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Monday Morning Update 9/27/10

September 25, 2010 News 25 Comments

From Sara Dippedy: “Re: crass KLAS. Our company suffered for years under KLAS ‘extortion.’ If we didn’t pay to belong, we were relegated to an asterisked account, insinuating that we were hiding something. All it took was one ticked off IT underling to nail you with an anecdotal crack, even though they were often happy as a bird 24 hours later. Opinions vary due to overambitious vendor guarantees and unrealistic customer expectations. We need an independent, not-for-profit testing authority, like Consumer Reports.”

From EHR Geek: “Re: proctologist. Did I beat Weird News Andy to the punch?” You did. A New York proctologist is arrested at his oceanfront condo for submitting $3.5 million in false Medicare charges, including charging for 85 hemorrhoidectomies performed on the same patient and procedures adding up to more than 24 hours in a single day. My mind immediately offered several witty comments, but I’m sure yours has already done the same.

From Me So Corny: “Re: eHealth Align. The Kansas City HIE’s board approved signing with ICA’s CareAlign as its HIE solution on Friday. It will be announced this week.” Verified, apparently, since it’s on ICA’s Twitter feed.

From The PACS Designer: “Re: ResolutionMD Mobile. The reading of image files on the iPhone is getting easier with ResolutionMD Mobile. The app is free from the iTunes Store. One of the key features is the DICOM processing, and storage stays on the server with window and level manipulation residing on the iPhone.”

Listening: a 1995 CD from obsolete harmonic Canadian power poppers Zumpano. Sounds great.

The California Academy of Family Physicians will use (warning: PDF) a $145K grant from The Physicians Foundation to create an online EMR resource for physicians, including a readiness assessment and tools for EMR selection. “We liken it to changing the tires on a moving car. Our physicians struggle every day to keep the doors open and keep patients healthy. Look, the office doors are open, patients are coming in, it’s flu season — and at the same time you have to adopt an EMR?”

9-25-2010 4-37-53 PM

I ran across a cool open source laptop security app called Prey Project. You install its invisible client on your laptop or mobile phone. If the device is stolen, the app phones home via the Internet or text message, sends you its location determined from geolocation services, takes the thief’s picture via webcam, grabs a screenshot of whatever the thief is doing, and locks down the PC. It will look for any open WiFi hotspot if the device isn’t connected to the Internet. If you’re feeling vengeful, you can annoy the thief by remotely triggering an alarm or an onscreen warning.

Doctors in Australia are warned by the New South Wales medical board not to make “flippant and derogatory” comments about patients after a patient complains. Related: the Australian Medical Association questions whether it’s a good idea for doctors to accept the Facebook friend requests of their patients, saying it’s inappropriate for them to blur the professional-social line.

This week’s company-wide e-mail from Kaiser chairman and CEO George Halvorson makes the point that by collecting ethnicity information in HealthConnect, Kaiser can uncover important ethnicity-specific health risks. He makes an interesting point: since every Kaiser patient has the same coverage, treatment, and providers, the only variable is often ethnicity.

Lisa Busby, CIO of Inter-Lakes Health, is named interim CEO after Kevin Haughney quits.

A couple of readers offered software alternatives for mind mapping. Luke O’Scyte recommends for the iPad and iPhone Headspace ($3.99) and iThoughtsHD ($9.99). For the desktop, he’s trying the open source Freemind, which Les also recommends. Ben suggests the free XMind

The Health 2.0 conference will be held October 7-8 at the Hilton San Francisco. Companies sending speakers include O’Reilly Media, Microsoft, HHS, Executive Office of the President, Wired Magazine, The New York Times, Cerner, Google, Kaiser Permanente, and WebMD. Other events during Health Innovation Week include a developer’s challenge at the Googleplex, a REC/HIE summit, and HealthCampSFBay. Early bird registration ends Thursday. You can save an extra $100 by using code “HIStalk” when you sign up. I have no financial interest – I’m just being nice in mentioning it.

