to the folks there for inviting me to attend without even asking to influence what I might say.

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Currently there are "39 comments" on this Article:

  1. From Dirk Squarejaw: “Re: speakers. Do you know of any dynamite speakers for a CIO-type crowd?”

    Check this one out: http://www.drumcafe.com/usa.html

    They performed and provided a mighty fine motivational “speech” at a users conference I went to a couple years ago. Very different. Simple concepts, even for CIOs. Easy to listen to. Fun!

  2. Re speakers: Long-time health care savants Uwe Reinhart and Steward Altman are both insightful and entertaining (not sure either are still on the circuit). Also, Dr. Atul Gawande has written some wonderful stuff for The New Yorker on health care systems. He’d be a great speaker on the broader issues.

  3. Re: speakers. Do you know of any dynamite speakers for a CIO-type crowd

    Dan Barchi is a CIO who spoke at HIMSS last year or the year before. Wow – interesting perspective, informative, and entertaining.

    I saw Ed Marx (the world famous HIT blogger) presented – inspiring as well.

  4. Re: Tucson Medical Center and Epic. Having seen the nursing staff struggle with the new system I’m not too sure they did such a great job with their implementation. My father was recently in the hospital and it took almost an hour for the nurse to figure out how to document the FFP transfusion. Additionally they didn’t chart his pain meds and insisted they never administered them despite the fact several of us watched them do so.

  5. Re; Tucson Medical Center and Epic.
    “While costly, the investment was worth it because, as we were told by Epic “…… I like how the CEO has determined it was worth it based off the vendor saying so.

  6. What is wrong with this picture? The good ID doctor is ordering up therapy on hospitalized patients while at Starbucks (reported by Ollie) and Tucsonan witnesses the disgusting care of a parent.

    I am regretably all too familiar with the physical and cognitive absence of physicians, nurses and care associated with these CCHITy certified devices.

    Did Starbucks computer clicker examine the patient? What if the computer was lost or stolen? The doc there is not too distracted, right?

    For the lazy and unprofessional who have joined the ranks of health care professionals and wish to provide vapourcare with vapourware, this is an ideal solution.

    On the other hand, patients like the Tucson parent, and there are millions who suffer injury via the mechanism described, will cry out in need of care.

  7. MedinformaticsMD is a fabulous speaker with a radio announcer quality voice, who is not only an expert in the field but can tell health IT professionals what NOT to do, the things that lead to CIO meaning “career is over”, which is more important than the usual “best practices” information they are usually fed.

  8. I think Suzy’s rant would make for an interesting poll. If you see a physician using his/her iPad to check on his/her patients while having a coffee at the local Starbucks, do you think that physician is:

    a. workaholic
    b. lazy
    c. evil
    d. murderer

  9. “The clinic complains that it cost them $15,000 to send the mandatory breach notification letters to its 25,000 patients, more than the cost of replacing the computers. ”

    They would have been spared the cost of sending breach notifications if their data had been stored encrypted, right? More politically palatable than a fine, I think.

  10. Suzy – there you go again. Seeing the glass half empty.

    I prefer to see it half full. See, I know my doctor is going to get coffee. I know that he/she is very busy, but they’re still entitled to coffee.

    If my doctor wants to review my electronic chart over coffee, order some tests to be performed before he/she sees me in the hospital, meaning that they HAVE THE RESULTS before they come to my bedside, perhaps meaning that I can be discharged earlier because my doctor worked more efficiently – well, I’m all for it!

    I would rather my doctor spend the time reviewing my chart BEFORE they see me, so that they aren’t spending all their time in my presence just reading a chart or viewing films, MRIs, etc. I want them examing and talking to ME, the person. In other words, in your “rose colored glasses world of yesteryear” – when the doctor came into the room – how many times did they look you in the eye, versus reading a paper chart! How many times did they NOT have the information they needed from tests and had to keep you another day until they were available?

    And you’re worrying about him leaving the iPAD at the Starbucks? How many times does the doctor go to look for a paper chart and it’s not available? And no one knows where it is? A lot.

    I hope you find that “way back machine” soon, so you can live in the past. But for me, I will take the present, where things aren’t perfect, but where information, at least, is available much faster and more accurately (yes, I’m glad that we don’t have to rely on manual handwriting or typed lab results). I’d rather work on making improvements on things in the present than wishing I was in the not-so-perfect past.

  11. Exactly Suzy, what if that doctor ordered a Raspberry Mocha Chip Frappuccino instead of of course of antibiotics? What if, rather than ordering isolation, he actually gets confused and orders a caramel carrot cake?

    All I can say is at least he was at a Starbucks and not a Jiffy Lube, that could have been disastrous.

    In response to BafOC’s. He was clearly all of the above. A lazy murderer and an evil workaholic.

  12. Suzy, I’m guessing that in your perfect world the MD would only provide care at the bedside using a paper chart? Well, sorry, we tried that and in case you didn’t notice, it didn’t work out so well for everybody. Incomplete information is the single biggest cause of ADEs, so making data access more limited is definitely not the solution to our woes, but that seems to be where you want us to go.

    Physicians spend their days moving between their office, the hospital, and the rest of their lives, and all the while being asked to provide care to their patients. With paper charts, every location has a huge data vacuum consisting of all the data at the other locations. Forget about getting data while driving. Unfortunately decisions need to be made in all circumstances, and a doctor can’t say “sorry, your chart is in the office and locked up until Monday, so hold off on your MI until then, please”.

    The MD in the Starbucks line is doing what every MD has done at one point in their lives, ordered coffee. He’s optimizing the downtime he has to find out more information on a patient he’s caring for. The fact that the patient isn’t right in front of him doesn’t mean care can’t continue, in fact care must continue in that situation and he’s making the best of it.

    You sound more and more like a Luddite every day. Are you sure you want to be using a computer to browse this site?

  13. @Samantha Brown
    I don’t think Allscripts knew that HIStalk was attending. I think they went incognito.

    [From Mr. HIStalk] Yes and no. They knew I was attending, but they helped me register under a phony name that they didn’t know (it was complicated, but effective). At the conference, nobody knew which of the 3,000 attendees was me. That’s another reason I declined their offer of face time with Glen, interviews with whatever executives I wanted, etc. I saw the conference exactly like any other attendee, except I knew less about Allscripts products than most of them.

  14. Ruminating writes:

    I hope you find that “way back machine” soon, so you can live in the past. But for me, I will take the present, where things aren’t perfect, but where information, at least, is available much faster and more accurately (yes, I’m glad that we don’t have to rely on manual handwriting or typed lab results

    This seems yet another example of the “HIT ruling class” wearning no clothes, that is, being incompetent on issues of nformation science vs. information technology (for more on this, including how how blurring of this distinction damaged the pipeline of new drugs from a major pharmaceutical company, see here).

    The 2,800 pages of ‘legible gibberish’ (poorly organized,largely clinically irrelevant, but perfectly legible garbage) spewed out by my HIT-injured mother’s major-vendor EMR system for a period covering a mere 15 days are another reflection on IT-amateur understandings of what clinicians need in order to take care of patients.

  15. DrM writes:

    “Incomplete information is the single biggest cause of ADEs”

    My mother’s injury was due to “incomplete information” CAUSED by a flawed ED EHR, in a scenario that would never have happened if the ED simply used paper.

    I know firsthand, because I once worked in the ED where the mishap occurred when they WERE using paper…..

  16. Re: my comment #19

    Oops, I’m sorry, I forgot, “my mother the anecdote” is just clouding my judgment of the complete beneficence of today’s clinical IT.

  17. Suzy – I think you need to manually write down your responses from now on and fax them in to Mr. Histalk. Then he can scan them and post a link to the scanned image out here. Or maybe that is too much technology for you?