9-25-2010 5-04-57 PM

9-25-2010 5-05-48 PM

9-25-2010 5-06-36 PM 

9-25-2010 5-09-21 PM 

Epic UGM photos from Wisailer.

Hyland Software, the OnBase document management company, acquires Computer Systems Company of Cleveland, OH. CSC offers document imaging, revenue cycle, and OB/GYN workflow and EHR tools.

Northern Ireland electronic document management vendor Kainos wins its third NHS contract in the last few months.

The Government Accountability Office appoints 19 members to its Patient-Centered Outcomes Research Institute, which was authorized under the Patient Protection and Affordable Care Act. It’s a big deal: this group will get $500 million per year of the $1.1 billion in ARRA money set aside for comparative effectiveness research, including setting research priorities and overseeing clinical trials. CMS can use its results for what sounds like setting co-pays that will encourage more effective treatments. The dean of UCLA’s medical school will head the group.

9-25-2010 6-45-18 PM

A patient sues Medical City Dallas (TX) for mishandling her electronic medical records after being called by collectors claiming she owed money for psychiatric treatment. The hospital had mistakenly chosen her medical record for that of an uncooperative psych patient with the same name, then merged the two accounts. Afterward, the hospital sent her a letter saying they would fix the problem, she got more collector calls, and she found the same patient had been admitted again and the same mistake had been made.

Greenway announces the start of its two-day, regionally-offered Meaningful Use training sessions for customers.

9-25-2010 7-05-22 PM

It would be fascinating to know why (heavy vendor response?) 75% of readers wouldn’t use a free, ad-supported EMR. New poll to your right: are the product ratings offered by KLAS representative of product performance in a way that’s useful to providers?

An ISMP survey finds that providers are exasperated with never-ending drug shortages. For those unfamiliar, let me explain why that’s a big deal for hospitals. Sometimes there’s only one source of a given drug, meaning doctors are forced to order alternatives they don’t know much about, often drugs that are less effective or more dangerous. Nurse are suddenly looking at unfamiliar drug packages, increasing the chance of medication error. From an IT standpoint, systems have to be changed: automated dispensing cabinets have to be set up for the new item, CPOE and pharmacy systems may require modification, and any systems that read drug bar codes must be re-programmed. Imagine being a high-acuity patient and finding out that your anesthesiologist or surgeon can’t have his or her critical drug, which they know inside and out from years of predictable use, and instead will be rolling the dice on some alternative they’ve already judged inferior, all because a drug company is mysteriously out of the A-team product. Nobody seems to know why shortages happen, but speculation usually runs to the cynical in my hospital: scumbag pharma tactics, wholesaler market fixing, and hoarding by other facilities who hear shortage rumors (that hoarding is often by us, I should add, since we’re just as unhappy about running out of drugs as anyone else and we don’t hesitate to use our clout to jump the line).

The FCC opens up “super WiFi”, the white space airwaves formerly taken up by analog TV signals, a boon for wireless device and service vendors (including those selling hospital technology). An early adopter is rumored to be Microsoft, which supposedly needed only two towers instead of thousands of routers to cover 500 acres on its Redmond campus. Strange: country singer Dolly Parton filed a complaint – she’s worried about the effect on wireless microphones.

This should fuel the usual HIT takeover rumors: Oracle’s Larry Ellison says the company’s string of acquisitions will selectively continue with semiconductor companies and vendors of industry-specific software.

This is scary, especially since it’s probably true here: the #1 organization that graduating college students in Canada would most like to work for is the federal government.

E-mail me.

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Currently there are "25 comments" on this Article:

  1. Re: KLAS – I am confused about the anecdotal crack about “pay to belong”. AFAIK, the “asterisk” is for vendors without enough surveyed customers, so the sample size is too small. How would have the vendor paying for the KLAS reports changed that?

  2. Re: Halvorsen and ethnicity specific health risks. Unfortunately, he cannot account for provider-specific bias or prejudice, which even if subtle or slight, could account for differences in treatment and outcome. Still, it would be a factor attributable to ethnicity, though whether the disease actually affected an ethnic population differently, or whether providers just treat that population differently due to racial bias would not be known.

  3. To Sara D from Suzy about Klas: You said ” We need an independent, not-for-profit testing authority, like Consumer Reports.”

    So many adverse events and defects of these devices go unreported. I commend you on your perspective.

    Yes, such an institution is needed, yesterday. The FDA is a start and already has the orchestra seated to perform, although it will not rank and file the products, but will assure some modicum of safety, efficacy and usability. That these products are not approved for safety and efficacy, and are shockingly unusable, is consistedn with slipshop performance of many other components of current government.

    The luxuriouas venue shown in the pictures above are consistent with excesses in the industry at the expense of patients and taxpayers. At least, if they were improving outcomes and costs. They are not, although they tweak the data to further convince Congress and HHS, there are noat any reported.

    I am glad to be back and reading HIStalk. I was in Haiti.

  4. The issue with KLAS is that vendors give KLAS the clients they want surveyed – and like all other references vendors give the good accounts. Also, KLAS calls all vendors and asks for their client information, they then do a survey, then they SELL it back to you. In addition, you have to wonder what the sample size is to get the badge BEST IN KLAS? Anything less than 100 why bother – so what if you get 10 good surveys out of 200+ clients. Small sample size means to us that it is a popularity contest, not independent. For vendors the more reports you buy about yourself, then better, I guess that is the pay to play comment, but I am not sure.

    Consumer reports buys what it wants to review and then tells it like it is.

    We don’t participate in KLAS – never have and never will.

  5. Yeah, I find the comment from Sara Dippedy to be somewhat hard to believe. I work for a vendor that is perennially left out of the “Top 20” awards even though we have the highest overall scores in the 1, 2-5, 6-25 PM categories. The continue to mis-categorize us. [Yes, you can easily figure out who I am and where I work now.]

    This is YEARS after paying them good $$ for “platinum-access” to their data every year. So if Sara is right, tell me how much you had to pay, ’cause it’s not working for us!

    For the record, I don’t think KLAS has ever had any effect on a decision for a potential client. We’ve certainly never generated a “lead” from them. But we would continue to pay our annual access fees simply for the line-level detail that we can get on ourselves and our competitors *regardless of our own scores*. Or even if they scored us.

    We’re small enough that I know all of our clients. And we read those customer comments EVERY MONTH to look for things that we need to know about. Yes, I am insanely frustrated when I see a customer, whom I can probably ID, say something that’s factually wrong. Or, when KLAS classifies something as “negative” that really isn’t (“We love our system and we’re sad the hospital is forcing us to leave.”). But I’ve never read anything in the 100s of comments that makes me think they made any of our scores or data up.

    I could go on, but there’s no question that having a small, specialty focused vendor at the top of their score chart isn’t a good business plan if they were trying to soak us. Logically, too, the _only_ thing they really have to sell is their reputation. If people really think they’re biased, they’re out of business.

    Your survey on the right should gather KLAS scores from those who answer…I bet you’d see a correlation 🙂 And do I need to post a list of consulting companies who have *directly offered* us positive reviews in their annual reports for a price?

  6. Cant Say’s comments about vendors hand picking customers to interview is PATENTLY FALSE and, frankly, I’d ask KLAS for a response to it.

    In fact, if you want to hand out surveys at, say, a Users’ Conference…KLAS has to have someone on-site ensuring unopened envelopes, appropriate messaging, etc.

    Or, at least, that’s what they make us small-time people do. We had to give them ALL of our customers, for example.

  7. All this stuff about Klas is sour grapes by the vendors and wannabees. To get out of this gig: Hey guys and girls, go post all defects and flaws in your devices that have been reported to help desks and your company, report them to the FDA, and then, report all of the errors and adverse patient care incidents that have occurred in association with your EMRs.