    Everyone else works on their laptops from Starbucks and Caribou Coffee – why not the MD?

    Time is the most precious commodity and using it effectively will become even more vital as we flood the system with “free healthcare for all”. Let’s see how everyone keeps up then. Technology will be the ONLY way to begin to handle the demand and, sadly, it will not be enough.

  18. Re: “I’ve complained to vendors about that before — as long as a new client is willing to take the risk of using someone else’s ideas and the old client doesn’t mind, it sure would be nice to start with a non-blank slate and piggyback on their experience.”

    You seem to be describing Epic’s model system…not perfect, but a pretty good starting point. I’m surprised something similar is not available with other vendors.

  19. My mother’s injury was due to “incomplete information” CAUSED by a flawed ED EHR

    I don’t recall seeing anything posted here to support this claim.

  20. MIMD and Suzy – You can keep railing about EHR’s and automation all you want, (and once again, we are all terribly sorry about the loss of your mother – my mother was recently in the hospital as well and, as always, numerous errors occurred, but none relatable to the EHR, in her case, and she is still with us so we are very lucky).

    But, EHR’s and healthcare automation is here to stay. You can either figure out how to help make these systems, processes and training better, safer, faster, cheaper – or you can keep whistling in the wind. I just don’t understand why you wouldn’t take your knowledge of what works, and what doesn’t work, and roll up your sleeves trying to make improvements going forward? Every technology can be improved upon. All processes can be made better.

    Continuing to fight to go backwards to paper is like peeing in the ocean – it might give you some personal relief, but it doesn’t change the tides. To be honest – I’m really not sure what your point is – is it to go back to paper?

  21. “Ruminating”.

    One of my points is to expose readers to the psyops of corporate sock puppets, like the Meditech sock puppet I exposed at this link.

    Another purpose, after the past ten years trying to advise the industry of the dangers it was creating, is to help medical malpractice attorneys defend patients for HIT-caused injuries, since the HIT industry is stone deaf and essentially amoral.

    Does that answer your question?

  22. Back away from the irony Says:

    — My mother’s injury was due to “incomplete information” CAUSED by a flawed ED EHR —

    I don’t recall seeing anything posted here to support this claim.

    And I don’t see anything posted here that would make me care about the beliefs of anonymous posters, either.

  23. Suzy, let’s shutdown the “what’s your point?” challenge. I”ll ghost-write a 500-word response for you for the “Readers Write” column.. Sure Mr. H. can connect us… What do you say?

  24. Just tellin it the way I see it. The truth hurts. That is obvious.

    Nurses are tethered to the CPOE device and obligatorily have to ignore the patient while waiting at the terminal so as to not miss a stat order.

    You doc clickers can scroll your patients while taking a stroll through Starbucks, but you have not seen your patients. I see what goes on.

    This patients need care, not coffee.

  25. And I don’t see anything posted here that would make me care about the beliefs of anonymous posters, either.

    You keep posting, so you must care what anonymous readers think. None of which changes the fact that you have provided absolutely nothing to support that claim. I just wanted to make that clear to any anonymous readers who might not be aware of it.

  26. Ah, Suzy, so we have hit at the crux of your angst.

    You are jealous of the doctors freedom to review charts and place orders from the iPAD at the Starbucks. Let’s face it – you are a disgruntled employee who won’t be happy no matter what anyone proposes, which is why you continue to not propose anything! Because of that, Annonymous has to offer to ghost-write a paper that will propose, what? What is the future as you see it? What should be done? Where are your ideas? It is easy to criticize. If you oppose, you must propose.

    Or, Go to Medical School so you can go to Starbucks.

    MIMD – I continue to struggle to be convinced that you are actually an MD. Your arguments lack substance, facts and proposals. Only emotion and anecdotal storytelling. You like to post links that actually prove little and also propose nothing. And to conclude that the entire HIT industry is amoral, stone deaf and uncaring is a HUGE generalization that a doctor should know better than to state. It is obvious that your mother experienced a horrific medical error of some sort, but other than that experience, I do not think you really understand what you are talking about regarding EHRs and how they are designed, developed, and installed.

  27. Back away from the irony Says:

    You keep posting, so you must care what anonymous readers think.

    Oy vey. In fact, as an information scientist, I find HisTALK an excellentway to spread information on health IT to thousands who would otherwise only be exposed to industry-controlled memes. I worked in Big Pharma; I know the game.

    Mr. HisTalk has the guts to allow multiple views to be posted.

    You want something supporting the claim my mother was injured by HIT causing incomplete medication information?

    Well then, do you have the guts to to take up this discussion non-anonymously? If so, I can be reached via the email at my Health IT teaching website.

  28. Well then, do you have the guts to to take up this discussion non-anonymously? If so, I can be reached via the email at my Health IT teaching website.

    This isn’t a discussion. You made serious claim. You either have evidence to support that claim, or you don’t. If you have the evidence, you have not posted it. Knowing who I am won’t change anything.

  29. Back away from the Irony,

    My claim is 100% true, and you are free to believe it or not. A lawsuit is underway.

    Knowing who you are would convince me you’re not just a paid industry shill. It would also convince me you have cojones.

  30. MIMD, you say your goal is to “…to spread information on health IT…” I’m sure most of us who take the time to read HISTalk appreciate well reasoned debate on that critically important topic, so thank you for that mission.

    However, I encourage you focus on the information you wish to spread. Your repeated requests for the email address of anyone who dares disagree with you hurts your credibility. Wanting to make someone prove they have “cojones” and are not a “paid industry shill” are not necessary precursors for meaningful discussion.

  31. Getting back to Information Says:

    Your repeated requests for the email address of anyone who dares disagree with you hurts your credibility.

    Thank you. I could not have asked for a better poster example of a lack of understanding of information science, in this case, trustworthiness of information, than this inverted piece of illogic.

    This is why trusted sources of information, as in biomedicine, do not generally include anonymous sources. I allowed none in The Merck Index of Chemicals, Drugs and Biologicals, for example.

    This is also why I am not anonymous, see my site at this URL.

    Not even The Journal of Irreproducible Results is anonymous! 🙂

  32. I truly wish you could refrain from talking down to everyone who disagrees with anything you say.

    We, the readers, are not positioning ourselves as experts, so our identities are irrelevant. We are not asking to be quoted or published – just that our requests for more information or consideration of dissenting opinion not be dismissed out-of-hand. You are the one making the assertions, and thus we are asking you to back them up and propose alternatives.

    Five posts in a row, all you have done is attack those seeking more information from you. You may have something of value to share, but I’m sorry to say that the way to choose to communicate is very counterproductive to your goal. I wish you the best.

  33. Fruitless Discussion Says:

    We, the readers, are not positioning ourselves as experts, so our identities are irrelevant.

    (laughing) Again, wrong. Your position lacks depth. Anonymity where none is needed speaks volumes about intentions, or perhaps fear, or other social phenomena that are most certainly worthy of consideration when, ultimately, people’s lives are at stake.

    This is a serious question: is the HIT industry that abusive that people *supporting* it as well as those who are not entirely supportive (e.g., Mr HisTalk) need to remain anonymous?

    As to the rest pf your points, I’ll just say it appears I’m writing to a younger audience not used to my generation’s gravitas.

    I do agree on one point, however: this is a fruitless discussion. So, let’s end it here.

    Thank you very much, and I wish you well, too.

  34. Fruitless Discussion Says:

    We, the readers, are not positioning ourselves as experts

    This is false for a lot of the people who write here. Blah, Ruminating, DrM and a whole bunch of others, for instance.

    You may have something of value to share, but I’m sorry to say that the way to choose to communicate is very counterproductive to your goal.

    I don’t think so.

    However, as they say in my avocation, I’m QRT on this frequency.







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