    Then you do not have to worry about what you pay to Klas and what Klas has to report about you.

  8. regarding documenting ethnicity, i think it’s a bad idea simply because of the definition of ethnicity. people nowadays, especially in the US, have such varied genetic backgrounds, how can you categorize people in a meaningful way? genetics/genomics is the better way to go imho

    [From Mr. HIStalk] Excellent point, especially given the loosey-goosey way systems prompt for ethnicity as though one label fits all (i.e., you can’t be both “African-American” and “Hispanic”). I imagine Kaiser is leading the charge in that way as well, although limited by the immeasurably tiny percentage of patients who have had DNA tested.

  9. To RTK – so how would they know that you gave them ALL of your clients? Your company gives them a list – also, why is the sample size to get an award so low? Come on now – it’s a popularity contest at best.

    Want valuable data – survey your own GD clients and ask the tough questions – most will tell you without having to pay for it

    and to the Irony MD – it’s always someone else’s fault right!

  10. That these products are not approved for safety and efficacy, and are shockingly unusable, is consistedn with slipshop performance of many other components of current government.

    Except the FDA, evidently. Or, are you not aware that the FDA is a government agency?

  11. CantSay:

    They know about your missing clients because they find out who your clients are – that’s what they did to us, for example. We were told about our initial appearance on KLAS by a competitor, we were surprised.

    They’ll throw out scores they think are manipulated. They’ve made that very, very clear to us. Why else would they pay to send one of their employees to our UC to ensure fair balloting? That’s crazy.

    As for their sample sizes – ask them. I know they’ve spoken with dozens and dozens of our clients and their sample of our total customer base is substantial. > 50% in some cases…I’m sure you understand degrees of confidence, right?

    Finally, we do survey our own “GD clients” often. ALL THE GD TIME. How do you we think we get such GOOD GD KLAS SCORES? But guess what? We still learn things all the time from the KLAS surveys that our clients won’t tell us. You’re familiar with surveyor bias and all that, right?

    And how else am I going to get the information on the OTHER vendors, exactly?

    KLAS – perfect? Not at all. Biased? Dunno’, haven’t seen it. We’ve had to jump through a lot of hoops to work with them and they probably hate us – yet there are our scores.

    But in MY experience (N=1, sure), they are a lot more honest than the consultants and RECs I’ve worked with and give me more insight into the patterns *I* see every day when I talk to people on the phone. GD clients and otherwise.

    Maybe you just don’t know what you’re missing.

    Meanwhile – perhaps other folks here should note that KLAS analyzes a LOT more than EHRs. We’ve recently been looking into partnering on some external functionality and I looked at KLAS immediately. If I knew of any pay-to-play bias, would I have done that?

  12. You were curious as to why folks might not support a free, ad-supported EHR.

    I can only speak for myself. When something is free, you “get what you pay for”.

    For example, I do use facebook every day (I have to because of the business I’m in). And, while I basically like it and use it because it is free, I also am daily frustrated with it as well. I get no real user input into design and usability. It is frequently slow and buggy. It is constantly getting hacked.

    While some may say that their expensive EHR/CPOE solutions suffer from some of these same problems, at least if you’re paying for something, you have some recourse.

    If it was free and ad-supported, who would make the architectural, usability and security decisions? The government? Hahahaha – now that is truly funny!!

  13. Not all governments are the same … in regards to students wanting to work for the government. In Singapore, the governement pays their employees more than the private sector … they hire the best and brightest.

    In regards to KLAS … Eliot Spitzer was planning on going after the market research firms when he finished up with the mutual fund companies … IDC, Gartner and the others for the same issues that folks are complaining about KLAS … but then Eliot had other thoughts and ambitions

  14. Misidentification in Dallas: “The hospital had mistakenly chosen her medical record for that of an uncooperative psych patient with the same name, then merged the two accounts.”

    This is an underreported problem of EMRs and when it is discovered, the hospital administration covers it up as best they can. Just like the recent revelation about the Tititanic.

    Mr. HIStalk, your excellence, I recall your having covered another type of misidentification problem several weeks ago involving a multiple hospital system whereby orders and data was incorrectly electronically applied to patients when multiple medical records were open.

  15. The biggest problem with the misidentification of patients is that hospitals do not take the problem seriously. As a result, rectifying the situation is done poorly and leads to more of the same problems to occur.

    … but it has serious ramifications for the patient… financial problems due to poor credit (leading to inability to buy property or suffer high interest rates) and possible death due to inaccurate allergy information during emergencies. It’s not just causing frustration to the patient, as Medical City Dallas appallingly oversimplifies the situation in their official statement. They do not get it. What will make them “get it?”

    I’d like to see the Feds get into this subject and put together strong laws to ensure the hospitals do not continue being the wild west of the 21st century.

  16. I would agree that genomics is a much more precise method to determine a person’s ancestry. But as Mr HIS said, we’re not there yet on any sort of large scale. So race/ethnicity is what is in common use. There is a standard that is part of the Meaningful Use rule for gathering the information on the two parts of ancestry. It is the Race and Ethnicity rule from the Office of Management and Budget passed in 1997 and updated in 2000 for the Census.
    This standard has been used for everything from enforcing the requirements of the Voting Rights Act, enforcing the Equal Credit Opportunity Act to presenting population and population characteristics data, labor force data, education data, and vital and health statistics. Standardizing on the OMB rule is the first step in controlling variables to study the impact of bias versus race/enthnicity and lay the foundation for more detailed and specific studies when genomes take over.
    The sites below provide the history of the standard (the first is an overview of the standard and the 2000 changes). We are basing our capture of race/ethnicity information on these categories, mapping our current HIS esponses to the OMB’s standard.
    http://www.census.gov/population/www/socdemo/race/racefactcb.html
    http://www.whitehouse.gov/omb/fedreg_notice_15
    http://www.whitehouse.gov/omb/fedreg_1997standards

  17. Even if Canadian graduates wanting to work for the government is truly ‘scary,’ it is not an isolated phenomena. I recall NPR doing a story months ago about many U.S. graduates looking to the federal government for employment because they just didn’t have the stomach for all the instability in the private sector.

    And I understand the Canadian banking sector and economy have actually fared much better than the U.S. Go figure.

    Is it so strange to think that many people would look for some sort of stability when the world economy looks like a lifeboat set adrift on a raging sea?

    [From Mr. HIStalk] It’s not strange to think, just discouraging that the bloated government assumes yet another role beyond payer and provider of healthcare, financier of education, issuer of big defense contracts, underwriter of retirement, and owner of vast resources: now the employer of choice over the private sector.

  18. It always amazes me how many people know little to nothing about basic survey sampling methodology and the principles behind it (e.g., power calculation for sample size, confidence interval, margin of error) etc.

    KLAS does report how many clients have responded for a particular product and has a rudimentary system for confidence intervals (3 ‘checks’). I would prefer to see the actual confidence intervals along with the average & mean but that would also likely confuse a bunch of folks who look at the data.

  19. CantSay – they took our entire client list for their review. Look how the legacy EHRs are trending down under their more agressive client interview process.
    ReleasetheKraken – You’re not an EMR as defined by MU – which is now the standard. That’s misleading.

    KLAS has pro’s and con’s, but they’ve responded to charges about cherry picking clients as fairly as possible. They’re legitimate. And, it’s certainly better than nothing. Much less dependent on a “consulting firm” that recommends a complicated product so they can get project management revenues on the install.

  20. BeenThere: How have I mislead anyone? I never suggested anything abour our EHR…which, btw, is defined as MU as much as anyone’s, given that the certifications aren’t out yet. KLAS doesn’t care whether it’s looking at an EHR, Patient Portal, or PM – they’re methods are the same.

    I guess I don’t understand your point.

  21. Seriously F. Nick? You’re suggesting a DNA test for race/ethnicity verification of your patient population? Meaningful Use aside (after all most providers wouldn’t even know about this if it didn’t provide financial incentives), there are tremendous opportunities for research in the area of population demographics and suggesting that patients can’t choose their own race/ethnicity is just silly.

    Zafirex…suggesting that providers base their care on a patient’s ethnicity/race is a tad insulting wouldn’t you say?

  22. That last comment there is just bizarre to me. So most of us live in America, right?

    Take the example of an individual whose father is Indian and mother is Brazilian (this is realistic, because it’s someone I know). Is that person Asian or Hispanic? Now a step further – is that father north Indian or south Indian – highly different genetics. Is the mother Afro-Brazilian or of European descent? If she’s of European descent, is she Portuguese or German? Again, highly different genetics. What population do you put that individual into for the sake of saying that Asians have better outcomes or Hispanics have worse outcomes?

    How about the designation “African-American?” Is a Nigerian immigrant really similar in any way to a Louisiana Creole, despite perhaps the fact that they may live in the same neighborhood?

    What about “Caucasian” or “white?” I know plenty of people who are proud to say “I’m 1/4 Cherokee” or “I’m half Irish, half German” but will check Caucasian on the ethnicity box. How do you lump those people together in any meaningful way for population studies?

    I can go on and on, but hopefully you get my point. Lumping people by ethnicity, particularly in the US, is an archaic and narrow-minded way of arriving at convenient conclusions for populations which leave major flaws in accounting for individuals within those populations.

  23. Actually Kaiser is doing research based on genomics- the database ncludes 500,000 people:

    Welcome to the Web site for the Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH)
    The RPGEH, a scientific research program housed at the Kaiser Permanente Division of Research in Oakland, California, is one of the largest research projects in the United States to examine the genetic and environmental factors that influence common diseases such as heart disease, cancer, diabetes, high blood pressure, Alzheimer’s disease, asthma and many others.

    The goal of the research program is to discover which genes and environmental factors—the air we breathe, the water we drink, as well as lifestyles and habits—are linked to specific diseases.

    This new knowledge has the potential to improve health and health care delivery by leading to new and improved diagnosis and treatment of disease and even prevention of some disease. One day your doctor may be even able to make a health care plan just for you based on your genetic profile and life experiences. This could include early testing for the diseases you might be likely to get, prescribing medications that will work best for you, and recommending lifestyle changes that will help keep you healthier.

    Building a Biobank
    Based on the 3.3 million-member Kaiser Permanente Medical Care Plan of Northern California (KPNC), the completed resource will link together comprehensive electronic medical records, data on relevant behavioral and environmental factors, and biobank data (genetic information from saliva and blood) from 500,000 consenting health plan members.

    In addition to learning more about the genetic and environmental determinants of disease, Kaiser Permanente research scientists, working in collaboration with other scientists across the nation and around the world, hope to translate research findings into improvements in health and medical care. We also hope to develop a broader understanding of the ethical, legal, and social implications of using genetic information in health care.

    This website is designed to help you learn more about our program. If you have questions or need more information please contact us.

  24. Don’t get me wrong here – there are always exceptions – but I think you’re missing the point. As we become more and more of a “melting pot” this will eventually become obsolete, but this does not mean that any current research studies based on race or ethnicity are invalid or should be ignored because there are people (here in America and elsewhere) that have multiple genetic backgrounds.

    Yes, I do live in America; I’m Norwegian, Scottish, American Indian and Irish, but if I were dying of cancer and had the opportunity to participate in a study about race specific drug reactions I’m pretty sure I’d choose be able to choose an appropriate designation out of the 38 pages of possibilities to choose from used by the CDC.

    It (and IT) should be about evidence – empirical and neutral – obviously genetic testing is the Rosetta Stone, but that doesn’t mean we should discount everything else.







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